Purchase this article with an account.
M.E. Ivanova, E.N. Eskina, V.A. Bondar, A.P. Budnik; Steroid–Induced Glaucoma After Excimer–Laser Surgery as a Model of POAG . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1846.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
The number of patients receiving excimer–laser operations increases daily. Steroid drugs are used postoperatively as anti–inflammatory agents and collagen synthesis inhibitors for the stability of refractive result, especially after PRK, which is performed more often last years. However, steroid drawbacks include initiation of proteins' expression, such as myocilin, which decreases aqueous humor outflow facility. Consequently, intraocular pressure (IOP) increases. In the majority of cases it is possible to return IOP to normal level by dropping steroid usage, but there are patients with elevated IOP despite of the treatment. Purpose of our study was to reveal risk factors for steroid–associated glaucoma in post–operative period following excimer–laser surgery.
We performed a retrospective analysis of 1500 histories of postoperative period of patients received PRK surgery due to different refractive error. All patients were administered with 0.1% dexamethasone solution which they applied topically for as long as 3,5 months after surgery. Follow–up period varied between 6 to 18 months. Diagnostic criteria were based on changes in IOP, ocular hydrodynamics, and trabecular meshwork, followed with tonography and gonioscopy.
Po increased in all patients by 32±16% (ranging from 2 to 75%) 1 month postoperatively. Three patients developed steroid–associated glaucoma from 1 to 3 months postop. Tonography carried out in those patients showed elevation of Po in all cases up to 58±15% on average and decrease of aqueous humor outflow facility by 3.07±0.59 times on average after one month of steroid treatment. Gonioscopy was unremarkable. Consequently, two of the three glaucoma developed patients had to be performed non–penetrating sclerectomy and the third one was administered with continuous topical eye pressure–controlling drug therapy.
We suppose that high frequency and level of IOP elevating is due to higher permeability of cornea after excimer–laser treatment. It’s appropriate to use low penetrating drugs postoperatively. Also we propose that the development of steroid–associated glaucoma in postoperative period following PRK surgery in three patients might be an indirect sign of possible myocilin gene mutation. We trust it would be appropriate to work out preoperative diagnostic genotyping methods for detection of myocilin gene mutation. Topical steroids could be used to create a model of myocilin glaucoma, which possibly might be proposed in future as independent class of glaucoma.
This PDF is available to Subscribers Only