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Allergic Diseases of the Eye
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
This patient underwent allergy evaluation and was counseled about the typical allergens that are present seasonally (trees in spring, grasses in summer and weeds such as ragweed in the fall in the USA). He was tried on dual action (antihistamine-mast-cell stabilizer) eye drops and had only partial benefit. He was given steroid nose spray and that helped partially as well. The antihistamine caused dry eyes and he discontinued them. At this point, he was prescribed a low-dose topical steroid eye drop—loteprednol which helped significantly but still not a hundred percent. The patient returned to the allergist’s office for further evaluation. Based on his allergy skin tests and severe seasonal allergies, he was counseled about allergen immunotherapy and he elected to begin the treatment. Within about one year of starting immunotherapy, he was dramatically better and hardly needed allergy medications to control the symptoms.
Pharmacotherapeutic management of atopic keratoconjunctivitis
Published in Expert Opinion on Pharmacotherapy, 2020
Ibtesham T Hossain, Priyanka Sanghi, Bita Manzouri
While effective anti-inflammatory agents, long-term use of topical corticosteroids can potentially result in a range of adverse effects. These include raised intraocular pressure, posterior subcapsular cataract formation, and increased susceptibility to infection (commonly herpetic keratitis). They are usually given as short, intensive courses with the aim to rapidly taper. Loteprednol etabonate is a topical corticosteroid that was engineered through retrometabolic drug design with the goal of maintaining robust and effective anti-inflammatory properties but also reducing the typical risks associated with this class of medication. A recent review by Comstock et al. of 20 years of clinical data on loteprednol demonstrated a lower risk profile for the treatment of allergic eye disease [37].
Systemic Immunosuppression in Cornea and Ocular Surface Disorders: A Ready Reckoner for Ophthalmologists
Published in Seminars in Ophthalmology, 2022
Studies on prevention and management of grafts usually include high risk grafts and so, the literature on protocols in low risk grafts is lacking. By and large topical steroids in a gradual tapering fashion are used in the first year of the postoperative period. Prednisolone acetate, which can penetrate an intact epithelium is preferred over prednisolone phosphate which requires denuded epithelium for better availability. In cases of steroid responders, shifting to loteprednol is recommended.130,131 Studies have failed to demonstrate any added benefits of topical or oral calcineurin inhibitors in patients with low risk grafts.132–134 Similarly, addition of oral steroids is also considered superfluous in these cases.
Loteprednol etabonate for inflammatory conditions of the anterior segment of the eye: twenty years of clinical experience with a retrometabolically designed corticosteroid
Published in Expert Opinion on Pharmacotherapy, 2018
Timothy L. Comstock, John D. Sheppard
Ophthalmic corticosteroids elicit numerous potent anti-inflammatory effects and are a standard of care for the management of anterior segment inflammation. Loteprednol etabonate (LE) is an ocular corticosteroid that was engineered with the goal of maintaining robust and effective corticosteroid anti-inflammatory activity while minimizing typical risks associated with this class of medication, notably elevated intraocular pressure (IOP) and cataract formation [1]. Although the chemical structure of LE shares many similarities with other corticosteroids, its molecular configuration was purposefully designed with the goal of improved safety without sacrificing anti-inflammatory effectiveness.