Rimexolone Shows Greater Anti-inflammatory Effect in Children

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Rimexolone Shows Greater Anti-inflammatory Effect in Children

Arch Ophthalmol. 2003;121:1716-1721

Dec. 15, 2003 — Rimexolone is associated with a higher risk of

ocular-hypertensive effect in postsurgical pediatric patients compared

with fluorometholone, according to the results of a double-masked,

randomized, crossover study published in the December issue of the

Archives of Ophthalmology.

Ocular-hypertensive responses of children to traditional

corticosteroids, including dexamethasone and fluorometholone, are more

frequent, severe, and rapid compared with those of adults, write Dorothy

S. P. Fan, FRCS, and colleagues of the Departments of Ophthalmology and

Visual Sciences at the Chinese University of Hong Kong in Kowloon. The

authors suggest that current therapeutic goals involve identifying drugs

exhibiting marked anti-inflammatory effects, while decreasing the

propensity to raise intraocular pressure (IOP) levels.

The study enrolled 54 pediatric surgical patients undergoing bilateral

symmetrical strabismus procedures: 24 boys and 30 girls, aged 4 to 8

years (mean age, 5.33 ± 1.26 years). After surgery, one eye was

randomized to receive topical 1% rimexolone (24 right eyes and 30 left

eyes), while the contralateral eye received topical 0.1% fluorometholone

(30 right eyes and 24 left eyes). Treatment was administered four times

daily for four weeks.

While both treatment groups had peak IOP levels significantly higher

than preoperative baseline values, the mean peak IOP level was

significantly higher in the rimexolone group than in the fluorometholone

cohort. Net increases in IOP from preoperative values were also higher

in the rimexolone group in the fluorometholone cohort.

Eyes treated with rimexolone showed clinically significant (>10 mm Hg)

increases in IOP in six cases (11.1%). No such increases were observed

among eyes treated with fluorometholone. Peak IOP levels were also

reached earlier in the rimexolone group (median, 6 days vs.13 days) than

in the fluorometholone cohort.

Both objective and subjective inflammatory scores decreased with time in

both groups, subsiding by day 27. However, a greater cumulative

percentage of eyes treated with rimexolone showed no conjunctival

erythema on day 13, and day 20 compared with those treated with

fluorometholone. In addition, the number of patients experiencing no

discomfort was greater in the rimexolone group than in the

fluorometholone group at both day 13 (18 patients [33.3%] vs. 6 patients

[11.1%]), and day 20 (45 patients [83.3%] vs. 33 patients [61.1%]).

While 1% rimexolone was significantly more effective in reducing

symptoms of inflammation, it was also associated with

corticosteroid-induced IOP elevation. Because ocular-hypertensive

response is more pronounced in the pediatric population, the authors

suggest that corticosteroid use be minimized with respect to type, as

well as frequency and duration of use. " It is necessary to monitor IOP

in children who receive rimexolone eyedrops, especially for those who

require treatment for a prolonged period or at an increased frequency, "

they recommend.

The study was partially funded by the Action for Vision Eye Foundation

in Hong Kong.