Low steroid response incidence found in glaucoma, nonglaucoma eyes
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The incidence of steroid response with prednisolone acetate 1% was low after phacoemulsification in eyes with and without glaucoma, according to a study published in the Journal of Glaucoma.
“Age-related cataract is the leading cause of visual impairment, and cataract surgery is one of the most frequently performed operations worldwide,” Karine Bojikian, MD, PhD, of Eye Associates Northwest, and colleagues wrote. “Several different corticosteroids are available, but prednisolone acetate 1% is the most widely prescribed after cataract surgery.”
Bojikian and colleagues conducted a retrospective review of patients with and without glaucoma who underwent phacoemulsification at the University of Washington between 2007 and 2016, with incisional surgery as an exclusionary factor.
The final analysis included 472 nonglaucoma eyes (age: 68.4±11.3 years; axial length 24.2±1.6 mm; baseline IOP 15.3±2.6 mm Hg) and 191 eyes of glaucoma patients (age: 71.8±9.9 years; axial length 24.1±1.6 mm; baseline IOP 16.3±4.4 mm Hg). Patients with glaucoma were taking an average of 2.1 medications and had a visual field mean deviation of 7.
In the nonglaucoma group, axial length and younger age were linked to higher incidences of steroid response (P .003). For glaucoma patients, longer axial length and preoperative medications were associated with steroid response (P .03). For both groups, an axial length of 26 mm or greater was associated with steroid response.
“In summary, we found that, although glaucoma patients were 3.72 times more likely to have a steroid response after postphacoemulsification prednisolone acetate 1% use compared with nonglaucoma patients, the incidence of steroid response was relatively low in both groups,” Bojikian and colleagues wrote. “Better identification of patients at risk for steroid-induced IOP elevation can aid in the clinical management of glaucoma patients.”
Perspective
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Elevated IOP is a well-known potential complication of steroid use. It is of particular concern with dexamethasone and Durezol (difluprednate ophthalmic emulsion, 0.5%; Alcon) but can also occur with Omnipred (prednisolone acetate 1%; Alcon) and other steroid drops as well.
This report examined the likelihood of significant IOP elevation when using prednisolone acetate 1% four times a day after cataract surgery. It further compared the rate of it occurring in eyes without glaucoma to the rate of it occurring in eyes with glaucoma. IOP elevation was defined as an increase from baseline of 50% or more, occurring on or after the second postoperative week.
The study included 472 nonglaucomatous eyes and 191 glaucomatous eyes. The rate of significant IOP elevation was quite low; only 2.1% percent of nonglaucomatous eyes and 8.4% of glaucomatous eyes met the defined criteria for substantial elevation.
While glaucomatous eyes did show a higher rate of IOP increase, the overall occurrence rate was still less than 10%. It is also interesting to note that in both glaucomatous and nonglaucomatous eyes, the risk for IOP elevation increased as axial length increased. This implies that myopic patients have a greater chance for developing an IOP elevation when taking topical steroids. From a clinical perspective, it is reassuring to see such relatively low rates of substantial IOP elevation when using a very common post-cataract surgery steroid regimen.
It will also be very interesting to see if future research corroborates an increased risk for steroid induced IOP elevation with increasing myopia.
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