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

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.