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A. Raj, E. Sykakis, M. S. Figueiredo, F. C. Figueiredo; Ocular Hypertensive Response to Topical Steroids After Corneal Transplantation. Invest. Ophthalmol. Vis. Sci. 2010;51(13):787.
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To determine the incidence, management and clinical outcomes of topical steroid induced rise in intraocular pressure (IOP) after corneal transplantation (CT)
This was a retrospective single-centre case review of a CT registry in a tertiary service (Royal Victoria Infirmary, Newcastle upon Tyne) in the UK between Feb 1997 and Nov 2009. Grafted eyes with raised IOP of >21 mmHg or ≥ 6 mmHg from preoperative normal level and on treatment with rimexolone 1% (Vexol®) or fluorometholone 0.1 %( FML®) instead of prednisolone acetate 1% (Pred Forte®) were analysed.
Ninety-six eyes from 568 corneal transplants were identified as steroid responders (16.9%). All eyes were operated by a single surgeon (FF) using standardized surgical technique and postoperative regimen. A total of 50 eyes of 47 patients were included for this analysis. The mean age was 60.5±21.1 years and the average follow up was 76.0±31.3 months. The main indications for corneal transplant were keratoconus (26%) and Fuch’s endothelial dystrophy (24%). Mean preoperative IOP was 15.5±3.6 mmHg. These eyes developed steroid response at 10.3±17.6 months after corneal transplantation. The mean rise in IOP was 12.7±5.8 mmHg (p<0.001, Wilcoxon signed-rank test). Prednisolone was changed to rimexolone in 41 eyes (82%) and to fluorometholone in 9 eyes (18%). Post-treatment, the mean IOP reduction was 11.9±6.9mmHg at 1.6±0.9 months. Initially 33 eyes (66%) needed anti-glaucoma treatment combined with topical steroid replacement; 25 eyes (50%) were still using anti-glaucoma treatment at the last visit. IOP reduction was much more significant when the anti-glaucoma agents were used in combination with rimexolone as compared to fluorometholone (P=0.021). Eight grafts (16%) had one or more rejection episodes at 7.2±3.3 months after switching steroid treatment, compared with 94 grafts for the entire series of 568 cases (16.5%).
The incidence of postkeratoplasty steroid response in our series is smaller than published literature. Despite steroid replacement, 50% still requires long-term anti-glaucoma treatment; however, it did not alter overall graft rejection rate. Rimexolone appears to be less hypertensive than fluorometholone.
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