risk factors of the steroid induced ocular hypertension after corneal refractive surgery
DESCRIPTION
Risk factors of the steroid induced ocular hypertension after corneal refractive surgery. Kyoung Min Lee, MD 1,2 , Won Ryang Wee 1,2 , Jin Hak Lee 1,3 , Mee Kum Kim, MD 1,2 1 Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea - PowerPoint PPT PresentationTRANSCRIPT
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