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Effectiveness of difluprednate in addition to systemic therapy for the treatment of anterior scleritis
  1. Paulina Liberman1,2,
  2. Jennifer Thorne2,3,
  3. Bryn Burkholder2,
  4. Meghan K Berkenstock2
  1. 1 Departamento de Oftalmologia, Pontificia Universidad Catolica de Chile, Santiago, Chile
  2. 2 Ocular Immunology Division, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  3. 3 Department of Biostatistics, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr Meghan K Berkenstock, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA; mberken2{at}


Aim To describe the effectiveness and side-effect profile of adding difluprednate therapy to patients with anterior scleritis being treated systemically.

Methods Retrospective chart review. Charts from all patients with anterior scleritis who were treated with topical difluprednate in addition to systemic therapy from 1 January 2018 to 1 January 2020 were reviewed. Data collected included: demographics, scleritis type, systemic diagnosis, presence of nodules or necrosis, changes in scleritis activity, intraocular pressure (IOP), number of difluprednate drops used, type of systemic treatment used, best-corrected visual acuity (BCVA) and lens status. The primary outcome was clinical resolution of scleritis. Secondary outcomes included BCVA loss ≥2 lines, change in lens status or cataract surgery and IOP ≥24 mm Hg.

Results Thirty-two patients (44 eyes) were analysed. The median age was 57 years (IQR 52, 72); 59% were female; 72% were Caucasian. An associated systemic disease was present in 59%. Systemic therapies used when difluprednate was added were: 65% immunosuppressive agents, 43% prednisone and 25% non-steroidal anti-inflammatory drugs. The addition of difluprednate resulted in clinical resolution in 79.6% of the treated eyes. Median time to inactivity was 9 weeks (IQR 5, 20). Eyes initially using 2–4 drops per day had a higher response rate (89%, p=0.005). Over a median follow-up of 34 weeks (IQR 21, 74), 11 eyes had IOP elevation; 6 eyes lost ≥2 lines of BCVA, 5 eyes had cataract progression.

Conclusion Most eyes treated with difluprednate achieved inactivity. The addition of difluprednate to systemic therapies provides an alternative to achieve control of inflammation.

  • sclera and episclera
  • inflammation
  • pharmacology
  • drugs
  • intraocular pressure

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors Drafting of the manuscript: PL, MKB, JT, BB. Concept and design: PL, MKB, JT. Analysis and interpretation: PL, MKB, JT, BB. Provision of materials, patients or resources: MKB, JT, BB. Statistical expertise: JT. All authors provided significant effort in the discussion of the results, reviewed the manuscript and approved the final manuscript. MB is guarantor

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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