Steroid-induced glaucoma and blindness in vernal keratoconjunctivitis

Abstract

PurposeTo report the clinical features, treatment outcomes and blindness associated with steroid-induced glaucoma in vernal keratoconjunctivitis (VKC).Materials and methodsRecords of patients with VKC, who visited our tertiary centre from 1992 and 2009, were reviewed and those with steroid-induced glaucoma were included in the study. Glaucoma was diagnosed based on intraocular pressure (IOP) ≥22 mm Hg on two consecutive visits (ocular hypertension) and/or glaucomatous optic disc damage. Blindness was defined as best corrected visual acuity of ≤20/400 or visual field <10°.ResultsOf the 4062 VKC subjects, 91 (157 eyes) had steroid-induced glaucoma (SIG), showing a prevalence of 2.24%. Of these 87% were men. The median (IQR) age at onset of VKC was 12 years (7–17). At presentation, the median duration of VKC was 48 months (24–72) and the median duration of steroid usage was 24 months (12–36). The median cup-to-disc ratio (CDR) was 0.9 (0.7–0.9) and median mean deviation was −21.9 dB (−30.0 to –10.2). IOP was medically controlled in 66% eyes (104/157) and 34% eyes (53/157) needed glaucoma surgery. High presenting IOP (OR: 1.04; p=0.05) and increased duration of steroid usage (OR: 1.07; p=0.02) were significantly associated with need for glaucoma surgery. At presentation, 29/91 subjects (31.8%) were bilaterally blind due to SIG. Higher CDR at presentation was significantly associated with blindness in this cohort (p=0.02).ConclusionIn this cohort of VKC with SIG, the disease predominantly affected adolescent males. Glaucoma was severe with one-third needing surgery and one-third blind due to SIG.

Stability and Safety Traits of Novel Cyclosporine A and Tacrolimus Ophthalmic Galenic Formulations Involved in Vernal Keratoconjunctivitis Treatment by a High-Resolution Mass Spectrometry Approach

“…Topical corticosteroids are the most effective treatment for moderate to severe VKC forms. However, their long-term use must be strictly limited and carefully monitored due to their potential complications (glaucoma, cataract, ocular hypertension, secondary bacterial or viral eye infections such as herpetic keratitis) [15]. In this context, to avoid the prolonged use of cortisone drugs, galenic ophthalmic preparations containing cyclosporine A (0.5-1% up to 2%) and tacrolimus (0.1%)-based eye drops have been developed and studied in various double-blind placebo trials, proving to be effective in various concentrations for the treatment of moderate and severe VKC [16,17].…”

Comparative Evaluation of Tacrolimus 0.03% Ointment vs Olopatadine 0.2% Eye Drops in the Treatment of Vernal Keratoconjunctivitis

“…However, in the severe and chronic cases, topical corticosteroid drops and supratarsal steroid injections have to be added to control the symptoms. Injudicious and prolong use of topical steroids may cause glaucoma, cataract, and secondary infections 16 . Children suffering from VKC are particularly at risk of developing steroidinduced complications, as they are the most commonly affected age group.…”

Combination of 0.05% Azelastine and 0.1% Tacrolimus Eye Drops in Children With Vernal Keratoconjunctivitis: A Prospective Study

“…In addition, topical steroids usually require months or years in treatment, leading to infectious episodes and elevations of intraocular pressure (IOP). More specifically, in the case of children and adolescents, the reported incidence of steroid-induced glaucoma is higher than that in adults, close to 2% (4,5). Besides, steroidinduced cataract has also raised the level of concern (6).…”