Investigation of Steroid-Related IOP Change After Refractive Surgery
Purpose
Topical steroid eye drops are routinely used during the first four post-operative months following photorefractive keratcetomy (PRK) to control healing and prevent corneal haze. However, steroids can be associated with an increase in intraocular pressure, sometimes requiring management with pressure lowering medications. This study investigates steroid response in eyes that underwent PRK and compares short and long steroid taper regimens. In addition, the study sought to look at required treatment for steroid responders and final visual outcomes.
Methods
This is a retrospective study of intraocular pressures for patients treated with PRK over a ten year period at the Lackland Joint Warfighter Refractive Surgery Center. Treatments greater than 50 microns of corneal ablation were treated with fluoromethalone 0.1% over four months and those less than 50 microns were treated for two months. Steroid response for short and long steroid tapers were compared. In addition, required treatment and visual outcomes were reviewed for a two year period for steroid responders.
Results
Of 19,213 eyes, 10,789 underwent a short taper and 8,424 underwent a long taper. Steroid response was 6% for both short and long tapers. Steroid response fell quickly during the taper with 0.03% response at 6 months for the short taper. During a two year period, 4,864 eyes were treated with 184 (3.8%) steroid responders. Of these, 63% (short) and 65% (long) required one medication while 13.5% (short) and 19.4% (long) required two or three medications. Visual acuity compared to nonresponders was not statistically significant. Average duration was 68, 101, and 161 days for one, two, and three medications, respectively.
Conclusion
Incidence of steroid response is 6% (10 year data) and 3.8% (2 year data). IOP was effectively treated or normal in all patients at six months. The majority required only one medication. Several did not require medication. Visual acuity outcomes were identical to nonsteroid responders. Furthermore, no surgical interventions were required.