Long-term Outcomes on de novo Ocular Hypertensive Response to Topical Corticosteroids After Corneal Transplantation

Abstract

Purpose: To determine incidence, demographics, management, and outcomes of topical steroid-induced ocular hypertension after penetrating keratoplasty (PKP) and to establish effects on intraocular pressure (IOP) and graft rejection when alternate corticosteroids are used. Methods: A single-center, retrospective review of 568 consecutive PKPs performed between 1997 and 2010 was conducted. Data were collected on demographics, best-corrected visual acuity, surgical indications, lens status, IOP, postoperative management, and incidence of rejection. Results: Eighty eyes (14.1%) of 74 patients were included. The most common indication was keratoconus (28.8%). Twenty-seven eyes (33.8%) were phakic, 46 (57.4%) had a posterior chamber intraocular lens, and 7 (8.8%) had an anterior chamber intraocular lens. Mean postoperative IOP increase was only significant in the anterior chamber intraocular lens group (18.7 mm Hg, SD 10.4; P = 0.02). The average time for developing hypertension was 9.8 months (SD 14.8) postoperatively, with an average IOP increase of 13.3 mm Hg (SD 5.9). Prednisolone acetate 1% was switched to rimexolone 1% in 64 eyes (80%) and to fluorometholone 0.1% in 16 eyes (20%), which alone achieved IOP normalization in 26 eyes (32.5%) (P < 0.01). Fifty-four eyes (67.5%) required additional antiglaucoma medication. An average IOP reduction of 12.3 mm Hg (SD 6.9) was achieved at an average of 2.3 months (SD 5.2) after the switch. Seventeen eyes (21%) developed glaucoma and 13 eyes (16.3%) developed graft rejection after switching formulations, with no statistically significant differences between rimexolone and fluorometholone (P > 0.05). Conclusions: The use of alternate topical corticosteroids may be considered in cases of steroid-induced ocular hypertension after PKP because they offer good antiinflammatory prophylaxis with reduced hypertensive response.

Long-Term Graft Survival and Decline in Endothelial Cell Density Following Penetrating Keratoplasty with Organ-Cultured Corneas

“…All cases were performed with the same PKP surgical technique and post-operative management as previously reported [ 17 ]. Fifty-six percent ( n = 333) of patients received a 7.5 mm graft, 24% ( n = 144) received an 8 mm graft, and 12% ( n = 69) received a 7 mm graft.…”

Current trends in the management of corneal neovascularization

“…Moreover, steroids may be limited in effectively reducing preexisting and chronic corneal NV as the absence of active inflammation does not allow for steroids to exert their effects on angiogenic factors such as VEGF [7]. Topical corticosteroids also pose a risk due to their numerous adverse effects, including steroid-induced glaucoma, cataracts, and ocular surface immunosuppression [24]. Concern for these side effects has led to the development of angiostatic steroids devoid of traditional ocular steroid activity, such as anecortave acetate, but limited clinical studies have examined the efficacy of these agents [25].…”

Topical Immunomodulators Improve Clinical Signs of Vernal Keratoconjunctivitis and Atopic Keratoconjunctivitis: A Meta-Analysis

“…The development of topical corticosteroids dramatically improved control over these severe forms of allergic eye disease [1,[16][17][18][19]. However, their use tends to be strictly limited and carefully monitored as long-term use may result in several significant side effects and complications, such as the formation of posterior sub-capsular cataract [20], glaucoma [21], and secondary infections such as bacterial or fungal infections [22][23][24][25][26].…”