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Severe vernal keratoconjunctivitis requiring trabeculectomy with mitomycin C for corticosteroid‐induced glaucoma
Author(s) -
Ang Marcus,
Ho ChingLin,
Tan Donald,
Chan Cordelia
Publication year - 2011
Publication title -
clinical and experimental ophthalmology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.3
H-Index - 74
eISSN - 1442-9071
pISSN - 1442-6404
DOI - 10.1111/j.1442-9071.2011.02591.x
Subject(s) - medicine , trabeculectomy , vernal keratoconjunctivitis , glaucoma , odds ratio , intraocular pressure , confidence interval , corticosteroid , mitomycin c , ophthalmology , surgery , risk factor , retrospective cohort study , dermatology
A bstract 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, 1.0–1.5; 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, 1.3–3.0; 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.