To compare the anti-inflammatory effect and ocular surface toxicity of nonpreserved methylprednisolone sodium succinate 1% and preserved prednisolone acetate suspension 1% eyedrops for management of acute anterior uveitis (AAU).

Patients with non-infectious AAU were assigned randomly to receive either hourly nonpreserved methylprednisolone 1% (Group A) or preserved prednisolone 1% (Pred Forte 1%, Allergan, Inc) eye drops (Group B) followed by a 2-week tapering regimen. Anterior chamber cells and flare were clinically evaluated for objective comparison of the anti-inflammatory effect. The main outcome measure was percent of patients with resolution of inflammation (anterior chamber cell < 1+ according to SUN classification group) on day 14. Ocular surface toxicity was assessed by objective ratings of corneal epitheliopathy (corneal fluorescein staining scores) and tear film stability indices (tear break-up time, and Schirmer I test), as well as questionaire-based grading of ocular discomfort parameters. Intraocular pressure measurement served as an index of safety.

Seventy two eyes of 68 patients were studied, of which 38 eyes were enrolled in Group A and 34 in Group B. On day 14, 76.3% of Group A patients had resolution of inflammation compared with 70.6% of Group B, proving noninferiority (X2 = 0.303, P=0.582). Mean anterior chamber cell grade reduction for Group A patients was similar to Group B patients (2.52 vs. 2.86, respectively; P=0.92). The anti inflammatory efficacy as measured by reduction of anterior chamber flare was also comparable between two groups (188.4 vs. 240.1 in Group A and B, respectively; P=0.141). 18.4% of patients in the Group A compared to 17.6% of patients in Group B were withdrawn because they were assessed to be “refractory to topical treatment” (X2 = 0.007, P=0.932). Group A patients showed significantly lower corneal fluorescein staining scores (P<0.001) and reported milder subjective ocular discomfort (P = 0.01) as compared with Group B.

: Both nonpreserved methylprednisolone sodium succinate 1% and preserved prednisolone acetate suspension 1% eyedrops demonstrated equal anti-inflammatory effect for treatment of AAU. Nonpreserved methylprednisolone eyedrops exhibited significantly lower ocular surface toxicity profile and milder subjective discomfort when compared with preserved eyedrops.