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

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.