J Korean Ophthalmol Soc.  2010 Oct;51(10):1333-1337.

Risk Factors of the Steroid Induced Ocular Hypertension After Corneal Refractive Surgery

• Lee KM
• Kim MK
• Wee WR
• Lee JH

Abstract

PURPOSE
To investigate changes in intraocular pressure (IOP) after corneal refractive surgery and determine risk factors associated with increased IOP (IIOP).
METHODS
This retrospective observational study was comprised of 450 eyes of 225 patients, each of whom had corneal refractive surgery in Seoul National University Hospital between January 2004 and January 2008, and were followed for more than one month. IIOP was defined as IOP above 130% of the predicted IOP, adjusted according to corneal thickness and repeated more than twice after postoperative 1 week or after anti-glaucoma medication was needed. Correlation and stratified regression analyses were performed for eyes with myopia and IIOP. Logistic regression analysis was performed to assess risk factors of IIOP and need for medication.
RESULTS
IIOP was detected in 22.2%, and anti-glaucoma medication was required in 12.0%, of eyes. The mean IIOP of the medication group was 5.6 +/- 3.4 mmHg. Stratified regression analysis showed that the proportion of IIOP did not differ significantly by the degree of myopia. Logistic regression analysis revealed that statistically significant risk factors of IIOP were female gender, preoperative low IOP, and thicker cornea. The statistically significant risk factor of need for medication was the corneal thickness.
CONCLUSIONS
Thick corneal thickness was found to be a significant risk factor of IIOP after corneal refractive surgery was performed, and IIOP was not affected by the degree of myopia.

Keyword

Myopia; Refractive surgery; Steroid induced ocular hypertension

MeSH Terms

Cornea
Eye
Female
Humans
Intraocular Pressure
Logistic Models
Myopia
Ocular Hypertension
Refractive Surgical Procedures
Retrospective Studies
Risk Factors

Reference

References

1. Francois J. Corticosteroid glaucoma. Ann Ophthalmol. 1977; 9:1075–80.

2. Podos SM, Becker B, Morton WR. High myopia and primary open-angle glaucoma. Am J Ophthalmol. 1966; 62:1038–43.

3. Bashford KP, Shafranov G, Tauber S, Shields MB. Considerations of glaucoma in patients undergoing corneal refractive surgery. Surv Ophthalmol. 2005; 50:245–51.

4. Hamilton DR, Manche EE, Rich LF, Maloney RK. Steroid-induced glaucoma after laser in situ keratomileusis associated with interface fluid. Ophthalmology. 2002; 109:659–65.

5. Morales J, Good D. Permanent glaucomatous visual loss after photorefractive keratectomy. J Cataract Refract Surg. 1998; 24:715–8.

6. Gartry DS, Kerr Muir MG, Marshall J. Photorefractive keratectomy with an argon fluoride excimer laser: a clinical study. Refract Corneal Surg. 1991; 7:420–35.

7. Seiler T, Holschbach A, Derse M, et al. Complications of myopic photorefractive keratectomy with the excimer laser. Ophthalmology. 1994; 101:153–60.

8. Hornová J, Sedlák P, Hlousková B. Refractive procedures-LASIK and intraocular pressure in myopic eyes. Cesk Slov Oftalmol. 2000; 56:98–103.

9. Alward WL. The genetics of open-angle glaucoma: the story of GLC1A and myocilin. Eye (Lond). 2000; 14(Pt 3B):429–36.

10. Alward WL, Fingert JH, Coote MA, et al. Clinical features associated with mutations in the chromosome 1 open-angle glaucoma gene (GLC1A). N Engl J Med. 1998; 338:1022–7.

11. Tang WC, Yip SP, Lo KK, et al. Linkage and association of myocilin (MYOC) polymorphisms with high myopia in a Chinese population. Mol Vis. 2007; 13:534–44.

12. Vatavuk Z, Skunca Herman J, Bencić G, et al. Common variant in myocilin gene is associated with high myopia in isolated population of Korcula Island, Croatia. Croat Med J. 2009; 50:17–22.

13. Zayats T, Yanovitch T, Creer RC, et al. Myocilin polymorphisms and high myopia in subjects of European origin. Mol Vis. 2009; 15:213–22.

14. Hsu SY, Chang MS, Lee CJ. Intraocular pressure assessment in both eyes of the same patient after laser in situ keratomileusis. J Cataract Refract Surg. 2009; 35:76–82.

15. Montes-Mico R, Charman WN. Intraocular pressure after excimer laser myopic refractive surgery. Ophthalmic Physiol Opt. 2001; 21:228–35.

16. Zadok D, Tran DB, Twa M, et al. Pneumotonometry versus Goldmann tonometry after laser in situ keratomileusis for myopia. J Cataract Refract Surg. 1999; 25:1344–8.

17. Galal A, Artola A, Belda J, et al. Interface corneal edema secondary to steroid-induced elevation of intraocular pressure aberrations diffuse lamellar keratitis. J Refract Surg. 2006; 22:441–7.

18. Weinreb RN, Polansky JR, Kramer SG, Baxter JD. Acute effects of dexamethasone on intraocular pressure in glaucoma. Invest Ophthalmol Vis Sci. 1985; 26:170–5.