Incidence of Steroid Induced-Ocular Hypertension in Postoperative Pterygium Excision
Manchima Makornwattana MD*, Wannisa Suphachearaphan MD**
Affiliation : * Department of Ophthalmology, Faculty of Medicine, Thammasat University, Rungsit Campus, Pathumthani, Thailand ** Department of Ophthalmology, Faculty of Medicine, Thammasat University, Rungsit Campus, Pathumthani, Thailand
Background : Steroid eye drops were widely used for suppression ocular inflammation in many conditions. Unfortunately,
steroid eye drops can cause many side effects; the important one was steroid-induced ocular hypertension that may progress
to secondary glaucoma.
Objective : To evaluate incidence of steroid responder, following topical dexamethasone use after pterygium excision with
amniotic membrane graft.
Design : Prospective descriptive study.
Material and Method: The present study was designed to evaluate intraocular pressure (IOP) change from topical
dexamethasone eye drops in postoperative pterygium excision with amniotic membrane grafting. The subjects were routinely
prescribed CD-oph (1 mg/ml dexamethasone sodium phosphate, 5 mg/ml chloramphenicol, and 0.25 mg/ml Tetrahydrozaline
hydrochloride) eye drops every 1 hour for 1 week, then every 2 hours until 1 month, then four times daily until 3 months
postoperatively. The subjects were measured IOP at 1 week, 1 month, and 3 month postoperatively by applanation tonometer.
The steroid responder was defined as an elevation of IOP at least 10 mmHg from preoperative. The incidence was calculated,
trend of IOP rising and timing of peak IOP were assessed.
Results : Of the 62 patients, 6 were diagnosed as steroid responders (IOP >10 mmHg), 9.68% (95% CI 3.6-19.9). Mean of
peak IOP rising was 4.02+3.18 mmHg with maximum IOP rising was 11 mmHg. 4 of 6 cases of steroid responders occur at
3 month postoperative, 2 another cases occur at 1 week and 1 month postoperative. Most of the subjects had IOP rising in
range of 0-4 mmHg (62.90%), follow by 5-9 mmHg (27.42%), and >10 mmHg (9.68%), respectively. Maximum IOP mostly
in range of 16-20 mmHg (43.55%), follow by 11-15 mmHg (40.32%), 21-25 mmHg (9.68%), and more than 26 mmHg
(6.45%), respectively. 45.16% of subjects showed the time of peak IOP at postoperative 1 month.
Conclusions: Steroid response is a common problem in steroid use, especially with topical steroid eye drops. The incidence
of steroid responder from this study was 9.68%, which may differ from the others by type, frequency of the topical steroid used,
including criteria to diagnosis of steroid responder.
Keywords : Steroid responder, Ocular hypertension, Pterygium excision, Dexamethasone
