Axial Length as a Risk Factor for Steroid-Induced Ocular Hypertension

Abstract

Purpose In this study, we aimed to assess whether axial length (AXL) is a true risk factor for steroid-induced ocular hypertension (OHT). We hypothesized that the proportion of patients with steroid-induced OHT among individuals who have received intravitreal dexamethasone (DEX) injections would differ according to the AXL of their eyes. Materials and Methods A single-center, cross-sectional, case-control study was conducted on 467 eyes that underwent DEX implant injection owing to various retinal diseases. Intraocular pressure (IOP) was measured before the injection and 1 week and 1, 2, 3, 6, and 12 months after the injection. Enrolled patients were divided into OHT and normal IOP groups. Univariable logistic regression analysis was used to calculate odds ratios of steroid-induced OHT with significant variables being analyzed using a multivariable model. Results A longer AXL was identified as a risk factor for steroid-induced OHT via both univariable and multivariable analyses, with an odds ratio of 1.216 [95% confidence interval (CI): 1.004–1.472, p =0.0452]. The optimal cut-off value for AXL in terms of steroid-induced OHT was 23.585 mm, with an odds ratio of 2.355 (95% CI: 1.429–3.882, p =0.0008). Conclusion Our findings indicate that a long AXL is a risk factor for steroid-induced OHT. Further, clinicians should be aware of steroid-induced OHT when treating patients with high myopia with steroids.

Association of trabecular meshwork height with steroid-induced ocular hypertension

“…TM is the core structure deeply implicated in the pathogenesis of glaucoma because of its widely accepted roles in IOP control by aqueous outflow pathway regulation 15 – 17 , 22 . Although the exact pathophysiology is unclear, evidence indicates that steroids induce molecular and ultrastructural changes by increasing the density of TM cells.…”

“…Efforts regarding these vision-threatening complications include the identification of risk factors of primary open angle glaucoma (POAG), a first-degree relative with a history of previous steroid-induced IOP elevation, type 1 diabetes mellitus, connective tissue disease, penetrating keratoplasty, high myopia, and younger age 14 – 17 .…”

New Concepts in Steroid Glaucoma

“…Several retrospective studies report an association of steroid-associated ocular hypertension with younger age and axial length [22,23]. There are likely many confounders and uncontrolled variables due to the retrospective nature of these studies, such as the nature of the underlying disease/ surgery, dosing versus body size, and ocular angle anatomy.…”