Long Term Steroid Use?
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    Cheyenne's Avatar
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    Default Long Term Steroid Use?

    Just wondering if anyone has any experience with long term use of steroid eyedrops to treat PK? Milo was on them for 2 months, first every day, then every other day and finally twice a week. He improved tremendously and the vet felt his PK had resolved about as well as it was going to and had stabilized and had gotten to the point where the pigment that still remained was not affecting his vision at all. We switched him to cyclosporine for awhile to see if his PK would stay in remission, but now after only a couple of months it is progressing again. We have an appointment later this coming week, but I'm thinking he is going to have to go back on the steroid eyedrops again. The insert in the package said long term use can cause cataracts and glaucoma, but it doesn't say what is considered long term use....months, years, etc. I am not inclined to put him through the corrective surgery only to have the likelihood of the pigment reforming during the healing process.

    While I know that glaucoma and cataracts would lead to blindness eventually, so will PK, so I feel like I'm between a rock and a hard place as to what to do. Milo is a young Pug and I don't want him to end up spending alot of his years blind. I would be very interested in anyone's experience with their Pugs having to be on the steroid eyedrops long term. How long were they on them? And did the Pugs have any serious side effects from them? Thanks.
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    I have been wondering that same thing myself. Roxy my Bt is taking steroid drops once a day for entropion. It's helped a lot and I don't even give it to her everyday since it's under control now.

    The vet doesn't think it's bad enough to do surgery on and she has an old injury that he thinks the steroid may help with that. So for now I am continuing with it.

    I wish I knew the answer to that, that is why I give her the smallest dose possible.
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    Solomon, our first rescue, has been on optimune drops for over 3 years, we have had no problems at all. He gets them twice a day. I really have no option as his pk was quite advanced when we got him. I tried to take him off after a year or so, and within days he couldn't see anything at all.

    Our vet told us that a lot of the problem with eyes and steroids is that they dry out the eye so much. So 15 minutes after we put in the drops we follow it with an eye lubricant...... visine, natural tears or any over the counter human stuff for dry eyes.

    I don't know if that will work for everyone, but we have ad good success with it for a long time.

    Joan

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    Thank you, Joan, that's good to know about adding the artificial tears to the regimen. I will ask the vet about that at Milo's appointment. He had rather advanced PK in his right eye when we adopted him, too. About 1/3 of his cornea was pigmented. The left eye had only a little tiny bit that wasn't affecting his vision, but I think it's a bit more now. Milo was on Prednisolone Acetate 1% drops. I'm wondering if Optimmune is the trade name for Prednisolone Acetate? I'll Google it later and find out.
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    Almost all the eye specialist that I have known in Illinois and now in Tennessee prescribe Tacrolimus over the Cyclosporine. They say it seems to help break up the pigment a little and keeps the pigment from forming. It may be something to ask your doctor about and to try. Chyna has mild pigment and has been on the Tacrolimus for over 2 years now, and she has not had any progression. She does have great tear production so that isn't a factor.
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    Optimmune and Prednisone are two different drugs. Optimmune is cyclosporine - in human medicines it's called Restasis. It improves tear production, which is one of the things that helps PK. Prednisone decreases inflammation - which is a different issue. I have no idea if long term Prednisone eye drops are a problem - long term pills are, but the drops, I have no idea. Good questions for a vet. SHORT term prednisone, like some folks do with a "dosepack", like after a bee sting or allergic reaction or asthma flare up, is not as dangerous, because it is for maybe a week. Although the side effects are pretty unpleasant, it is only for a week. With some folks, though, that is a long week, lemme tell ya! We use a lot of high dose steroids in the hospital, and they can make a person jittery all the way to crazy - at least they know the medicine is doing it! Peg
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    Now I got the curiosity - because we use Tacrolimus too, in humans after liver transplants, especially. Both Cyclosporine and Tacrolimus are anti-rejection drugs - immunosupressants, that work differently than steroids. My guess is that both are spendy, but Optimmune may be less so, because it is a bit older.
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    And two cats - Othello and Vasco, who hate pugs

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    We used to use prednisone drops, but one of the 3 pugs on them, did not tolerate it well at all...runny eyes etc. So we switched to the optimune, and everyone has done well on it. But when we were on the prednisone I researched the h... out of it and found that eye drops are not absorbed or affect any internal organs as an oral administration would do. the long effect on the eye might be different, not sure.

    I have always hated steroids, (systemic not eye) and a few months ago finally gave in to my vet a gave our little blind rescue Bella, the stuff for a week as our vet had been wanting. she is now diabetic as the adrenal glands and/or pancreas were damaged. We are still hoping she will regain her insulin production, but it has been 2 months now, so lots of doubt. Not trying to scare anyone, but a caution, as systemic steroids can (and in my case did) affect every single organ in the body.
    Joan, owned by Faith, Samson, Solomon, Louie, Casper, Brutus, Sarah, Bella, and Peanut

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    I have questioned my vet about long term effects on the eye from steroid eye drops. The insert in the box had said long term use can cause cataracts and glaucoma, but did not define long term use., i.e., weeks, months, years? The Pred Acetate drops worked wonders for Milo's PK, even when he was weaned down to only twice a week. But only a short time since we switched him to cyclosporine and the pigment is worsening. Suki gets cyclosporine for dry eye, but Milo doesn't have dry eye. He doesn't have any eyelid or eyelash problems, and his eyes do close when he sleeps. The vet said his PK could have been caused from exposure or perhaps even his allergies contributed to it, of which he has many. She wasn't keen on him staying on the steroid eyedrops once the PK had gotten to the point where it stopped improving and the hope was that the cyclosporine would hold it at bay, but be safer in the long term. I know that when Milo was going to undergo his intradermal allergy testing, the dermatologist told us to stop using the steroid eye drops for a minimum of 2 weeks prior, so apparently there must be the possibility of some of it being absorbed into the body. He felt it could possibly skew the results of the skin tests. Right now Milo's right eye is back to where it was, about 1/4 to 1/3 of his cornea to the point where his vision is starting to be compromised when he looks in the direction where the pigment is. It's rather dense. And his left eye has a bit of it again, but not enough to affect his vision in that eye. I will ask about Tacrolimus drops when we see the vet Thursday. Do you know if this is something that has to be made at a compounding pharmacy? We have Suki's cyclosporine drops made at a compounding pharmacy because our vet doesn't stock them. She only stocks an ointment which I would prefer not to use. I'm more comfortable with drops.
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    In agony they linger, In loneliness they die.
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    If your vet doesn't carry the Tacrolimus drops, you can ask for him to fax a prescription to www.roadrunnerpharmacy.com This is the one that I use, and they have been great so far. The drops usually arrive within a couple of days of my ordering them, and they send a little toy in the box. They also have free shipping. I believe for a 15ml bottle, its is $47. There are other pharmacies that have this medicine. You would just want to compare prices and shipping prices. Some of the places only have a 10ml bottle for the same price so you want to make sure you know what size you are getting for your money.
    Leslye, Chyna, Tinker, Ruffy and husband Tim &
    our angels Pugsly and Taz waiting for us in heaven

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    www.northernillinoispugrescue.org

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