What is the treatment plan for Prednisolone Acetate (Pred Forte) 1% Ophthalmic Suspension (Op Suso) administered four times a day (QID) for 30 days?

From the Guidelines

Prednisolone Acetate Suspension (Pred Forte) 1% should be administered as one drop in the affected eye(s) four times daily for a short-term period, such as 30 days, to control inflammation in conditions like uveitis, with the goal of tapering the medication as soon as the anterior chamber cellular reaction comes under control, as recommended by the 2019 American College of Rheumatology guideline 1. When using this medication, it is essential to follow proper administration techniques to ensure effectiveness and minimize potential side effects.

• Shake the bottle well before each use to ensure proper suspension of the medication.
• After washing your hands, tilt your head back, pull down your lower eyelid to form a pocket, and place one drop into this pocket.
• Close your eyes gently for 1-2 minutes to allow the medication to be absorbed and prevent drainage.
• If using other eye drops, wait at least 5-10 minutes between applications.
• Do not touch the dropper tip to any surface to avoid contamination. The medication may temporarily blur vision, so use caution when driving or operating machinery.
• If you experience increased eye pain, vision changes, or worsening redness, contact your healthcare provider immediately. It is also crucial to be aware of the potential risks associated with long-term use of topical glucocorticoids, such as elevated intraocular pressure and cataract formation, and to work with your healthcare provider to minimize these risks, as highlighted in the guideline 1.
• The risk for elevated IOP and cataracts increases with greater frequency of topical glucocorticoid drops/day and longer duration of therapy.
• Regular close follow-up with an ophthalmologist is necessary to monitor for potential complications and adjust the treatment plan as needed.

From the FDA Drug Label

INDICATIONS AND USAGE Prednisolone acetate ophthalmic suspension 1% is indicated for the treatment of steroid-responsive inflammation of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe. PRECAUTIONS General The initial prescription and renewal of the medication order beyond 20 milliliters of prednisolone acetate ophthalmic suspension 1% should be made by a physician only after examination of the patient with the aid of magnification, such as slit lamp biomicroscopy, and, where appropriate, fluorescein staining If signs and symptoms fail to improve after 2 days, the patient should be re-evaluated.

The recommended treatment duration is not explicitly stated in the provided drug labels. However, it is advised that if signs and symptoms fail to improve after 2 days, the patient should be re-evaluated 2.

• The use of prednisolone acetate ophthalmic suspension 1% for 30 days, QID, should be made by a physician only after examination of the patient with the aid of magnification, such as slit lamp biomicroscopy, and, where appropriate, fluorescein staining 2.
• Fungal invasion should be suspected in any persistent corneal ulceration where a corticosteroid has been used or is in use 2.
• It is recommended to re-evaluate the patient if signs and symptoms fail to improve after 2 days 2.

From the Research

Prednisolone Acetate Suso (Pred Forte) 1% Op Suso QID for 30 days

• The use of prednisolone acetate for ocular inflammatory conditions is a common practice, as corticosteroids are potent anti-inflammatory agents 3.
• However, topical corticosteroids like prednisolone acetate can have side effects, including increased intraocular pressure and risk of cataract formation after long-term use 4, 5.
• The risk of intraocular pressure elevation may increase with prolonged use, high frequency of administration, young age, higher ocular penetrance, and higher anti-inflammatory potency 6.
• Early generation corticosteroids, such as dexamethasone and prednisolone, are more likely to result in clinically significant increases in intraocular pressure 7.
• Newer corticosteroids, such as loteprednol etabonate, offer similar anti-inflammatory efficacy to older corticosteroids with less effect on intraocular pressure 4, 5, 7.
• It is essential to monitor intraocular pressure in individuals using topical corticosteroids, especially those who are known to experience a high degree of intraocular pressure elevation with low doses or short durations of treatment 7.