Difluprednate 0.05% versus Prednisolone Acetate Post-Phacoemulsification for Inflammation and Pain: An Efficacy and Safety Clinical Trial

Review on the Use of Difluprednate in Inflammatory Eye Disorders: The Topical Steroid That Goes the Distance

Difluprednate (DFP) (difluoroprednisolone butyrate acetate, or DFBA) ophthalmic emulsion 0.05% (Durezol®) was the first potent corticosteroid to be approved for both postoperative pain and inflammation in 2008. In June 2012, it was approved for the treatment of endogenous anterior uveitis. It is a synthetic difluorinated prednisolone derivative that was originally developed in Japan as a dermatologic ointment. The glucocorticoid binding affinity of its active metabolite was demonstrated to be 56 times stronger than prednisolone. Experimental models showed that it reached the anterior and posterior segments of the eye quickly, via both transcorneal and noncorneal (conjunctiva and sclera) absorption routes. Its clinical applications have been expanded to treat patients with uveitic macular edema and anterior scleritis. Case reports and case series also describe its use in some forms of posterior uveitis and in non-uveitic entities. Elevated intraocular pressure and acceleration of cataract formation are the main concerns with DFP as with all corticosteroids. Because IOP elevation is particularly pronounced in the pediatric age group, IOP is to be closely monitored at every visit in children. High incidence of cataract formation and progression was also documented in children, thus necessitating vigilant follow-up of children on chronic treatment. This review aims to give a comprehensive and up-to-date overview of difluprednate's pharmacological properties, clinical applications, safety profiles, and alternative delivery methods.

HPLC-UV Method Development and Validation to Monitor Difluprednate Synthesis

During the synthesis of active pharmaceutical ingredients (APIs) there is a need for the development and validation of a simple and rapid high performance liquid chromatography (HPLC) method for the determination and quantification of the synthesized product and related by-products. An HPLC method gives a better understanding of how a synthesis is proceeding. A rapid and easy to use HPLC-UV (ultraviolet) method for the determination of difluprednate and monitoring of impurities generated during synthesis was developed and validated. A Shimadzu VP Series HPLC equipped with a LabSolutions software and UV detector set at 240 nm was used for analysis. The mobile phase consisted of phosphate buffer (pH 6) and acetonitrile 50:50 (v/v) and was eluted at a flow rate of 1.2 mL/min. Separation took place on a reversed-phase Kinetex C18 column (150 × 4.60 mm; 5 μm i.d.). Column temperature was set at 40°C. The developed method was found to have good linearity and acceptable accuracy and precision. The developed method may be effectively applied to determine products and by-products formed during synthetic reactions of steroids and to calculate the yield of the products obtained during each step of the synthesis.

Therapeutic Efficacy of Difluprednate 0.05% Versus Prednisolone Acetate 1% in Controlling Inflammation and Macular Oedema Following Phacoemulsification: An Optical Coherence Tomography-Based Study

BACKGROUND

Topical corticosteroids have been the cornerstone in the management of postoperative inflammation following cataract surgery. Due to potential side effects of the older topical steroids like prednisolone acetate and dexamethasone or betamethasone, newer potent steroids preparation like difluprednate, loteprednol or fluorometholone are now being used at lesser dose and frequency to control inflammation. There is scanty literature on the efficacy of these drugs in preventing inflammation and macular oedema in the Indian population.

PURPOSE

The purpose of this study was to compare the efficacy of difluprednate 0.05% against prednisolone 1% eye drops for control of inflammation following phacoemulsification. The adverse effects of both drugs were also evaluated in this retrospective study.

METHODS

This retrospective cohort study included 181 patients operated for age-related cataracts by a single surgeon at a tertiary referral eye hospital between December 2018 and March 2019. Patients received either difluprednate 0.05% emulsion (n=90 eyes) or prednisolone acetate 1% (n=91 eyes) after phacoemulsification with the same brand intraocular lens (IOL) and same phaco machine. The topical medication was initiated one day postoperatively and continued for six weeks in tapering dosage. Pain score (Visual Analogue Scale, VAS), conjunctival hyperemia, anterior chamber (AC) cell grading, corneal oedema, central retinal thickness, subclinical cystoid macular oedema (SCME), intraocular pressures (IOP) and best-corrected visual acuity (BCVA) were examined after one week and six weeks of cataract extraction.  Results: There was no statistically significant difference observed with regards to pain score (no pain in any patients after six weeks), conjunctival hyperemia (no hyperemia in any patients after six weeks), AC inflammation (no reaction in any patients), central retinal thickness (234.44 ± 35.75µ vs. 234.8 ± 34.99µ, p-value 0.946), SCME (16.67% vs. 13.19%, p-value 0.511), IOP (16.8 vs. 15.47 mmHg, p-value 0.101) and BCVA (BCVA 6/6 in 57.7% vs. 70.32%, p-value >0.05) between both groups. The mean change in IOP in both the groups at one week (0 ± 4.4 vs. 1.87 ± 3.54, p-value 0.0007) and six weeks (-0.01 ± 5.53 vs. 1.88 ± 4.01, p-value 0.004) was significant.  Conclusion: Both the groups were equivalent with regards to their therapeutic efficacy in controlling postoperative inflammation and restoration of vision following phacoemulsification.