Influence factors and clinical treatment of high intraocular pressure after LASEK / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the influence factors of high intraocular pressure after laser epithelial keratomileusis(LASEK), and to discuss the clinical treatment and prognosis of the high intraocular pressure patients. <p>METHODS: A retrospective study was used. From August 2013 to February 2016, 160 LASEK patients(160 eyes)in our hospital were selected. Visual acuity after operation was recorded. The incidence and influence factors of high intraocular pressure were investigated. The treatment method and prognosis of high intraocular pressure were recorded. <p>RESULTS: In the 160 patients, all patients had complete epithelial flap and different degree of photophobia. There were 19 patients with postoperative photophobia, conjunctival hyperemia and foreign body sensation significantly. At postoperative 3mo, average intraocular pressure were 18.40±4.98mmHg, which was higher than that of preoperative, 16.27±2.24mmHg(<i>P</i><0.05), and at postoperative 3mo, visual acuity was significantly higher than preoperative(<i>P</i><0.05). There were 9 patients with postoperative steroid induced ocular hypertension, the incidence rate was 5.6%; Multiple linear regression analysis showed that the cutting depth(<i>OR</i>=3.209), maximum diameter of curvature(<i>OR</i>=3.071)and fundus C/D(<i>OR</i>=9.224)value were the main risk factors leading to postoperative steroid induced ocular hypertension(<i>P</i><0.05). <p>CONCLUSION: The postoperative steroid induced ocular hypertension in LASEK is common, but has no obvious effect on visual acuity. The cutting depth, maximum diameter, curvature fundus C/D value were the main influencing factors, so we should careful use the hormone drugs in treatment and prevention. Periodic review and detection for change of intraocular pressure are needed.

Incidence of Steroid-Induced Ocular Hypertension Following Myopic Refractive Surgery

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.

Incidence of Steroid-Induced Ocular Hypertension Following Myopic Refractive Surgery

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.

The Effectiveness of Selective Laser Trabeculoplasty in Steroid-Induced Ocular Hypertension

PURPOSE: To report the effectiveness of selective laser trabeculoplasty (SLT) in patients with intraocular hypertension refractory to maximum tolerated medical therapy after intravitreal triamcinolone acetonide (IVTA). CASE SUMMARY: The records of 3 patients with steroid-induced intraocular hypertension that did not respond to maximum tolerated medical therapy were retrospectively reviewed. The patients received SLT instead of filtering surgery or Argon laser trabeculoplasty. The mean intraocular pressure (IOP) of 13.7 mm Hg increased to 30.7 mm Hg within 13 days of IVTA. IOP was uncontrolled despite maximum tolerated medical therapy. Patients underwent SLT 15.3 weeks after IVTA. Mean IOP decreased to 16 +/- 3.0 mm Hg after 1 day, 19.7 +/- 8.0 mm Hg after 1 week, 17 +/- 8.0 mm Hg after 1 month, 12.3 +/- 2.9 mm Hg after 3 months and 12.3 +/- 0.6 mm Hg after 4 to 6 months. The number of IOP lowering drugs were decreased to 1 from 4.3 after 6 months of SLT. CONCLUSIONS: SLT may be effective and safe for the treatment of steroid-induced intraocular hypertension refractory to maximum tolerated medical therapy.

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

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.