Severe vernal keratoconjunctivitis requiring trabeculectomy with mitomycin C for corticosteroid-induced glaucoma

被引:16
作者
Ang, Marcus [1 ,2 ]
Ho, Ching-Lin [1 ,3 ]
Tan, Donald [1 ,2 ,3 ]
Chan, Cordelia [1 ]
机构
[1] Singapore Natl Eye Ctr, Singapore 168751, Singapore
[2] Singapore Eye Res Inst, Singapore, Singapore
[3] Natl Univ Hlth Syst, Dept Opthalmol, Singapore, Singapore
关键词
cornea; glaucoma; steroid; vernal keratoconjunctivitis; INDUCED OCULAR HYPERTENSION; STEROID-INDUCED GLAUCOMA; INTRAOCULAR-PRESSURE; CASE SERIES; CYCLOSPORINE; EFFICACY;
D O I
10.1111/j.1442-9071.2011.02591.x
中图分类号
R77 [眼科学];
学科分类号
100212 ;
摘要
Background: To describe clinical features of severe vernal keratoconjunctivitis with steroid response in Asian children and risk factors for glaucoma filtration surgery. Design: Retrospective non-controlled, comparative case series. Participants: Patients with severe vernal keratoconjunctivitis seen at a single centre over 6 years. Methods: Clinical features, symptoms and treatment modalities were recorded for patients (i) diagnosed with severe VKC (clinical grade =3); (ii) had >2 recordings of increased intraocular pressures of >21 mmHg; (iii) and a minimum follow-up period of 1 year post-presentation. Main Outcome Measure: Corticosteroid-induced glaucoma requiring trabeculectomy with mitomycin-C. Results: Six patients (eight eyes) of 36 patients required trabeculectomy/mitomycin-C. All were male. Mean age of disease onset was 9.3 +/- 4.5 years for a mean duration of 6.08 +/- 3.5 years. Mean intraocular pressures increase from baseline was 29.0 +/- 8.2 mmHg and all required >2 anti-glaucoma medications. The main risk factor for trabeculectomy was a greater increase in intraocular pressures from baseline (odds ratio 1.3; 95% confidence interval, 1.01.5; P = 0.011), which was independent of potential confounders such as type and duration of corticosteroid use. Comparing eyes pre- and post-trabeculectomy, all improved in clinical severity of vernal keratoconjunctivitis (mean clinical grade improvement 2.1; 95% confidence interval, 1.33.0; P < 0.001) and reduced dependence on topical corticosteroids for mean duration of 22.5 +/- 15.3 months. Conclusion: In our study, patients with a greater steroid response, that is, higher increase in intraocular pressures from baseline are associated with a 30% higher risk toftrabeculectomy.
引用
收藏
页码:E149 / E155
页数:7
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