The Incidence of Increased Intraocular Pressure when Using 0.1% Fluorometholone after Photorefractive Keratectomy

Wook Kyum Kim; Eun Young Cho; Hee Sun Kim; Jin Kuk Kim

doi:10.3341/jkos.2015.56.7.985

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Kim, Cho, Kim, and Kim: The Incidence of Increased Intraocular Pressure when Using 0.1% Fluorometholone after Photorefractive Keratectomy

Original Article

J Korean Ophthalmol Soc 2015;56(7):985-991.

Published online: 28 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.7.985

The Incidence of Increased Intraocular Pressure when Using 0.1% Fluorometholone after Photorefractive Keratectomy

Wook Kyum Kim, M.D, Eun Young Cho, M.D, Hee Sun Kim, M.D, Jin Kuk Kim, 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.

Received 14 November 201416 February 2015 Accepted 26 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 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.

Keywords: Fluorometholone, Intraocular pressure, LASEK, Photorefractive keratectomy, Steroid-induced glaucoma

References

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Figure 1.

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

Table 1.

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.

Table 2.

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 (%).

Table 3.

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.

Table 4.

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 (%).

Table 5.

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.

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