Risk factors of the steroid induced ocular hypertension after corneal refractive surgery

Kyoung Min Lee, MD1,2, Won Ryang Wee1,2, Jin Hak Lee1,3, Mee Kum Kim, MD1,2

1Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

2 Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea,

3Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea

Authors have no financial interests

PurposeSteroid induced glaucoma

-prolonged steroid use-myopia

Corneal refractive surgery

-changes in corneal thickness-IIOP could be masked

David Rex Hamilton et al.Ophthalmology 2002; 109:659-

665

To investigate the changes of IOP after corneal refractive surgery To determine the risk factors

of steroid induced increased IOP

Methods• Inclusion

– 2004. 1 ~ 2008. 1– Corneal refractive surgery in SNUH

• Eximer laser• PRK• LASIK• LASEK

• Exclusion– Follow up less than 1 month– Refractive surgery in single eye for the eldlery– Hyperopia

225 patients, 450 eyes

Retrospective

Methods• Steroids– Normal

• 0.1% fluometholone (flarex) for 1week

• 0.1% fluometholone (ocumetholone) tapering

– DLK• 1% prednisolone (Pred

Forte)

– Myopic regression• 1% prednisolone (Pred

Forte)

• IOP– Pneumatic tonometer

– Sheng-Yao Hsu et al.– J Cataract Refract

Surg 2009;35:76-82– Adjusted baseline

IOP• 4.8mmHg / 100μm

– Hornova J et al.– Cesk Slov Oftalmol

2000;56:98-103

Methods• Definition of IIOP– Increase of IOP• More than 130% of adjusted baseline IOP• After 1 week• Repeated more than two times

– Need of medication• With evidence of IOP increase

Methods• Variables

– Patient related• Age, Sex• Myopia• Preoperative IOP• Corneal thickness

– Operation related• Type• Zone• Ablation depth

– Steroid related• DLK• Myopic regression

• Analysis– Correlation

• Myopia• IOP change

– Grouping – myopia• IIOP

– medication– Binary logistic

regression• IIOP

– medication

Results• Demographics

225 patients, 450 eyesAge 26.0±6.1M:F 82 : 143

Myopia -4.7±1.8 DCorneal

thickness538.5±28.3 μm

IOP 16.5±2.8mmHg

Results• IOP change & myopia

r=-0.097p=0.04*

* Pearson correlation

Myopia IOP change

n

myopia ≥ -3 D 0.67 ± 3.33

85

-3 > myopia ≥ -6 D

1.03 ± 3.30

248

-6 > myopia ≥ -8 D

1.62 ± 2.85

99

-8 > myopia 1.51 ± 2.96

18

F=1.524p=0.207

ANOVA comparison

Results

Myopia IIOP Medication nmyopia ≥ -3 D 24.7% 17.6% 85

-3 > myopia ≥ -6 D 21.0% 10.1% 248-6 > myopia ≥ -8 D 22.2% 12.1% 99

-8 > myopia 27.8% 11.1% 18

IIOP 22.2%Medication 12%*

*5.6±3.4mmHg from the adjusted baseline IOP

IIOP Medication

n

DLK 75% 50% 8Regressio

n20.1

%17.6% 248

IIOP

mx

(%)

ResultsRisk factors of IIOP

p-value Exp(B)Patients Age 0.462 0.980

Sex(F) 0.048* 0.514Myopia 0.654 1.151

IOP 0.166 1.091Corneal

thickness0.197 1.008

Operation

Op typea 0.995Op zoneb 0.649

Ablation depth 0.670 0.989After op IOP change 0.000* 1.995

DLK 0.227 0.305Regression 0.574 0.721

a OP type PRK Eximer LASIK LASEK

b Op zone (mm) 6.0 6.0 with blending 6.5 custom

M 18.9%F 23.1%

ResultsRisk factors of medication

p-value Exp(B)Patients Age 0.179 0.960

Sex(F) 0.135 0.574Myopia 0.551 1.223

IOP 0.001* 1.271Corneal

thickness0.019* 1.015

Operation

Op typea 0.996Op zoneb 0.699

Ablation depth 0.869 0.995After op IOP change 0.000* 1.423

DLK 0.099 0.208Regression 0.049* 0.336

a OP type PRK Eximer LASIK LASEK

b Op zone (mm) 6.0 6.0 with blending 6.5 custom

Conclusion

• Steroid induced IIOP– 22.2%– Independent from

myopia

• Risk factors of IIOP– Female

• IOP change and myopia– Possibility of wrong model

• IIOP– Similar rates in variable

degree of myopia– More medication in low

myopia• More detection

• Risk factors– Thick preoperative

corneal thickness and high IOP• More medication – more

detection