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

Kyoung Min Lee; Mee Kum Kim; Won Ryang Wee; Jin Hak Lee

doi:10.3341/jkos.2010.51.10.1333

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Lee, Kim, Wee, and Lee: Risk Factors of the Steroid Induced Ocular Hypertension After Corneal Refractive Surgery

Original Article

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

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.10.1333

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

Kyoung Min Lee, MD¹, Mee Kum Kim, MD^1,², Won Ryang Wee, MD^1,², Jin Hak Lee, MD^1,³

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

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

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

Address reprint requests to Mee Kum Kim, MD Department of Ophthalmology, Seoul National University Hospital #28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea Tel: 82-2-2072-2437, Fax: 82-2-741-3187, Email: kmk9@snu.ac.kr

Received 19 May 2010 Accepted 10 June 2010

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 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.

Keywords: Myopia, Refractive surgery, Steroid induced ocular hypertension

References

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Table 2.

Risk factors of IIOP^*

		p-value	Exp (B)^§
Patients	Age (yr)	0.059	0.962
	Sex (F)	0.021	1.773
	Myopia	0.276	1.075
	IOP	0.000	0.842
	Corneal thickness	0.008	1.012
Operation	Type^†	0.822	
Complicatio	n DLK^‡	0.982	0.990
	Myopic regression	0.204	3.089

^* IIOP=increased intraocular pressure which was defined by the increased intraocular pressure above 130% of predicted postoperative baseline intraocular pressure or eyes need the anti-glaucoma medication

^† Type=Excimer laser, Laser in-situ Keratomileusis, Laser Epithelial Keratomileusis

^‡ DLK=Diffuse lamellar keratitis

^§ Exp (B): odds ratio.

Table 1.

Changes in of intraocular pressure according to myopia

Degree of refravtive error	IOP change^*	IIOP^†	Medication^‡	Eyes
Myopia ≥ −3D	0.67 ± 3.33	24.7%	17.6%	85
−3 > Myopia ≥ −6D	1.03 ± 3.30	21.0%	10.1%	248
−6 > Myopia ≥ −8D	1.62 ± 2.85	22.2%	12.1%	99
−8 D > Myopia	1.51 ± 2.96	27.8%	11.1%	18

^* Although, there was a tendency that higher myopia correlated with more increase in intraocular pressure, that difference was none of significance (F=1.524, p=0.207, ANOVA comparison)

^† IIOP=increased intraocular pressure, this column means the proportion of the increased intraocular pressure above 130% of predicted postoperative baseline intraocular pressure or eyes need the anti-glaucoma medication

^‡ Medication means the proportion of eyes needed the anti-glaucoma medication.

Table 3.

Risk factors of medication^*

		p-value	Exp (B)^§
Patients	Age (yr)	0.193	0.965
	Sex (F)	0.223	1.504
	Myopia	0.069	1.172
	IOP	0.466	1.043
	Corneal thickness	0.014	1.014
Operation	Type^†	0.923	
Complication	DLK^‡	0.051	0.373
	Myopic regression	0.351	2.287

^* Medication means the proportion of eyes needed the anti-glaucoma medication

^† Type=Excimer laser, Laser in-situ Keratomileusis, Laser Epithelial Keratomileusis

^‡ DLK= Diffuse lamellar keratitis

^§ Exp (B): odds ratio.

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