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A prospective study on ocular hypertensive and antiinflammatory response to different dosages of fluorometholone in
1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong.
Insights
Fluorometholone (FML) eye drops can cause increased intraocular pressure (IOP) in children, with higher doses leading to a more pronounced and rapid hypertensive response. Regular IOP monitoring is recommended when using FML frequently in pediatric patients.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Pharmacology
Background:
- Strabismus surgery is common in children.
- Topical corticosteroids like fluorometholone (FML) are used postoperatively.
- Understanding FML's effects on intraocular pressure (IOP) and inflammation is crucial.
Purpose of the Study:
- To evaluate the dose-dependent ocular hypertensive and anti-inflammatory effects of fluorometholone (FML) in children.
- To compare the impact of different FML application frequencies on IOP and inflammation post-strabismus surgery.
Main Methods:
- A prospective, randomized clinical trial involving 31 children undergoing bilateral strabismus surgery.
- One eye received FML six times daily (Group 1), the fellow eye received FML three times daily (Group 2) for 4 weeks.
- Intraocular pressure (IOP) and anti-inflammatory responses were monitored for 8 weeks postoperatively.
Main Results:
- Both FML dosages significantly increased IOP compared to pre-operative levels (P < 0.001).
- Group 1 (higher FML frequency) showed a significantly higher mean peak IOP (19.00 mmHg vs. 17.13 mmHg, P < 0.001) and earlier peak IOP onset (median 6 days vs. 13 days, P = 0.033).
- No significant difference in anti-inflammatory response was observed between the groups.
Conclusions:
- Ocular hypertension induced by FML in children is dose-dependent.
- Higher frequency FML application leads to a quicker and more severe ocular hypertensive response.
- Regular IOP monitoring is advised for children using FML frequently and long-term.
Objective:
To investigate the ocular hypertensive and antiinflammatory response to different dosages of fluorometholone (FML).
Design:
Prospective clinical trial with randomization of fellow eyes to different postoperative treatment.
Participants:
Thirty-one consecutive children undergoing bilateral symmetrical strabismus operation.
Intervention:
Among 31 children who received bilateral squint operations, one eye was randomized to receive topical FML six times daily (group 1), whereas the other eye received topical FML three times daily (group 2), both for 4 weeks. Intraocular pressure (IOP) and antiinflammatory response were measured serially in the postoperative period for 8 weeks.
Main Outcome Measures:
Intraocular pressure was measured on the day before surgery and on postoperative days 1, 3, 6, 13, 20, 27, 41, and 55. The antiinflammatory response was also assessed subjectively and objectively at days 6, 13, 20, and 27 after the operations. Peak IOP, net increase in IOP, and antiinflammatory responses in the two study groups were analyzed.
Results:
Thirty-one children, age 3 to 9 years, (mean +/- standard deviation [SD], 5.52 +/- 1.81) participated in the study. Intraocular pressure increased significantly in both groups compared with the preoperative values (P < 0.001). The peak IOP ranged from 12.00 to 31.00 mmHg and 12.30 to 25.00 mmHg in groups 1 and 2, respectively. The mean peak IOP (19.00 +/- 5.06 mmHg vs. 17.13 +/- 3.32 mmHg) was significantly higher in group 1 (P < 0.001). The net increase in IOP was similar (mean +/- SD, 4.37 +/- 4.79 vs. 2.57 +/- 3.32 mmHg; P = 0.005). Ranges of the net IOP increase were -1.00 to 16.00 mmHg and -2.50 to 10.30 mmHg in groups 1 and 2, respectively. Children in group 1 reached the peak IOP earlier than those in group 2 (median, 6 vs. 13 days; P = 0.033). However, there was no significant difference in antiinflammatory response between the two groups.
Conclusions:
Ocular hypertension occurs in a dose-dependent manner in children treated with FML. Children in group 1 had a quicker onset and more severe ocular hypertensive response than those in group 2. It would be desirable to monitor the IOP regularly when FML is used with a high frequency and for a long duration in children.
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