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Difficulty tapering off prednisone in one eye after cataract surgery

Posted by pb50 @pb50, Jun 6 7:35am

I had bilateral cataract removal two weeks apart on April 19th for right eye and May 3rd for left. Following surgery there was a prescribed regiment of eye drops for antibiotic, NSAID, and steroid (Prednisone). The antibiotic was qid x 1 wk. The nsaid was qid x 2 wks. The steroid was qid x 1wk, tid x 1wk, bid x 1wk, and qd x 1wk.

The right eye did fine. Prednisone in the left eye should have stopped May 31 but is stubborn in tapering off . It feels swollen and hurts in the morning and periodically throughout the day. Ive kept it going every other day but that just means it hurts on the off day. My surgeon says the eye is healed and i seem to understand the principle of tapering so use my judgment. 🙄

Since I'm my own clinician here, has anyone experienced this? If it matters, the drops are Prednisolone 1%.

@dadcue I'm out of my element here.

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Mentor
John, Volunteer Mentor | @johnbishop | Jun 6 8:13am

@pb50, I'm sorry to hear that the second cataract surgery didn't go as well. When I had both of mine done a few years ago I was given a specific tapering schedule for 2 different eyedrops one of which was the steroid and it went fairly smoothly for me. I did see a couple of references that seem similar to what you are experiencing. The second one may provide some suggestions.

-- Corneal Edema after Cataract Surgery: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10647590/
-- Chronic Inflammation After Cataract Surgery - Tips on the management and comanagement of these cases from a retina specialist.: https://crstoday.com/articles/nov-dec-2022/chronic-inflammation-after-cataract-surgery

Are you able to get a second opinion from another eye surgeon or doctor based on the swelling?

REPLY
2 replies
elisabeth007 | @elisabeth007 | Jun 6 8:36am

i had problems with my second cataract surgery which included sensitivities to the preservatives in the eye drops. i am afraid to self prescribe prednisone and when i use it, my cornea specialist often orders it from a compounding pharmacy preservative free. How about getting a second opinion?

REPLY
pb50 | @pb50 | Jun 6 8:56am

You only had that sensitivity in one eye?

REPLY
pb50 | @pb50 | Jun 6 9:06am
In reply to @johnbishop "@pb50, I'm sorry to hear that the second cataract surgery didn't go as well. When I..." + (show)
@johnbishop

@pb50, I'm sorry to hear that the second cataract surgery didn't go as well. When I had both of mine done a few years ago I was given a specific tapering schedule for 2 different eyedrops one of which was the steroid and it went fairly smoothly for me. I did see a couple of references that seem similar to what you are experiencing. The second one may provide some suggestions.

-- Corneal Edema after Cataract Surgery: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10647590/
-- Chronic Inflammation After Cataract Surgery - Tips on the management and comanagement of these cases from a retina specialist.: https://crstoday.com/articles/nov-dec-2022/chronic-inflammation-after-cataract-surgery

Are you able to get a second opinion from another eye surgeon or doctor based on the swelling?

Jump to this post

Thanks! Im sure i could get a second opinion ..
Maybe because of my RA and some experience with a prednisone for flares, my instinct is that i just need a different tapering achedule. I just thought someone else might have had experience. Im still within what should have been week one after stopping. So i will read the links you sent - and thanks - and see what im dealing with in a few days.

REPLY
pb50 | @pb50 | Jun 6 9:24am
In reply to @johnbishop "@pb50, I'm sorry to hear that the second cataract surgery didn't go as well. When I..." + (show)
@johnbishop

@pb50, I'm sorry to hear that the second cataract surgery didn't go as well. When I had both of mine done a few years ago I was given a specific tapering schedule for 2 different eyedrops one of which was the steroid and it went fairly smoothly for me. I did see a couple of references that seem similar to what you are experiencing. The second one may provide some suggestions.

-- Corneal Edema after Cataract Surgery: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10647590/
-- Chronic Inflammation After Cataract Surgery - Tips on the management and comanagement of these cases from a retina specialist.: https://crstoday.com/articles/nov-dec-2022/chronic-inflammation-after-cataract-surgery

Are you able to get a second opinion from another eye surgeon or doctor based on the swelling?

Jump to this post

Thanks again John. The second article was quite helpful. Consensus seems to be to either stretch it out for a bit (the ‘it just needs a little more time’ approach, vs dropping back, increase the dose a bit and taper it longer. So I’m going to stick with every other day for a week and see where i am.

REPLY
DadCue | @dadcue | Jun 6 5:55pm

My cataract surgeries were uneventful except for a dramatic rise in my intraocular pressure. The surgeon who did my cataract surgeries was the same ophthalmologist who treated me for recurrent uveitis. He was always concerned about my intraocular pressures while I was on prednisone. He labeled me a "steroid responder" which I thought was a good thing because uveitis responded to prednisone. However, it wasn't a good thing when my intraocular pressures increased and "responded" to prednisone. A well-known side effect of steroid eye drops is an increase in intraocular pressure (IOP), particularly in “steroid responders."

https://eyewiki.aao.org/Steroid-Induced_Glaucoma#:~:text=Since%20it%20was%20first%20reported,considered%2C%20%E2%80%9Csteroid%20responders%E2%80%9D.

The combination of topical and systemic steroids might be increasing your intraocular pressures. Have your intraocular pressures been checked? You won't feel much until a threshold pressure is reached and then it made my eye feel like it was going to explode.

Are you aware of "secondary cataracts?" That was disconcerting to me when my vision deteriorated after cataract surgery. Fortunately it was a quick fix.
https://my.clevelandclinic.org/health/diseases/24737-posterior-capsular-opacification

REPLY
2 replies
pb50 | @pb50 | Jun 6 7:15pm
In reply to @dadcue "My cataract surgeries were uneventful except for a dramatic rise in my intraocular pressure. The surgeon..." + (show)
@dadcue

My cataract surgeries were uneventful except for a dramatic rise in my intraocular pressure. The surgeon who did my cataract surgeries was the same ophthalmologist who treated me for recurrent uveitis. He was always concerned about my intraocular pressures while I was on prednisone. He labeled me a "steroid responder" which I thought was a good thing because uveitis responded to prednisone. However, it wasn't a good thing when my intraocular pressures increased and "responded" to prednisone. A well-known side effect of steroid eye drops is an increase in intraocular pressure (IOP), particularly in “steroid responders."

https://eyewiki.aao.org/Steroid-Induced_Glaucoma#:~:text=Since%20it%20was%20first%20reported,considered%2C%20%E2%80%9Csteroid%20responders%E2%80%9D.

The combination of topical and systemic steroids might be increasing your intraocular pressures. Have your intraocular pressures been checked? You won't feel much until a threshold pressure is reached and then it made my eye feel like it was going to explode.

Are you aware of "secondary cataracts?" That was disconcerting to me when my vision deteriorated after cataract surgery. Fortunately it was a quick fix.
https://my.clevelandclinic.org/health/diseases/24737-posterior-capsular-opacification

Jump to this post

When i had the surgery and went 45 mins later to the surgeons office and my ocular pressure was up and he put drops in and i couldn't leave until it was down to some level and he sent me home with Bromonidine ?) Tartrate to drop in every 3 hours that evening. The next day was a Saturday and my vision got really cloudy. I called, he said that was normal, and I think went back to his tee shot

After that it was ok until i stopped prednisone last Saturday. I had seen the surgeon for quick check friday just
Verifying my prescription they were ordering. I think the tech thought pressure was high but he said it was ok.

REPLY
pb50 | @pb50 | Jun 6 7:28pm
In reply to @dadcue "My cataract surgeries were uneventful except for a dramatic rise in my intraocular pressure. The surgeon..." + (show)
@dadcue

My cataract surgeries were uneventful except for a dramatic rise in my intraocular pressure. The surgeon who did my cataract surgeries was the same ophthalmologist who treated me for recurrent uveitis. He was always concerned about my intraocular pressures while I was on prednisone. He labeled me a "steroid responder" which I thought was a good thing because uveitis responded to prednisone. However, it wasn't a good thing when my intraocular pressures increased and "responded" to prednisone. A well-known side effect of steroid eye drops is an increase in intraocular pressure (IOP), particularly in “steroid responders."

https://eyewiki.aao.org/Steroid-Induced_Glaucoma#:~:text=Since%20it%20was%20first%20reported,considered%2C%20%E2%80%9Csteroid%20responders%E2%80%9D.

The combination of topical and systemic steroids might be increasing your intraocular pressures. Have your intraocular pressures been checked? You won't feel much until a threshold pressure is reached and then it made my eye feel like it was going to explode.

Are you aware of "secondary cataracts?" That was disconcerting to me when my vision deteriorated after cataract surgery. Fortunately it was a quick fix.
https://my.clevelandclinic.org/health/diseases/24737-posterior-capsular-opacification

Jump to this post

I am aware of posterior capsulation.

The surgeon is closed after his friday surgeries. If it is needed,
I will just stretch out Prednisone on an every other day pattern and see what Monday is like. For
the record, I had relief 15 mins after dropping in Prednisone this morning. Sounds responsive to me.

I was sadly also responsive to the nsaid eye drops and they triggered my microscopic colitis and after a month of symptoms managememt, i am back on Budesonide- the colon steroid.
I just didnt think I would absorb enough systemically to trigger it. Stupid of me

REPLY
annebw | @annebw | Jun 7 12:47pm

My ocular pressure also shot up, and I ended up with closed angle glaucoma. I think that is a possible side effect of prednisolone eyedrops. They put a shunt in my eye, which relieved the pressure and pain, but I am now blind in that eye.

REPLY
1 reply
pb50 | @pb50 | Jun 7 2:09pm

Today is the Off day on my every other day taper schedule and i was prepared to go to the surgeon’s
Office if it felt as if it was swollen or inflamed. But its neither. Tomorrow will be the test. That will be Saturday and i have mo idea where one goes to get an ocular pressure taken other than the eye doc. I mean its just a little hand held air gun gizmo that feeds back a number - oh you know better than i do.
Here’s hoping tomorrow is as good as today!

REPLY
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