Transcript Risk factors of the steroid induced ocular hypertension

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
Purpose
Steroid 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
Retrospective
– 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
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 eyes
Age
26.0±6.1
M:F
82 : 143
Myopia
-4.7±1.8 D
Corneal thickness
538.5±28.3 μm
IOP
16.5±2.8mmHg
Results
• IOP change & myopia
r=-0.097
p=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=1.524
p=0.207
ANOVA comparison
Results
IIOP
Medication
22.2%
12%*
*5.6±3.4mmHg
from the adjusted baseline IOP
Myopia
IIOP
Medication
n
myopia ≥ -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
Medication
n
DLK
75%
50%
8
Regression
20.1%
17.6%
248
(%)
IIOP
mx
Results
Risk factors of IIOP
Patients
Operation
After op
p-value
Exp(B)
Age
0.462
0.980
Sex(F)
0.048*
0.514
Myopia
0.654
1.151
IOP
0.166
1.091
Corneal thickness
0.197
1.008
Op typea
0.995
Op zoneb
0.649
Ablation depth
0.670
0.989
IOP change
0.000*
1.995
DLK
0.227
0.305
Regression
0.574
0.721
M
F
18.9%
23.1%
a OP
type
PRK
Eximer
LASIK
LASEK
b Op
zone (mm)
6.0
6.0 with blending
6.5
custom
Results
Risk factors of medication
Patients
Operation
After op
p-value
Exp(B)
Age
0.179
0.960
Sex(F)
0.135
0.574
Myopia
0.551
1.223
IOP
0.001*
1.271
Corneal thickness
0.019*
1.015
Op typea
0.996
Op zoneb
0.699
Ablation depth
0.869
0.995
IOP change
0.000*
1.423
DLK
0.099
0.208
Regression
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
• IOP change and myopia
• Steroid induced IIOP
– 22.2%
– Independent from
myopia
– Possibility of wrong model
• IIOP
– Similar rates in variable
degree of myopia
– More medication in low
myopia
• More detection
• Risk factors of IIOP
– Female
• Risk factors
– Thick preoperative corneal
thickness and high IOP
• More medication – more
detection