What is the preferred treatment between prednisolone (Prednisolone) and fluorometholone (Fluorometholone) for intraocular pressure (IOP) inflammation?

From the FDA Drug Label

Corticosteroids are capable of producing a rise in intraocular pressure In clinical studies of documented steroid-responders, fluorometholone demonstrated a significantly longer average time to produce a rise in intraocular pressure than dexamethasone phosphate; however, in a small percentage of individuals, a significant rise in intraocular pressure occurred within one week.

The preferred treatment between prednisolone and fluorometholone for intraocular pressure (IOP) inflammation cannot be directly determined from the provided drug labels, as there is no direct comparison between prednisolone and fluorometholone regarding their effects on IOP. However, it is noted that corticosteroids, including fluorometholone, can produce a rise in IOP.

• Fluorometholone has a longer average time to produce a rise in IOP compared to dexamethasone phosphate 1.
• Both fluorometholone and prednisolone are indicated for the treatment of steroid-responsive inflammation of the eye 1, 2. No conclusion can be drawn regarding the preference between prednisolone and fluorometholone for IOP inflammation.

From the Research

Fluorometholone is generally preferred over prednisolone for treating ocular inflammation when there are concerns about intraocular pressure (IOP) elevation. This is because fluorometholone 0.1% ophthalmic suspension typically causes less IOP elevation compared to prednisolone acetate 1%, making it a safer choice for patients at risk for steroid-induced glaucoma or those requiring prolonged treatment 3. The typical dosing for fluorometholone is 1-2 drops in the affected eye(s) four times daily initially, then tapered according to clinical response.

While fluorometholone offers better IOP safety, it is less potent than prednisolone, so it may be more appropriate for mild to moderate anterior segment inflammation rather than severe cases. Prednisolone acetate 1% remains the first choice for severe ocular inflammation when potent anti-inflammatory effect is needed, despite its greater tendency to raise IOP. This difference in IOP effect occurs because fluorometholone undergoes more rapid metabolism in the eye, particularly in the iris and ciliary body, resulting in less accumulation and reduced impact on the trabecular meshwork that regulates aqueous humor outflow.

Some key points to consider when choosing between fluorometholone and prednisolone include:

• The potency of the steroid: prednisolone is more potent than fluorometholone, but also has a greater risk of raising IOP
• The severity of the inflammation: fluorometholone may be sufficient for mild to moderate inflammation, while prednisolone may be needed for more severe cases
• The patient's risk factors for steroid-induced glaucoma: patients with a history of glaucoma or those at high risk for developing glaucoma may be better candidates for fluorometholone
• The need for prolonged treatment: fluorometholone may be a better choice for patients who require long-term treatment due to its lower risk of raising IOP. Patients using either steroid should have their IOP monitored regularly, especially during the first few weeks of treatment 4, 5, 6.