Steroid Induced Ocular Hypertension Following Myopic Photorefractive Keratectomy

PURPOSE To determine the incidence of steroid induced ocular hypertension following myopic photorefractive keratectomy (PRK). METHODS Myopic PRK was performed on 506 eyes of 269 patients. Preoperatively, spherical equivalent refractive error ranged from -1.00 to -5.00 diopters (D) and cylinder was less than 4 D. Baseline intraocular pressure (IOP) before PRK and at different time intervals after the procedure was measured by Goldmann applanation tonometry. IOP readings were corrected according to central corneal thickness as measured by Orbscan pachymetry. For the purpose of the study, corrected IOP >21 mmHg was considered as ocular hypertension. RESULTS Ocular hypertension developed in 40 (7.9%) eyes overall, which occurred in 16 eyes (40%) 2-3 weeks postoperatively (mean IOP=23.5±3.0mmHg), in 20 eyes (50%) after 4-6 weeks (mean IOP=25.1±4.2 mmHg) and in 4 eyes (10%) 8-12 weeks following PRK (mean IOP=29.0±3.1 mmHg). There was no correlation between the level of IOP rise and preoperative spherical equivalent refractive error. IOP recovered to normal in all eyes after discontinuation of topical steroids and initiation of anti-glaucoma medications. Mean duration of IOP normalization was 28.5±27.7 (range 7-108 ) days and no instance of steroid-induced glaucoma was observed in any patient. CONCLUSION Topical steroids may cause ocular hypertension following PRK. Early detec-tion, prompt treatment and close follow-up are recommended. We suggest measuring IOP in post-PRK patients no later than 10 to 14 days after initiation of corticosteroid treatment.