Corneal topographic response to intraocular pressure reduction in patients with vernal keratoconjunctivitis and steroid-induced glaucoma

Abstract

Purpose: To study the corneal topographic response to IOP reduction in vernal keratoconjunctivitis (VKC) with steroidinduced glaucoma. Methods: A total of 42 eyes of 21 patients with VKC and steroid-induced glaucoma (Group I) and 66 eyes of 33 patients with VKC without glaucoma (Group II) underwent an evaluation by Orbscan topography. In eyes with glaucoma, the IOP was controlled medically and the corneal topography was repeated at 3 months to evaluate effect on corneal parameters. Results: The mean baseline IOP was 36.40713.08 mmHg in Group I, 14.6774.62 mmHg in Group II (Po0.0001). The IOP after treatment at 3 months follow-up was 15.0075.41 mmHg in Group I (Po0.0001). In Group I, the mean maximum Sim K decreased from 44.8673.21 D to 43.8772.62 D (P ¼ 0.031) and mean posterior corneal elevation decreased from 64.9722.36 lm to 35.7728.91 lm at 3 months after reduction of IOP (P ¼ 0.001). There was a significant positive correlation between the reduction in the IOP and the decrease in the posterior corneal elevation (r ¼ 0.664, P ¼ 0.001). Conclusion: Eyes with VKC with and without glaucoma have similar corneal topography. Increased IOP associated with steroid-induced glaucoma and VKC may contribute to an increase in the corneal curvature and posterior corneal elevation. These changes may be reversed by a reduction in the IOP with medical therapy.

Topical Cyclosporine A 0.05% Eyedrops in the Treatment of Vernal Keratoconjunctivitis – Randomized Placebo-Controlled Trial

“…Steroids can be highly effective, but there are risks of glaucoma, superinfection with viruses and bacteria due to local immunosuppression, delayed wound healing, and cataract induction warrant cautious use of topical steroids [17][18][19][20][21][22][23][24]. Therefore, non-steroidal medications are desirable for the treatment of VKC as alternative, but new topical agents with dual antiallergic activity (mast cell stabilizers and antihistamine) may also be used for long-term treatment of allergic inflammation to alleviate signs and symptoms of the disease [21,25,26].…”

Orbscan Topography in Primary Open-Angle Glaucoma

“…These differences in corneal topography between glaucomatous and CCT-matched healthy subjects and the significant correlation between the IOP level and the posterior corneal elevation we found in the POAG group suggest that they are somehow related to the glaucomatous disease. 25 Reports of transient keratectasia with evident posterior corneal surface elevation after episodes of acute IOP elevation have suggested that high IOP could compress fluid out of the corneal stroma, 12 causing an inverse relationship between the IOP and corneal thickness. We do not know exactly the reason for the increased elevation of the posterior corneal surface in our patients with POAG.…”

“…6 The importance of the CCT in patients with glaucoma seems to depend not only on its effect as a source of error in IOP measurement 7 but also because it seems to be a significant risk factor, independent of IOP, for the development of glaucomatous damage in patients with OHT and for POAG in the general population. 11 Using the Orbscan II, Dada et al 12 found a significant decrease in the posterior corneal elevation after lowering the IOP in eyes with steroid-induced glaucoma; but to the best of our knowledge, no previous study has analyzed the anterior and posterior corneal curvatures of POAG patients using this device. 9 Ultrasound-based devices are the most widely used for measuring the corneal thickness 10 ; however, this technology offers limited information about the overall corneal morphology.…”

Clinical grading of vernal keratoconjunctivitis

“…Topical steroids have been shown to be effective in controlling ocular surface inflammation in VKC, but they should be used with particular caution due to their ocular side effects including glaucoma and cataract formation [2,4,[9][10][11][12][13]. As alternative, new topical agents with dual antiallergic activity (mast cell stabilizers and antihistamine) may be used for long-term treatment of allergic inflammation, to alleviate signs and symptoms of the disease [4,12,[14][15][16][17][18][19][20].…”