Loteprednol Suspension Eye Drops Reduce IOP Following Corneal Transplantation

Female applying eye drops to open, blue eye. close up
The topical medication is appropriate for long-term use, the report shows.

After corneal transplantation, 0.5% loteprednol suspension eye drops decrease intraocular pressure (IOP) 6 months postoperatively and can be considered for long-term use following these procedures, according to research published in BMC Ophthalmology. 

The investigators explain that “the treatment of corticosteroid-induced ocular hypertension is extremely challenging, especially after corneal transplantation since premature discontinuation of hormonal drugs can easily lead to graft rejection and long-term use may cause corticosteroid-induced ocular hypertension.”

In this retrospective study, researchers sought to compare the effect of 0.5% loteprednol suspension drops with 1% prednisolone acetate drops. 

The total cohort included 234 eyes from 234 patients who underwent penetrating keratoplasty and lamellar keratoplasty (149 men; mean age, 50.06±15.114 years). Patients were grouped based on the treatment they received, with 96 patients receiving 1% prednisolone acetate and 138 patients receiving 0.5% loteprednol suspension. All patients received a 20% mannitol injection (250 ml) twice daily plus methazolamide tablets 25 mg twice daily and sodium bicarbonate tablets 0.5 g 3 times daily to stabilize IOP. All patients also received pressure bandages changed daily, followed by levofloxacin eye drops 4 times daily, calf blood deproteinized extract eye gel 3 times daily, and tobramycin dexamethasone ointment once daily after patients were permitted to open their eyes. 

Patients were follow-up at 1 week and months 1, 3, 6, and 12 postoperatively. At each visit, slit lamp microscopy was used to view the attachment of the eye grafts and graft beds, with measurements for IOP, average best corrected visual acuity (BCVA), and postoperative complications taken. 

No significant differences were noted between the 2 patient groups in terms of preoperative characteristics like age, gender, surgical method, diagnosis, or BCVA. 

After the procedure, 35 and 27 patients in the 1% prednisolone acetate group and the 0.5% loteprednol suspension group developed corticosteroid-induced ocular hypertension. Among these patients, there were no significant differences in characteristics. No significant differences were seen in preoperative IOP and average IOP at week 1, month 1, month 3, or month 12 postoperatively. However, the loteprednol group had a significantly lower average IOP at postoperative month 6. 

The researchers saw a significant difference in the number of patients with IOPs lower than 30 mm Hg in each group with 94.29% in the prednisolone acetate group and 96.30% in the loteprednol group. 

In either group, they saw no significant differences in the rates of development of leukoma, corneal dystrophy, corneal degeneration, keratoconus, infectious corneal ulcer, or infective corneal perforation, or in the risk factors for corticosteroid-induced ocular hypertension — including aphakia, pseudophakia, and cataracts

Postoperative BCVA was not significantly different at any point, with the exclusion of month 6 where average BCVA was significantly lower in the loteprednol group compared with the prednisolone acetate group. 

Graft rejection rates were also similar between groups, with no postoperative cataracts in the prednisolone group and 1 postoperative cataract in the loteprednol group. 

Study limitations include the small sample size and the “disappearance” of the significantly reduced IOP increase at month 12, requiring further study in large, randomized controlled trials. 

“Treatment with 0.5% loteprednol suspension eye drops reduced the increase in the IOP 6 months postoperatively compared with the IOP increase induced by 1% prednisolone acetate eye drops,” the research explains. “Vision loss and incidence of postoperative rejection were not different between the 2 eye drop treatments. 

“Thus, 0.5% loteprednol suspension eye drops may be considered for long-term use after corneal transplantation.” 


Chen Y, Wang X, Gao M, Gao R, Song L. The effect of loteprednol suspension eye drops after corneal transplantation. BMC Ophthalmol. 2021;21(1):234. doi:10.1186/s12886-021-01982-8