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Dai Miyazaki, Atsuki Fukushima, Yuichi Ohashi, Eiichi Uchio, Naoki Kumagai, Jun Shoji, Etsuko Takamura, Yayoi Nakagawa, Kenichi Namba, Hiroshi Fujishima; Clinical features associated with steroid-induced ocular hypertensive response in eyes with refractory allergic ocular diseases with proliferative lesions or corneal involvement. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4884.
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© ARVO (1962-2015); The Authors (2016-present)
To identify clinical factors significantly associated with steroid-induced ocular hypertension in refractory allergic ocular diseases with proliferative lesion or corneal involvement.
The 1436 refractory allergic ocular disease patients enrolled for topical tacrolimus treatment trial were retrospectively analyzed. Of the 1436 eyes treated with topical tacrolimus, 410 patients necessitated with topical steroids in conjunction during the 3 months follow up, were analyzed.<br /> The baseline intraocular pressures (IOP) were measured, and the clinical signs were rated on a 4 grade scale. The change in the IOP (ΔIOP) during the follow up were calculated by subtracting the base line from the maximum IOP. Patients responded with ≥ third quartile of IOP change was defined as steroid-induced hypertensive.
The mean ΔIOP was 0.72 ± 0.17 mmHg (median, 0 mmHg; third quartile, 3 mmHg). The incidence of giant papillae was significantly higher for patients who had steroid-induced hypertension (P=0.0007). The IOP elevation was inversely correlated with age (ρ=-0.142, P<0.005), and the incidence of IOP elevation was significantly higher in patients without eczema (P<0.05). Logistic analysis on the ocular hypertensive responders showed that eyes with giant papillae had a significant high OR of 3.43 for the maximum score after age adjustments (95% confidence interval, 1.57-7.49; P=0.002). The area under the receiver operating characteristic curve for prediction of ocular hypertensive response was 0.60, 0.54, and 0.56 for giant papilla, younger age (≤median), and eyes without eczema, respectively.
Refractory allergic eyes with giant papillae, without eczema, and younger age were significantly associated with positive ocular hypertensive response. These findings may help to predict eyes that will have steroid-induced hypertension.
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