The mainstay for graft preservation is topical steroids, even in the event of an acute immunologic attack. Sins of omission and commission. “But for blepharitis with a fair amount of skin involvement, the irritation can be quite trying for patients,” he said. Once the patients are in a successful maintenance phase, Dr. Sheppard recommends that they use their steroid for acute flare-ups triggered by travel, allergies, respiratory infection, or exposure to environmental irritants. Sustained-release corticosteroid implants are an exciting development for long-term therapy and are appropriate for advanced noninfectious posterior uveitis. Curious about the potency of topical steroids? Perhaps your health care provider prescribed you a treatment and you’d like to know how potent it is. Because the study was not designed to compare the usefulness of steroids in more severe vs. less severe ulcers, Dr. McLeod advises caution when drawing conclusions. “Patients have to be treated a bit beyond resolution before you start weaning—and then you wean with a controlled stepwise plan.”. Relative Potency Of Ophthalmic Steroids The relative potency of the various corticosteroids is tabulated in Table 1. “They’re truly a godsend for a distinct, albeit small, group of the most severe cases,” said Dr. Sheppard. (For a detailed discussion of treatments for noninfectious uveitis, see EyeNet’s October 2012 feature article. “The larger the optic nerve cup and the worse the visual field, the more careful we must be in the administration of steroids,” said Dr. Sheppard. “That’s where the challenge is, and that’s what they pay us for—to find the best solution for each patient,” Dr. Sheppard said. One of these is diffuse lamellar keratitis (DLK; aka “sands of the Sahara”) following LASIK surgery. Generally, Dr. Friedman keeps her patients on the starting dose of prednisone for at least a few weeks, then starts to taper over a few months (by 10-20 mg every few weeks) to get the maintenance dosage down to between 10 and 20 mg per day. The only other decision involves the frequency of instillation; we typically prescribe a steroid Q2H for two days, then QID for one WHEN ARE STEROIDS APPROPRIATE? Nor were they associated with any benefit overall. His steroid of choice for this indication is loteprednol. Just don’t remove the cataract until the inflammation has been fully controlled for three months.”. Loteprednol ((Alrex, Lotemax) Dexamethasone ophthalmic; Difluprednate ophthalmic (Durezol) Fluorometholone; Prednisolone acetate (Omnipred, PredFort), prednisolone sodium phosphate; Rimexolone (Vexol) Relative Strengths Comparative Steroid Potencies . But not everyone has an abnormal ESR, in which case she carefully monitors clinical signs. PREOPERATIVE PROPHYLAXIS. Below you will find a chart of topical steroids classified by their potency. Steroid therapy is used in nearly all cases of chalazion and vernal keratoconjunctivitis. The potency of topical steroids is determined by the amount of vasoconstriction (narrowing of the blood vessels) they produce. Steroid therapy for dry eye is controversial. MEDIUM POTENCY (GROUP 4) Steroid Trade name Vehicle Size Strength Generic / Price; Betamethasone dipropionate: Sernivo® spray: 60 ml, 120 ml bottle: 0.05%: NO / $$$$ Clocortolone pivalate: Cloderm® cream: 45 g, 90 g tube 30 g, 75 g pump bottle: 0.1%: NO / $$$$ Fluocinolone acetonide: Synalar® ointment: 15 g, 60 g, 120 g: 0.025%: YES / $$ … Steroid eye drops can raise intra-ocular pressure (IOP) and therefore precipitate glaucoma. Topical steroid potencies In the UK topical steroid preparations are divided into four categories according to how strong or potent they are. Albert & Jakobiec’s Principles and Practice of Ophthalmology, 3rd ed. But for diseases that don’t threaten the eye structurally, the risks of steroids can outweigh the benefits. “It’s the less severe conditions where the question of whether to use steroids is harder to answer,” said cornea and external disease specialist Stephen D. McLeod, MD, professor and chairman of ophthalmology at the University of California, San Francisco (UCSF). A fluocinolone acetonide implant (Retisert) and a dexamethasone implant (Ozurdex) are currently approved in the United States. The implants eliminate systemic absorption and related toxicity.1 (See the “Uveitis Key Points” section for more information.). Examples of macular disease include cystoid macular edema, diabetic maculopathy, epiretinal membrane, and lamellar macular hole. There are seven groups of topical steroid potency, ranging from ultra high potency (group I) to low potency (group VII). 8 Holsclaw DS et al. 7 Srinivasan M et al. Zum Beispiel, eine steroid potency chart found on a simple Google images search merely rated anabolic steroids on a 1 An 10 skalieren, Gewichtszunahme, Kraftzuwachs, Fettabbau, und Nebenwirkungen. Steroids also are integral to treating conditions of immune hyperreactivity (e.g., noninfectious uveitis, graft rejection, allergic disorders such as atopic or vernal keratoconjunctivitis) and certain diseases that have both immune and infectious components (e.g., bacterial corneal ulcers).1 Moreover, steroids are key to damage control following ocular injuries. However, a subset of more severe ulcers with central axial involvement did benefit from steroids—and these are the cases clinicians worry about most. Financial disclosure: Is a consultant for or has clinical research affiliations with Abbott, Alcon, Allergan, Aseoptics, Bausch + Lomb, Eleven Biotherapeutics, EyeGate, EyeRx Research, Lux Bio, Merck, OcuCure, Otsuka, Santen, SARcode, ScienceBased Health, TearLab, and Vistakon. Topical Steroid Potency Chart. Given that there seems to be a subset of cases where steroids are helpful, I’m now more comfortable with earlier use of steroids, specifically in bacterial keratitis.” The key is confirming that the keratitis is bacterial because the use of steroids with other types of microbial keratitis, such as fungal or Acanthamoeba, is very worrisome, said Dr. McLeod. Topical steroids are available in a variety of potencies and preparations. MONITOR FOR POTENTIAL SIDE EFFECTS. “You want to prepare your ‘normal’ patients for the surgery by downregulating the activity of the inflammatory cascade, and it takes about a day or so for the steroid to kick in.” This will reduce the patient’s ability to muster a strong inflammatory response to surgery. Dr. McLeod sometimes sees a patient with a corneal dendrite that was overlooked, and the patient is being treated with steroids for epithelial keratitis. For a steroid to effectively penetrate the cornea, it must be both lipophilic and hydrophilic. The negatives include heightened risk of infections, indolent ulcers, recurrent ulcers, perforations, endophthalmitis, and impaired re-epithelialization. He learned it from Todd P. Margolis, MD, PhD, professor of ophthalmology at UCSF and director of the Francis I. Proctor Foundation in San Francisco. 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