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Risk factors of the steroid induced ocular hypertension after corneal refractive surgery

Risk factors of the steroid induced ocular hypertension after corneal refractive surgery. Kyoung Min Lee, MD 1,2 , Won Ryang Wee 1,2 , Jin Hak Lee 1,3 , Mee Kum Kim, MD 1,2 1 Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

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Risk factors of the steroid induced ocular hypertension after corneal refractive surgery

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  1. Risk factors of the steroid induced ocular hypertension after corneal refractive surgery Kyoung Min Lee, MD1,2, Won Ryang Wee1,2, Jin Hak Lee1,3, Mee Kum Kim, MD1,2 1Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea 2 Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea, 3Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea Authors have no financial interests

  2. Purpose Steroid induced glaucoma -prolonged steroid use -myopia Corneal refractive surgery -changes in corneal thickness -IIOP could be masked David Rex Hamilton et al. Ophthalmology 2002; 109:659-665 To investigate the changes of IOP after corneal refractive surgery To determine the risk factors of steroid induced increased IOP

  3. Methods • Inclusion • 2004. 1 ~ 2008. 1 • Corneal refractive surgery in SNUH • Eximer laser • PRK • LASIK • LASEK • Exclusion • Follow up less than 1 month • Refractive surgery in single eye for the eldlery • Hyperopia 225 patients, 450 eyes Retrospective

  4. Methods • Steroids • Normal • 0.1% fluometholone (flarex) for 1week • 0.1% fluometholone (ocumetholone) tapering • DLK • 1% prednisolone (Pred Forte) • Myopic regression • 1% prednisolone (Pred Forte) • IOP • Pneumatic tonometer • Sheng-Yao Hsu et al. • J Cataract Refract Surg 2009;35:76-82 • Adjusted baseline IOP • 4.8mmHg / 100μm • Hornova J et al. • Cesk Slov Oftalmol 2000;56:98-103

  5. Methods • Definition of IIOP • Increase of IOP • More than 130% of adjusted baseline IOP • After 1 week • Repeated more than two times • Need of medication • With evidence of IOP increase

  6. Methods • Variables • Patient related • Age, Sex • Myopia • Preoperative IOP • Corneal thickness • Operation related • Type • Zone • Ablation depth • Steroid related • DLK • Myopic regression • Analysis • Correlation • Myopia • IOP change • Grouping – myopia • IIOP • medication • Binary logistic regression • IIOP • medication

  7. Results • Demographics

  8. Results • IOP change & myopia r=-0.097 p=0.04* * Pearson correlation F=1.524 p=0.207 ANOVA comparison

  9. Results • IIOP 22.2% • Medication 12%* • *5.6±3.4mmHg from the adjusted baseline IOP (%) IIOP mx

  10. Results Risk factors of IIOP M 18.9% F 23.1% a OP type PRK Eximer LASIK LASEK b Op zone (mm) 6.0 6.0 with blending 6.5 custom

  11. Results Risk factors of medication a OP type PRK Eximer LASIK LASEK b Op zone (mm) 6.0 6.0 with blending 6.5 custom

  12. Conclusion • Steroid induced IIOP • 22.2% • Independent from myopia • Risk factors of IIOP • Female • IOP change and myopia • Possibility of wrong model • IIOP • Similar rates in variable degree of myopia • More medication in low myopia • More detection • Risk factors • Thick preoperative corneal thickness and high IOP • More medication – more detection

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