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Clin Ophthalmol. 2012;6:1253-8. doi: 10.2147/OPTH.S32936. Epub 2012 Aug 3.

Steroid-induced ocular hypertension in Asian children with severe vernal keratoconjunctivitis.

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1
Singapore National Eye Centre, Singapore.

Abstract

BACKGROUND:

We describe clinical characteristics and risk factors for corticosteroid response in children with severe vernal keratoconjunctivitis (VKC).

DESIGN:

Retrospective, noncontrolled, comparative case series.

PARTICIPANTS:

Patients from three tertiary centers in Singapore.

METHODS:

We reviewed patients with severe VKC (clinical grade > 2) who were on topical steroid therapy, with a minimum follow-up period of 1 year post-presentation. Logistic regression was used to determine risk factors for corticosteroid response.

MAIN OUTCOME MEASURE:

Corticosteroid response was defined as intraocular pressure (IOP) >21 mmHg (three consecutive readings), or a rise of more than 16 mmHg from baseline, after commencement of steroid therapy in the absence of other possible causes of raised IOP.

RESULTS:

Forty-one of 145 (28.3%) patients developed a corticosteroid response, of which eight (5.5%) progressed to glaucoma. The overall mean age of onset of VKC was 9.9 ± 4.4 years. Longer duration of corticosteroid use (OR, 5.06; 95% CI: 1.04-25.56; P = 0.45) and topical dexamethasone 0.01% (OR, 2.25; 95% CI: 1.99-5.08; P = 0.40) were associated with corticosteroid response. Mixed type of VKC (OR, 9.76; 95% CI: 3.55-26.77; P < 0.001), the presence of limbal neovascularization of ≥ three quadrants (OR, 6.33; 95% CI: 2.36-16.97; P < 0.001), and corneal involvement (OR, 3.51; 95% CI: 1.31-9.41; P = 0.012) were significant clinical risk factors after adjusting for potential confounders such as age, sex, ethnicity, duration, and type of corticosteroid used.

CONCLUSION:

Children on long-term oral corticosteroids with severe, mixed-type VKC and corneal involvement are more likely to develop corticosteroid response, and may require early treatment to prevent progression to glaucoma.

KEYWORDS:

glaucoma; steroids; vernal keratoconjunctivitis

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