J Korean Ophthalmol Soc.  2015 Jul;56(7):1081-1088. 10.3341/jkos.2015.56.7.1081.

Incidence of Steroid-Induced Ocular Hypertension Following Myopic Refractive Surgery

• Kim SM
• Bae HW
• Kang SY
• Hong SM
• Seong GJ
• Kim CY

• KMID: 2148809
• DOI: http://doi.org/10.3341/jkos.2015.56.7.1081

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 refractive 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 hypertension 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 ocular hypertension and used more antiglaucoma medications than the phakic IOL group (p < 0.05). Most patients with ocular hypertension 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 hypertension 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.

Keyword

Myopic refractive surgery; Steroid induced ocular hypertension

MeSH Terms

Glaucoma
Humans
Incidence*
Intraocular Pressure
Keratomileusis, Laser In Situ
Lenses, Intraocular
Medical Records
Ocular Hypertension*
Refractive Surgical Procedures*
Retrospective Studies

Figure

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  Figure 1. Management of the steroid induced ocular hyper-tension after myopic refractive surgery. IOP = intraocular pressure.

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  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.

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