JKOS Journal of the Korean Ophthalmological Society J Korean Ophthalmol Soc 0378-6471 2092-9374 The Korean Society for Quality Management 10.3341/jkos.2015.56.7.985 jkos-56-985 Original Article The Incidence of Increased Intraocular Pressure when Using 0.1% Fluorometholone after Photorefractive Keratectomy KimWook Kyum M.D ChoEun Young M.D KimHee Sun M.D KimJin Kuk M.D B&Viit Eye Center, Seoul, Korea ￭ Address reprint requests to Jin Kuk Kim, MD B&Viit Eye Center, #3 Seocho-daero 77-gil, Seocho-gu, Seoul 137-856, Korea Tel: 82-2-501-6800, Fax: 82-2-501-6435 E-mail: bestjinkuk@gmail.com

∗ This study was presented as an e-poster at the 113th Annual Meeting of the Korean Ophthalmological Society 2015.

 08 2015 28 8 2015 56 7 985 991 14 11 2014 16 02 2015 26 05 2015 Copyright © 2015 Korean Ophthalmological Society 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose:

To analyze the time and incidence of increased intraocular pressure (IOP) induced by 0.1% fluorometholone used to prevent corneal haze after photorefractive keratectomy (PRK).

 Methods:

The present study included 826 patients (826 eyes) who underwent PRK between November 2012 and October 2013 and were followed up for more than 6 months. After surgery the patients were treated with 0.1% fluorometholone for 3-6 months according to their corneal conditions. The time and incidence was analyzed with the time and incidence when anti-glaucoma eye drops were used.

 Results:

Anti-glaucoma eye drops were used in 312 eyes (38%). The anti-glaucoma eye drops were started before 4 weeks postoperatively in 105 eyes (13%) and postoperatively at 5-8 weeks in 86 eyes (10%), at 9-12 weeks in 83 eyes (10%), at 13-16 weeks in 25 eyes (3%) and after 17 weeks in 13 eyes (2%).

 Conclusions:

The overall incidence of increased IOP when treated with 0.1% fluorometholone for 3-6 months after PRK was ap-proximately 38%. The incidence of increased IOP in each month for the first 3 months was almost identical implying that the lon-ger 0.1 fluorometholone was used, the higher incidence of increased IOP occurred. These results can be helpful in educating pa-tients regarding the risk of increased IOP and determining the follow-up period after PRK.

 Fluorometholone Intraocular pressure LASEK Photorefractive keratectomy Steroid-induced glaucoma References O'BrartDPShalchiZMcDonaldRJ Twenty-year follow-up of a randomized prospective clinical trial of excimer laser photo-refractive keratectomy Am J Ophthalmol 201415865163 YukselNBilgihanKHondurAM Long term results of Epi-LASIK and LASEK for myopia Cont Lens Anterior Eye 2014371325 SiaRKRyanDSEdwardsJD The US. army surface abla-tion study: comparison of PRK, MMC-PRK, and LASEK in mod-erate to high myopia J Refract Surg 20143025664 HofmeisterEMBishopFMKauppSESchallhornSCRandomized dose-response analysis of mitomycin-C to prevent haze after photorefractive keratectomy for high myopia J Cataract Refract Surg 201339135865 CorbettMCO'BrartDPWarburtonFGMarshallJBiologic and environmental risk factors for regression after photorefractive keratectomy Ophthalmology 1996103138191 BaekSHChoiSYChangJH Short-term effects of flurbipro-fen and diclofenac on refractive outcome and corneal haze after photorefractive keratectomy J Cataract Refract Surg 199723 131723 KimSIOhTHEffects of topical tranilast on corneal haze with the Pentacam(R) after photorefractive keratectomy J Korean Ophthalmol Soc 201455127783 DengYWnagLLiuCCaiREffects of Dexamethasone, Fluorometholone and Florex on intraocular pressure after photo-refractive keratectomy Hua Xi Yi Ke Da Xue Xue Bao 199930 2057 VetrugnoMQuarantaGMMainoACardiaLA, comparative study of fluorometholone 0.2% and fluorometholone 0.1% acetate after photorefractive keratectomy Eur J Ophthalmol 2000103945 MachatJJDouble-blind corticosteroid trial in identical twins fol-lowing photorefractive keratectomy Refract Corneal Surg 19939(2 Suppl)S1057 LevyYHefetzLZadokD Refractory intraocular pressure increase after photorefractive keratectomy J Cataract Refract Surg 1997235934 YamaguchiTMuratDKimuraI Diagnosis of steroid-in-duced glaucoma after photorefractive keratectomy J Refract Surg 2008244135 MoralesJGoodDPermanent glaucomatous visual loss after pho-torefractive keratectomy J Cataract Refract Surg 1998247158 RazeghinejadMRKatzLJSteroid-induced iatrogenic glaucoma Ophthalmic Res 2012476680 MorrisonEArcherDBEffect of fluorometholone (FML) on the intraocular pressure of corticosteroid responders Br J Ophthalmol 1984685814 JavadiMAMirbabaei-GhafghaziFMirzadeM Steroid in duced ocular hypertension following myopic photorefractive keratectomy J Ophthalmic Vis Res 20083426 LeeKMKimMKWeeWRLeeJHRisk factors of the steroid in-duced ocular hypertension after corneal refractive surgery J Korean Ophthalmol Soc 20105113337 HashemiHMiraftabMAsgariSComparison of the visual out-comes between PRK-MMC and phakic IOL implantation in high myopic patients Eye (Lond) 20142811138 KangHChoeCMChoiTHKimSKComparison of clinical re-sults between transepithelial photorefractive keratectomy and brush photorefractive keratectomy J Korean Ophthalmol Soc 201455128490 KuoICLeeSMHwangDGLate-onset corneal haze and myopic regression after photorefractive keratectomy (PRK) Cornea 2004233505 KimWKChoEYKimHS Analysis of postoperative intra-ocular pressure underestimation measured with non contact ton-ometry after corneal refractive surgery J Korean Ophthalmol Soc 20145516772 NagyZZSzabóAKruegerRRSüvegesITreatment of intra-ocular pressure elevation after photorefractive keratectomy J Cataract Refract Surg 200127101824 ParkHSChoiCYBaeJHKimJMThe effect of fixed combina-tion of brinzolamide 1% and timolol 0.5% in normal-tension glaucoma J Korean Ophthalmol Soc 201455105663 JangSRLeeMVAhnJHComparison of dorzolamide-timolol fixed combination and latanoprost, effects on intraocular pressure and ocular pulse amplitude J Korean Ophthalmol Soc 2014558549 PleyerUUrsellPGRamaP Intraocular pressure effects of com-mon topical steroids for post-cataract inflammation: are they all the same? Ophthalmol Ther 201325572 Figures and Tables

The graph shows the time when the patients started to use anti glaucoma medication during 0.1% fluorometholone treatment after photorefractive keratectomy.

General characteristics of 826 eyes of 826 patients who received photorefractive keratectomy

Characteristics Values
Age at operation (years) 28.6 ± 5.0
Male:female (No. of patients) 251:575
Preoperative myopia (diopters) -4.27 ± 1.81
Preoperative astigmatism (diopters) -1.04 ± 0.76
Preoperative BCVA (log MAR) -0.02 ± 0.04
Preoperative IOP (mm Hg) 14.87 ± 2.70
Preoperative central cornea thickness (μ m) 526.8 ± 29.2
Postoperative UCVA (log MAR) -0.09 ± 0.03
Postoperative IOP (mm Hg) 10.4 ± 2.0

Values are presented as mean ± SD.

BCVA = best corrected visual acuity; IOP = intraocular pressure; UCVA = uncorrected visual acuity.

The analysis of the time when the anti-glaucoma medication started to use for lowering intraocular pressure

Time - 4 weeks 5-8 weeks 9-12 weeks 13-16 weeks 17-20 weeks 20-24 weeks Total
Number of patients 105 (13) 86 (10) 83 (10) 25 (3) 10 (1) 3 (0) 312 (38)
Accumulative number of patients 105 (13) 191 (23) 274 (33) 299 (36) 309 (37) 312 (38) 312 (38)

The increased intraocular pressure was induced by 0.1% fluorometholone after photorefractive keratectomy. Values are presented as n (%).

The comparison of IOP increased group and IOP normal group after LASEK

IOP increased (312 eyes) IOP normal (514 eyes) p-value∗
Age at operation (years) 28.1 ± 4.9 28.9 ± 5.0 0.58
Preoperative myopia (diopters) -4.71 ± 1.84 -3.99 ± 1.75 0.31
Preoperative astigmatism (diopters) -0.98 ± 0.84 -0.83 ± 0.76 0.06
Ablation depth (μ m) 81.2 ± 22.3 71.7 ± 22.8 0.66
Preoperative central cornea thickness (μ m) 525.8 ± 29.2 527.4 ± 29.3 0.98
Residual corneal thickness (μ m) 444.5 ± 35.0 455.5 ± 34.9 0.96
Preoperative IOP (mm Hg) 15.2 ± 2.8 14.7 ± 2.6 0.23
Preoperative pupil size (mm) 6.7 ± 0.7 6.7 ± 0.7 0.92
Preoperative white to white (mm) 11.7 ± 0.4 11.7 ± 0.4 0.94
Preoperative visual acuity (log MAR) -0.12 ± 0.04 -0.02 ± 0.04 0.61
Postoperative visual acuity (log MAR) -0.09 ± 0.04 -0.09 ± 0.03 0.85
Duration of usage of fluorometholone (weeks) 19.2 ± 3.8 17.7 ± 3.7 0.54

The patients in IOP increased group need to use anti g IOP = intraocular pressure; LASEK = laser-assisted

Student’s t-test was done.

The analysis of durations for while the anti-glaucoma medication was used to lower the intraocular pressure elevated by 0.1% fluorometholone

- 4 weeks 5-8 weeks 9-12 weeks 13-16 weeks 17-20 weeks >21 weeks Total
No. of patients 41 (13) 73 (23) 89 (29) 75 (24) 30 (10) 4 (1) 312 (100)

Values are presented as n (%).

The analysis about which anti-glaucoma eye drops were used initially and to which the initial eye drops changed if it hap-pened

Anti-glaucoma eye drops Number of patients
Timolol 0.5% only 82 (26)
DTFC/BTFC∗ only 196 (63)
Timolol 0.5% →† DTFC/BTFC 26 (8)
DTFC/BTFC → DTFC/BTFC + Brimonidine 0.15% 5 (2)
DTFC/BTFC + Brimonidine 0.15% → DTFC/BTFC or Brimonidine 0.15% 2 (1)
DTFC/BTFC → Timoptic XE 1 (0)

Values are presented as n (%).

DTFC = dorzolamide-timolol fixed combination; BTFC = brinzolamide-timolol fixed combination.

One of DTFC or BTFC;

‘→’ means initial anti-glaucoma eye drops changed during treatment.