ABSTRACT
PURPOSE: To compare the effects of 2 corticosteroids on corneal thickness and visual acuity after cataract surgery. DESIGN: Multicenter, randomized, contralateral-eye, double-masked trial. METHODS: Fifty-two patients (104 eyes) underwent bilateral phacoemulsification. The first eye randomly received difluprednate 0.05% or prednisolone acetate 1%; the fellow eye received the alternative. Before surgery, 7 doses were administered over 2 hours; 3 additional doses were given after surgery, before discharge. For the remainder of the day, corticosteroids were administered every 2 hours, then 4 times daily during week 1 and twice daily during week 2. Corneal pachymetry, visual acuity, and corneal edema were evaluated before surgery and at days 1, 15, and 30 after surgery. Endothelial cell counts were evaluated before surgery and at 30 days after surgery. Retinal thickness was evaluated before surgery and at 15 and 30 days after surgery. RESULTS: Corneal thickness at day 1 was 33 µm less in difluprednate-treated eyes (P = .026). More eyes were without corneal edema in the difluprednate group than in the prednisolone group at day 1 (62% vs 38%, respectively; P = .019). Uncorrected and best-corrected visual acuity at day 1 were significantly better with difluprednate than prednisolone by 0.093 logMAR lines (P = .041) and 0.134 logMAR lines (P < .001), respectively. Endothelial cell density was 195.52 cells/mm(2) higher in difluprednate-treated eyes at day 30 (P < .001). Retinal thickness at day 15 was 7.74 µm less in difluprednate-treated eyes (P = .011). CONCLUSIONS: In this high-dose pulsed-therapy regimen, difluprednate reduced inflammation more effectively than prednisolone acetate, resulting in more rapid return of vision. Difluprednate was superior at protecting the cornea and reducing macular thickening after cataract surgery.
Subject(s)
Corneal Edema/prevention & control , Fluprednisolone/analogs & derivatives , Glucocorticoids/administration & dosage , Phacoemulsification , Prednisolone/analogs & derivatives , Uveitis, Anterior/drug therapy , Aged , Aged, 80 and over , Cell Count , Cornea/drug effects , Double-Blind Method , Endothelium, Corneal/drug effects , Female , Fluprednisolone/administration & dosage , Humans , Inflammation/drug therapy , Inflammation/physiopathology , Intraocular Pressure/drug effects , Lens Implantation, Intraocular , Male , Middle Aged , Prednisolone/administration & dosage , Prospective Studies , Pulse Therapy, Drug , Refraction, Ocular/physiology , Uveitis, Anterior/physiopathology , Visual Acuity/physiologyABSTRACT
PURPOSE: To present a case of pemphigus vulgaris, involving the conjunctiva, specifically the plica semilunaris, in both eyes of a 33-year-old woman. METHODS: Ocular evaluation showed bilateral plica semilunaris vegetations extending for 3 mm linearly. Sequential excisional biopsies of both affected plica were performed and sent for pathological examination and immunofluorescent staining. RESULTS: After each excisional biopsy, the patient's ocular symptoms resolved. Excisional biopsies showed suprabasilar clefting within the epithelium; lymphoplasmacytic infiltration and immunopathology showed intraepithelial intercellular and basement membrane zone staining with immunoglobulin G consistent with pemphigus vulgaris. At 1-year follow-up, the patient continues to be asymptomatic with no signs of recurrence. CONCLUSIONS: Excisional biopsy, in a very symptomatic patient with pemphigus vulgaris with conjunctival vegetations, may hasten his or her recovery.