Corticosteroid-induced intraocular pressure elevation in keratoconus is common following uncomplicated penetrating keratoplasty

Abstract

Aims To determine the incidence of postkeratoplasty intraocular pressure (IOP) elevation in the eyes of subjects with keratoconus and establish the relationship between IOP and corticosteroid administrations in this population. Methods Following strict inclusion/exclusion criteria, a retrospective analysis was performed on a consecutive series of penetrating keratoplasties performed for keratoconus observing a standardised surgical and postoperative regimen in Auckland, New Zealand. Patient demographics, ocular, medical, and family history, and pre-and postoperative data were recorded until 12 months postkeratoplasty. Results In all, 57 eyes of 48 patients were includedF31% New Zealand Europeans, 42% Pacific people, 15% Maori, and 12% other. Eighteen eyes (32%) of 17 patients (35%) exhibited elevated IOP and 12 (21%) eyes exhibited moderate-to-severe elevation of IOP. IOP elevation occurred 3-6 months postkeratoplasty in 78% of eyes. Elevated IOP was significantly less common in Maori and Pacific peoples (P ¼ 0.02). All eyes except one required reduction/cessation of corticosteroids to normalise IOP. Conclusions The incidence of presumed steroid-related postkeratoplasty IOP elevation, in 35% of subjects with keratoconus, is markedly higher in this New Zealand study than previously reported in the US and UK studies. Further clinical and genetic analysis of associations between keratoconus and steroid-induced IOP elevation and glaucoma might improve our current understanding of this condition.

Bilateral Juvenile Onset Primary Open-Angle Glaucoma Among Keratoconus Patients

“…Normal tension glaucoma, however, has been reported among adult patients with keratoconus. 11 In conclusion this case series points toward the need of the awareness of coexistence of keratoconus with JOAG. Increased IOP may be associated with progression of keratoconus especially in young patients.…”

Corneal Transplantation and Glaucoma

“…[70][71][72][73] Management Determination of corticosteroid dosing may be equally important to medical and surgical treatment of OHTN. Although the reported incidence of steroidinduced OHTN varies significantly from 10-35%, 74,75 the steroid response may be difficult to distinguish from other risk factors for OHTN post-PK. Erdurmus et al found steroid-induced OHTN post-PK with higher incidences of 73% and 60.3% in patients with keratoconus and Fuchs dystrophy, respectively, diagnoses that are typically associated with lower risk.…”

Understanding keratoconus: what have we learned from the New Zealand perspective?

“…Fan and collegaues examined the occurrence of intraocular pressure (IOP) elevation in patients following primary penetrating keratoplasty for keratoconus. The incidence of post‐keratoplasty elevated IOP was substantial between one week and 12 months post‐keratoplasty at 32 per cent, with 11 per cent of eyes developing mild, 12 per cent moderate and nine per cent severe IOP elevation.…”