Incidence of Steroid-Induced Ocular Hypertension Following Myopic Refractive Surgery

Sang Myung Kim; Hyoung Won Bae; Sung Yong Kang; Sa Min Hong; Gong Je Seong; Chan Yun Kim

doi:10.3341/jkos.2015.56.7.1081

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Kim, Bae, Kang, Hong, Seong, and Kim: Incidence of Steroid-Induced Ocular Hypertension Following Myopic Refractive Surgery

Original Article

J Korean Ophthalmol Soc 2015;56(7):1081-1088.

Published online: 27 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.7.1081

Incidence of Steroid-Induced Ocular Hypertension Following Myopic Refractive Surgery

Sang Myung Kim, M.D¹, Hyoung Won Bae, M.D¹, Sung Yong Kang, M.D², Sa Min Hong, M.D, PhD¹, Gong Je Seong, M.D, PhD¹, Chan Yun Kim, M.D, PhD^1,

The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

Eyereum Eye Clinic, Seoul, Korea

Address reprint requests to Chan Yun Kim, MD, PhD Department of Ophthalmology, Severance Hospital, #50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea Tel: 82-2-2228-3570, Fax: 82-2-312-0541 E-mail: kcyeye@yuhs.ac

Received 8 November 201422 January 2015 Accepted 20 May 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 determine the incidence of steroid-induced ocular hypertension following myopic vision correction.

Methods:

This study retrospectively reviewed the medical records of 6,087 patients (12,164 eyes) who underwent myopic re-fractive surgery (laser-assisted in-situ keratomileusis [LASIK]/ photorefractive keratectomy [PRK]/phakic intraocular lens [IOL] implantation) at Eyereum Eye Clinic between July 2011 and February 2013. Ocular hypertension was defined when post-operative intraocular pressure (IOP) was increased more than 30% compared to predicted IOP adjusted according to corneal thickness. All preoperative IOPs were measured using Goldmann applanation tonometer (GAT). Postoperative IOPs were measured using non-contact tonometer first and with GAT when the IOP was suspiciously increased.

Results:

Steroid-induced ocular hypertension after a myopic refractive surgery occurred in 680 eyes (5.58%) of 404 patients (6.64%). The incidence based on surgery was LASIK (0.06%, 2/3, 514 eyes) followed by PRK (7.63%, 575/7,533 eyes) and phakic IOL implantation (9.2%, 103/1,117 eyes). The average increased IOP level in patients with steroid-induced ocular hyper-tension was 5.62 ± 3.73 mm Hg after PRK and 9.35 ± 4.95 mm Hg after phakic IOL implantation. A statistically significantly higher change in IOP was observed in the phakic IOL group ( p < 0.001). However, the PRK group had a longer treatment period for ocu-lar hypertension and used more antiglaucoma medications than the phakic IOL group ( p < 0.05). Most patients with ocular hyper-tension were successfully treated with cessation of topical steroid or use of antiglaucoma medications. Only 2 eyes required glaucoma surgery because IOP was not controlled.

Conclusions:

IOP measurements should be initiated no later than 1 week after surgery because steroid-induced ocular hyper-tension following myopic refractive surgery can occur in approximately 5.58% of patients and most cases of ocular hypertension can be controlled with careful follow-up and use of antiglaucoma medications.

Keywords: Myopic refractive surgery, Steroid induced ocular hypertension

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Figure 1.

Management of the steroid induced ocular hyper-tension after myopic refractive surgery. IOP = intraocular pressure.

Figure 2.

The incidence of the steroid-induced ocular hypertension in each group after myopic refractive surgery between July 2011 and February 2013. LASIK = laser-assisted in-situ keratomileusis; PRK = photorefractive keratectomy; IOL = intraocular lens.

Table 1.

Baseline characteristics in non-steroid responder vs. steroid responder after myopic refractive surgery

Total (n = 12,164)	Non responder (n = 11,485)	Responder (n = 680)	p-value
Age (years)	26.43 ± 4.79	27.88 ± 4.91	0.713^∗
Gender (female, %)	6,202 (54.0)	316 (46.5)	0.641^†
SE (diopter)	-4.98 ± 2.40	-9.12 ± 2.12	<0.001^∗
Sim K1 (diopter)	43.01 ± 1.74	42.87 ± 1.80	0.825^∗
Sim K2 (diopter)	44.21 ± 1.50	44.19 ± 1.76	0.863^∗
CCT (μ m)	542.67 ± 29	541.76 ± 32	0.742^∗

Values are presented as mean ± SD or n (%).

SE = spherical equivalent; Sim K = simulated keratometry; CCT = central corneal thickness.

^∗ Independent t-test;

^† Pearson’s chi-square test.

Table 2.

Baseline characteristics in non-steroid responder vs. steroid responder after photorefractive keratectomy or phakic intra-ocular lens implantation

	PRK (n = 7,533)			Phakic IOL (n = 1,117)
	Non responder	Responder	p-value	Non responder	Responder	p-value
No. of eyes	6,958	575	1,014	103
Age (years)	26.25 ± 4.73	26.87 ± 4.97	0.832^∗	27.72 ± 5.11	27.88 ± 5.69	0.741^∗
Gender (female, %)	3,068 (44.1)	259 (45.0)	0.662^†	766 (75.5)	57 (55.3)	<0.001^†
SE (diopter)	-4.40 ± 3.40	-4.88 ± 2.12	0.622^∗	-8.06 ± 4.12	-9.12 ± 5.40	0.036^∗
CCT (μ m)	545.67 ± 29	537.76 ± 32	0.742^∗	521.30 ± 39	522.44 ± 36	0.981^∗

Values are presented as mean ± SD or n (%).

PRK = photorefractive keratectomy; Phakic IOL = phakic intraocular lens, including ICL®, Artiflex®, Toric Artiflex®, Veriflex®, and Artisan®; No.= number; SE= spherical equivalent; CCT= central corneal thickness.

^∗ Independent t-test;

^† Pearson’s chi-square test.

Table 3.

Duration and number of medications required for IOP control and average IOP rise in steroid responders for each surgical groups

	PRK (n = 575)	Phakic IOL (n = 103)	p-value
Duration of glaucoma medications (days)	70.40 ± 49.06	31.35 ± 21.11	<0.001^∗
No. of glaucoma medications	1.90 ± 0.81	1.70 ± 0.73	0.020^∗
Average IOP rise (mm Hg)	5.62 ± 3.73	9.35 ± 4.95	<0.001^∗

Values are presented as mean ± SD or n (%).

IOP = intraocular pressure; PRK = photorefractive keratectomy; Phakic IOL = phakic intraocular lens, including ICL®, Artiflex®, Toric Artiflex®, Veriflex®, and Artisan®; No. = number.

^∗ Independent t-test.

Table 4.

Characteristics of patient with steroid induced ocular hypertension undergoing femtosecond LASIK

Pt	Gender	Eyes	Preop SE (D)	Preop CCT (μ m)	Postop CCT (μ m)	IOP change^∗(mm Hg)	Meds (n)	Duration of Meds (days)
1	female	OD	-4.12	563	410	7.46	1	25
		OS	-4.19	571	442	8.03	1	25

LASIK = laser-assisted in-situ keratomileusis; Pt = patient; Preop = preoperation; SE = spherical equivalent; D = diopter; CCT = central corneal thickness; Postop = postoperation; IOP = intraocular pressure; Meds = anti-glaucoma medications; OD = oculus dexter; OS = oculus sinister.

^∗ Post-operative IOP-predicted postoperative baseline IOP.

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