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Effect of Topical Periocular Steroid Use on Intraocular Pressure: A Retrospective Analysis.
Ophthalmic Plast Reconstr Surg 2019 Sep/Oct; 35(5):465-468OP

Abstract

PURPOSE

To study the effect of periocular steroid use on intraocular pressure (IOP).

METHODS

Charts of adult patients with atopic dermatitis or eczema treated with topical periocular steroid creams and ointments from January 1st, 2007 to October 1st, 2017 were reviewed. Patients with the following were excluded: glaucoma, ocular hypertension, known systemic/topical/injectable steroid history, and lack of documented IOP prior to or during treatment with periocular steroid ointment. Patient data were collected regarding gender, treatment regimen, as well as IOP prior to and during treatment. Steroid responders were identified. Statistical analysis was performed using linear mixed effects models adjusting for follow-up time to test the relationship between pre and posttreatment IOP change adjusting for intereye correlations.

RESULTS

Thirty-one patients were identified. Twenty-one were treated bilaterally and 10 unilaterally. Five patients were glaucoma suspects. The mean treatment period was 14.2 weeks with a range of 0.1-83.9 weeks. Patients were treated with fluorometholone (42%), loteprednol etabonate (23%), dexamethasone-neomycin-polymyxin B (13%), hydrocortisone 1% or 2.5% (3%), and tobramycin-dexamethasone (19%). In the combined sample, there was no significant IOP change even after adjusting for follow-up time (mean change: +0.44 mm Hg, p = 0.126). However, eyes with baseline IOP ≥ 14 mm Hg had a significant increase (+0.73 mm Hg/year, p = 0.032). Individual steroid responses included the following: 1 intermediate and 30 low responders, of which 19 patients had an IOP change of <1 mm Hg. One patient had a clinically significant intermediate steroid response of 7 mm Hg.

CONCLUSIONS

Periocular steroid treatment causes a statistically significant rise in IOP in eyes with higher baseline IOP measurements, the risk of which increases with follow up. While this change is not always correlated with a clinically significant rise in IOP, clinicians should monitor more closely patients at greatest risk of steroid response.

Authors+Show Affiliations

Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York, U.S.A.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30730433

Citation

Maeng, Michelle M., et al. "Effect of Topical Periocular Steroid Use On Intraocular Pressure: a Retrospective Analysis." Ophthalmic Plastic and Reconstructive Surgery, vol. 35, no. 5, 2019, pp. 465-468.
Maeng MM, De Moraes CG, Winn BJ, et al. Effect of Topical Periocular Steroid Use on Intraocular Pressure: A Retrospective Analysis. Ophthalmic Plast Reconstr Surg. 2019;35(5):465-468.
Maeng, M. M., De Moraes, C. G., Winn, B. J., & Glass, L. R. D. (2019). Effect of Topical Periocular Steroid Use on Intraocular Pressure: A Retrospective Analysis. Ophthalmic Plastic and Reconstructive Surgery, 35(5), pp. 465-468. doi:10.1097/IOP.0000000000001320.
Maeng MM, et al. Effect of Topical Periocular Steroid Use On Intraocular Pressure: a Retrospective Analysis. Ophthalmic Plast Reconstr Surg. 2019;35(5):465-468. PubMed PMID: 30730433.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of Topical Periocular Steroid Use on Intraocular Pressure: A Retrospective Analysis. AU - Maeng,Michelle M, AU - De Moraes,Carlos Gustavo, AU - Winn,Bryan J, AU - Glass,Lora R Dagi, PY - 2019/2/8/pubmed PY - 2019/2/8/medline PY - 2019/2/8/entrez SP - 465 EP - 468 JF - Ophthalmic plastic and reconstructive surgery JO - Ophthalmic Plast Reconstr Surg VL - 35 IS - 5 N2 - PURPOSE: To study the effect of periocular steroid use on intraocular pressure (IOP). METHODS: Charts of adult patients with atopic dermatitis or eczema treated with topical periocular steroid creams and ointments from January 1st, 2007 to October 1st, 2017 were reviewed. Patients with the following were excluded: glaucoma, ocular hypertension, known systemic/topical/injectable steroid history, and lack of documented IOP prior to or during treatment with periocular steroid ointment. Patient data were collected regarding gender, treatment regimen, as well as IOP prior to and during treatment. Steroid responders were identified. Statistical analysis was performed using linear mixed effects models adjusting for follow-up time to test the relationship between pre and posttreatment IOP change adjusting for intereye correlations. RESULTS: Thirty-one patients were identified. Twenty-one were treated bilaterally and 10 unilaterally. Five patients were glaucoma suspects. The mean treatment period was 14.2 weeks with a range of 0.1-83.9 weeks. Patients were treated with fluorometholone (42%), loteprednol etabonate (23%), dexamethasone-neomycin-polymyxin B (13%), hydrocortisone 1% or 2.5% (3%), and tobramycin-dexamethasone (19%). In the combined sample, there was no significant IOP change even after adjusting for follow-up time (mean change: +0.44 mm Hg, p = 0.126). However, eyes with baseline IOP ≥ 14 mm Hg had a significant increase (+0.73 mm Hg/year, p = 0.032). Individual steroid responses included the following: 1 intermediate and 30 low responders, of which 19 patients had an IOP change of <1 mm Hg. One patient had a clinically significant intermediate steroid response of 7 mm Hg. CONCLUSIONS: Periocular steroid treatment causes a statistically significant rise in IOP in eyes with higher baseline IOP measurements, the risk of which increases with follow up. While this change is not always correlated with a clinically significant rise in IOP, clinicians should monitor more closely patients at greatest risk of steroid response. SN - 1537-2677 UR - https://www.unboundmedicine.com/medline/citation/30730433/Effect_of_Topical_Periocular_Steroid_Use_on_Intraocular_Pressure:_A_Retrospective_Analysis L2 - http://dx.doi.org/10.1097/IOP.0000000000001320 DB - PRIME DP - Unbound Medicine ER -