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Asako Okamura, Kenji Suda, Tadamichi Akagi, Takanori Kameda, Hanako Ohashi Ikeda, Masahiro Miyake, tomoko hasegawa, Eri Nakano, Yoko Okamoto, Naohiro Motozawa, Akitaka Tsujikawa; Clinical characteristics of eyes with steroid-induced glaucoma requiring surgery. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3744. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To identify clinical characteristics of eyes with steroid-induced glaucoma that required surgery.
The clinical charts of 382 eyes of 196 subjects with steroid use who visited the glaucoma clinic of the Kyoto University Hospital from August 2011 to October 2017 were retrospectively reviewed for history of glaucoma surgery. Cases were evaluated for operative method, reason for steroid use, age at time of first surgery, and timing and type of reoperative surgery if needed. Comparisons of the outcomes between the atopic dermatitis and other diseases were analyzed by the Kaplan-Meier survival curve and the log-rank test. Surgical failure was defined by the need for additional glaucoma surgery.
Surgical intervention was required for 87 eyes of 56 subjects. The most common reason for steroid use was atopic dermatitis (23 eyes). The average age at first surgery was 50.3 ± 4.4 years. The operative method most frequently used in the first surgery was trabeculotomy (77 eyes of 50 subjects; 88.5%) followed by trabeculectomy (9 eyes of 8 subjects; 10.3%) and glaucoma implant surgery(1 eye 1 subject; 1.1%). The rate at which surgery was required was significantly higher for cases of atopic dermatitis (38.3%) than for cases of other diseases (19.9%; p = 0.004, Fisher's exact test). Re-operative surgery was required for 20 eyes: 12 underwent trabeculotomy, 6 underwent trabeculectomy and 2 underwent glaucoma implant surgery. No significant differences were noted in reoperation rates between cases of atopic dermatitis and those of other diseases (p = 0.77). Survival analyses revealed significant differences between cases with atopic dermatitis and those with other diseases in 5-year reoperation rates (p = 0.04, log-rank test) but not in 10-year reoperation rates (p = 0.24, log-rank test).
Eyes with atopic dermatitis had higher operation rates and reoperation rates in 5 years. These results may suggest that atopic glaucoma is a different clinical entity from steroid glaucoma. Glaucoma surgery is performed more frequently for cases of atopic dermatitis, and careful observation of such cases is necessary.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Kaplan-Meier survival curves of surgical outcomes of subjects with atopic dermatitis vs those of subjects with other diseases.
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