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The hazy corneal donor-recipient interface after corneal transplant may cause difficulties when implanting the XEN gel stent via ab-interno approach. We aim to describe XEN gel stent implantation via ab-externo approach in refractory steroid-induced glaucoma after corneal lamellar keratoplasty. Under local anaesthesia, the XEN injector needle was inserted 7 mm behind the limbus with the bevel facing up, directly beneath the conjunctiva and advanced to the marked 2.5 mm scleral entry wound. The needle then pierced the sclera until the needle tip was just visible in the anterior chamber (AC). The slider was pushed until the tip of the XEN stent was seen in the AC. The needle was slowly withdrawn while still pushing the slider to complete stent deployment. Subconjunctival Mitomycin C 0.01% (30 µg/0.3 mL) was then injected posterior to the bleb. Three eyes of three patients with steroid-induced glaucoma after lamellar keratoplasty underwent XEN gel stent implantation via ab-externo approach placed at the superotemporal quadrant. Pre-operatively, all patients had uncontrolled IOP between 30-45 mmHg despite maximum medications and selective laser trabeculoplasty. After XEN gel stent implantation, IOP ranged between 10-17 mmHg with one or two topical antiglaucoma at 12 months. Complications include hypotony maculopathy, stent migration and hyphaema, all of which were successfully managed. Corneal graft remained clear at 12 months. XEN gel stent implantation via ab-externo approach is able to achieve good intraocular pressure (IOP) control without compromising cornea graft in patients with steroid-induced glaucoma after lamellar keratoplasty at 12 months.

A 41-year-old woman was treated with topical corticosteroid eye drops for nonspecific inflammation of both eyes by an optometrist for over a year without proper follow-up eye examinations. She developed severe corticosteroid-induced glaucoma with near-complete loss of her peripheral vision of both eyes.

Purpose: To know the pattern of presentations and management outcome of steroid induced glaucoma in vernal keratoconjunctivitis (VKC). Methods: Children of VKC using steroid with two of the following criteria were enrolled: Intraocular pressure (IOP) >21 mm Hg, glaucomatous optic disc and visual field defects. Misused topical steroids were classified in 4 groups; A- Highly potent drugs (dexamethasone, betamethasone), B- Moderate (prednisolone), C- Weak (loteprednol, fluorometholone), D- Unknown drugs. Active/conservative interventions were done to control IOP. Corrected distance visual acuity (CDVA), IOP, anterior segment and fundus examinations were noted. One-way ANOVA test and post hoc Tukey HSD test were used to compare the groups. Results: Out of 1423 VKC patients, 240 were using topical steroid without prescriptions. 92 eyes of 47 patients had steroid induced glaucoma. Hence prevalence of this complication was 3.30% in this study population. Mean age was 14.1 ± 3.8 years. Mean IOP was 38 ± 12 mm of Hg and mean vertical cup disc ratio was 0.67 ± 0.25. IOP was controlled by withdrawal of steroids (9 eyes), with antiglaucoma medications (27), trabeculectomy (57) and glaucoma drainage device (1). Mean CDVA at presentation was better in group C (0.23 log MAR). Mean IOP was highest in group A (43.1 mm Hg) followed by group D (40.5 mm Hg). At presentation 17 were blind (CDVA

Diabetic macular edema (DME) is one of the major causes of blindness, caused primarily by hyperglycemia and results from multiple pathological processes mostly secondary to increased levels of VEGF and other inflammatory cytokines. DME management includes control of systemic risk factors together with laser photocoagulation, frequent intraocular injections of anti-VEGF agents and steroids implants. Recent adoption of novel alternative drug delivery options has led to the development of sustained release ocular implants with longer duration of action with less injection frequency. This article will review the pharmacology and clinical data in terms of efficacy, safety and benefits of the sustained release steroid implants in treatment of DME with special emphasis on the fluocinolone acetonide ILUVIEN® implant.

Purpose: To assess the efficacy and safety of high-energy selective laser trabeculoplasty (SLT) for steroid-induced glaucoma in patients with quiescent uveitis.Methods: A retrospective study of steroid-induced glaucoma in quiescent uveitic patients who underwent SLT at our center from December 2014 to November 2017 and had been followed up for at least 1 year. Intraocular pressure (IOP) and IOP-lowering medications were recorded at baseline, and at 1 week, 1 month, 3 months, 6 months and 12 months after SLT. Treatment success was defined as IOP ≤18 mmHg and a ≥ 20% reduction in IOP without additional glaucoma surgery.Results: Twenty eyes from 19 patients were included. At the 12-month visit, mean IOP and mean number of IOP-lowering medications were significantly reduced as compared to baseline with an overall success rate of 65.0%.Conclusions: High-energy SLT appeared to be an effective and safe procedure for steroid-induced glaucoma with quiescent uveitis.

PURPOSE To report a case of successful intraocular pressure (IOP) reduction after a 360-degree gonioscopy-assisted transluminal trabeculotomy (GATT) using the iTrack catheter in a patient with steroid-induced glaucoma as a result of treatment of vernal keratoconjunctivitis (VKC). MATERIALS AND METHODS Case report. RESULTS An 8-year-old male individual with a long-standing history of VKC, treated with topical steroids, developed elevated IOP and glaucoma in the right eye despite maximum topical glaucoma therapy. Reducing the steroid was not a viable option given the severity of VKC. A 360-degree GATT was successfully performed and IOP has been maintained off all glaucoma drops. CONCLUSIONS GATT is a viable option for steroid-induced glaucoma in the pediatric population. This obviates the need for riskier, more invasive conjunctival-based procedures.

Glucocorticoids are a class of anti-inflammatory drugs commonly used to treat various ocular and systemic conditions. Although the role of glucocorticoids in the treatment of numerous serious inflammatory diseases is pivotal, their prolonged use may increase intraocular pressure resulting in steroid-induced glaucoma. We provide a detailed update on steroid-induced glaucoma as a preventable cause of blindness in the adult and pediatric population and describe its epidemiology, social impact, and risk factors. Furthermore, we explore the propensity of different steroids to increase the intraocular pressure, the role of different routes of steroid administration, dosage and duration of treatment, as well as the clinical features, genetics, and management of steroid-induced glaucoma.

This case report illustrates the use of ExPRESS mini-shunt in a pediatric glaucoma patient. We describe the management of steroid-induced glaucoma with ExPRESS mini-shunt in a 9-year-old boy with allergic keratoconjunctivitis. The intraocular pressure of both of his eyes was uncontrolled with medical and laser treatment. Both eyes were treated with ExPRESS mini-shunt and mitomycin-C. Transient overfiltration with postoperative hypotony occurred in both eyes and resolved after 2 weeks. One year postoperatively, intraocular pressure was maintained below 21 mm Hg without medication in 1 eye. Bleb needling with mitomycin-C was done to maintain filtration. The fellow eye received cataract extraction but developed bleb failure a few months afterwards. The intraocular pressure was controlled medically. To conclude, ExPRESS mini-shunt is a new surgical option in selected patients. Bleb failure developed after cataract extraction. Postoperative inflammation should be minimized. Patient selection, such as those with stable ocular condition, is important to increase surgical success.

Steroids are known to cause glaucoma in certain predisposed people (steroid responders). We present three cases where patients developed refractory steroid induced glaucoma following the use of skin whitening creams.

The ocular‐hypertensive response to steroids is reported to be of greater frequency and severity in children than in adults.2005 However, there have as yet been no observations of accompanying stru...

Glaucoma following penetrating keratoplasty (PKP) remains the leading cause of blindness following PKP. Patients with post-PKP glaucoma can be managed medically and surgically. Evidence studying glaucoma surgical techniques following PKP is limited, but suggests the possibility for high-risk complications, including graft failure. Minimally invasive glaucoma surgeries offer an alternative. We report the first case of post-PKP glaucoma managed with gonioscopy-assisted transluminal trabeculotomy (GATT). The patient was a 33-year-old man with a history of keratoconus who underwent PKP in his right eye. On presentation, his visual acuity was 20/60 and intraocular pressure was 48 mm Hg OD. He underwent GATT and cataract phacoemulsification. Following 22 months of follow-up, the patient's visual acuity was 20/30 and intraocular pressure 13 mm Hg, off all glaucoma medications. This case demonstrates GATT may be a good surgical option for post-PKP glaucoma, given the ability to perform future incisional surgery and avoidance of high-risk complications associated with traditional glaucoma surgeries.

Purpose: To report the surgical results of goniotomy for corticosteroid-induced glaucoma and to provide evidence to support its use as initial surgical therapy. Methods: The medical records of 5 patients with a history of goniosurgery for steroid-induced glaucoma were reviewed. Preoperative and postoperative clinical findings were reviewed, including the topical use of steroids, tonometric and gonioscopic findings, goniosurgery, and postoperative results. In addition, tonography was performed on one patient to document the improved facility of outflow following successful goniosurgery. Results: Surgical success was achieved in all patients, with intraocular pressures less than 18 mm Hg without the use of medication for an average follow-up period of 11.5 years (range: 9 months to 30 years). A normal postoperative facility of outflow (C = 0.30 mm 3 /min/mm Hg) was determined in one patient. No complications of surgery were experienced. Conclusion: Goniotomy is an effective procedure for persistent steroid-induced glaucoma, and should be considered for initial surgical treatment. [ J Pediatr Ophthalmol Strabismus. 2015;52(3):183–188.]

Purpose. To evaluate the outcome of primary nonpenetrating deep sclerectomy (NPDS) in patients with steroid-induced glaucoma.Methods. This was a retrospective interventional clinical study that included 60 eyes of 60 steroid-induced glaucoma patients that had undergone NPDS. Patients were followed up for 4 years. Data from the records was retrieved as regards corrected distance visual acuity (CDVA), intraocular pressure (IOP), visual field mean defect (dB), and number of antiglaucoma medications needed if any. Complete success of the surgical outcome was considered an IOP ≤ 21 mmHg with no antiglaucoma medications. Qualified success was considered an IOP ≤ 21 mmHg using antiglaucoma medications.Results. The mean age was 21.2 ± 8.5 years (ranged from 12 to 35 years). At 48 months, mean IOP was 13.6 ± 2.8 mmHg (range 11–23 mmHg). This represented 60% reduction of mean IOP from preoperative levels. One case had YAG laser goniopuncture. Three cases required needling followed by ab interno revision. Using ANOVA test, there was a statistically significant difference between preoperative and postoperative mean IOP values (P=0.032). Twelve, 16, and 20 patients required topical antiglaucoma medications at 24, 26, and 48 months postoperative, respectively.Conclusion. Primary nonpenetrating deep sclerectomy is a safe and an effective method of treating eyes with steroid-induced glaucoma. No major complications were encountered. After 4 years of follow-up, complete success rate was 56.7% and qualified success rate was 70%.

Purpose: To know the pattern of presentations and management outcome of steroid induced glaucoma in vernal keratoconjunctivitis (VKC). Methods: Children of VKC using steroid with two of the following criteria were enrolled: Intraocular pressure (IOP) >21 mm Hg, glaucomatous optic disc and visual field defects. Misused topical steroids were classified in 4 groups; A- Highly potent drugs (dexamethasone, betamethasone), B- Moderate (prednisolone), C- Weak (loteprednol, fluorometholone), D- Unknown drugs. Active/conservative interventions were done to control IOP. Corrected distance visual acuity (CDVA), IOP, anterior segment and fundus examinations were noted. One-way ANOVA test and post hoc Tukey HSD test were used to compare the groups. Results: Out of 1423 VKC patients, 240 were using topical steroid without prescriptions. 92 eyes of 47 patients had steroid induced glaucoma. Hence prevalence of this complication was 3.30% in this study population. Mean age was 14.1 ± 3.8 years. Mean IOP was 38 ± 12 mm of Hg and mean vertical cup disc ratio was 0.67 ± 0.25. IOP was controlled by withdrawal of steroids (9 eyes), with antiglaucoma medications (27), trabeculectomy (57) and glaucoma drainage device (1). Mean CDVA at presentation was better in group C (0.23 log MAR). Mean IOP was highest in group A (43.1 mm Hg) followed by group D (40.5 mm Hg). At presentation 17 were blind (CDVA

Purpose: The aim of this study was to compare the ocular hypertensive effect of the commercially available Betamethasone, Fluorometholone in Iran and Loteprednol Etabonate in patients undergoing keratorefractive surgery. Methods: In this prospective randomized clinical trial, 300 eyes of 150 patients were included, and patients were randomly assigned to 3 groups and used one of the 3 steroid drops (Betamethasone 0.1%, Fluorometholone 0.1%, and Loteprednol Etabonate 0.5%) after myopic photorefractive keratectomy (PRK). Intraocular pressure (IOP) was measured 2, 4, and 6 weeks post-surgery. Twenty-two mmHg was set as the threshold IOP for starting anti-glaucoma medication and tapering steroid drops. Results: Of 300 eyes from 150 patients over the first 6 postoperative weeks, 2 eyes in Fluorometholone group (2%), 12 eyes in Betamethasone group (12%), and 16 eyes in Loteprednol group (16%) had IOP equal or more than 22 mmHg. Analysis of variance (ANOVA) test showed that the rise in IOP was significantly different between groups in the 2nd and 4th (P ≤ 0.001) postoperative weeks but not at 6th week (P = 0.230). An IOP rise equal or more than 10 mmHg was detected in 13 and 15 eyes in Betamethasone and Loteprednol groups, respectively. None of the eyes in Fluorometholone group had such an IOP rise. Conclusions: Loteprednol and Fluorometholone were associated with the most and least increase in IOP, respectively. The highest pressures were detected 4 weeks after surgery in the Betamethasone and Loteprednol groups and 6 weeks after surgery in the Fluorometholone group. Fluorometholone was the safest among the three examined steroid drops in terms of IOP rise. Keywords: Steroid induced glaucoma, Loteprednol etabonate, Keratorefractive surgery, Photorefractive keratectomy

Objectives: To evaluate possible ocular hypotensive effect of 0.5% diltiazem and 0.1% verapamil eye drops on intra ocular pressure in steroid induced glaucoma model of rabbits. And compare with 0.5% timololeye drops. Methodology: Glaucoma wa s induced in rabbits (N=18) by bilateral topical instillation of 1% prednisolone eye drop (10 µl) twice a day for a period of 40

Steroid medications may cause elevation of intraocular pressure, sometimes with permanent damage to the optic nerve. These therapies, via various routes of administration, are commonly prescribed for children, but the potential sequelae of elevated intraocular pressure and glaucomatous optic nerve damage can be even more severe and devastating in children than in adults. This review discusses the pathophysiology and potential risk factors, including the impact of intraocular pressure elevation via the different common routes of administration of steroids, clinical evaluation, and management of steroid response and steroid-induced glaucoma in children.

Raised intraocular pressure in uveitis, either due to the disease itself or secondary to treatment with steroids, is one of the most common causes of secondary glaucoma in clinical practice. There are currently no standardized criteria for the diagnosis nor guidelines for the management of raised intraocular pressure in uveitis. Intraocular pressure elevation may be due to any combination of several mechanisms and, as a result, the prognosis differs from primary glaucomas. In addition, the management of ongoing inflammation without elevating the intraocular pressure remains a challenge. Ideally, new anti-inflammatory agents should have better anti-inflammatory properties with safer intraocular pressure profiles, while sustained release medications to lower intraocular pressure would improve patient compliance.

Vernal Keratoconjunctivits (VKC) is a bilateral recurrent allergic interstitial conjunctival inflammation with a periodic seasonal incidence and of self limiting nature, mainly affecting the younger population. Patients of VKC on steroid therapy are at higher risk of developing steroid induced glaucoma. Raised intraocular pressure due to steroids typically occurs within few weeks of starting steroid therapy and comes back to normal on immediate stoppage of steroids. A case of steroid induced glaucoma in a 30 years old female with vernal keratoconjunctivitis. She was on topical steroids for 3-4 years. She was incompliant with the instructions to stop steroids. She eventually developed steroid induced glaucoma and glaucomatous optic neuropathy with tunnel vision.

Nach komplizierter hyperoper Laser-in-situ-Keratomileusis (LASIK) sowie Revision auf einem Auge wurde uber 2 Jahre mit lokalen Steroiden behandelt. Auf dem behandelten Auge kam es in der Folge zu einem Anstieg des Intraokulardrucks (IOD) mit konsekutiver Schadigung des N. opticus, der uber die Dauer der Behandlung zu einem subtotalen Erloschen des Gesichtsfeldes mit einem Restvisus von 1/15 fuhrte. Eine falsch niedrige Messung des IOD, die fur eine zu spate Erkennung verantwortlich sein konnte, wurde bereits in einzelnen Fallen berichtet. Als Grund muss eine Flussigkeitsansammlung im Interface oder eine stark veranderte Biomechanik nach exzessiver hyperoper LASIK diskutiert werden. Die Notwendigkeit umfassender Untersuchungen nach refraktiver Chirurgie wird betont. Dieser Fall zeigt eine Kaskade von Komplikationen nach LASIK mit Erblindung auf einem Auge.

A 43-year-old male underwent laser-assisted in situ keratomileusis and maintained good vision for 9 years. Later, he developed interface fluid syndrome secondary to steroid-induced glaucoma as a consequence of the use of steroids postoperatively for vitrectomy with silicone oil infusion for retinal detachment and cataract surgery.

Exogenous steroid usage is a documented cause of increase in intraocular pressure in susceptible individuals; with systemic use having a lower propensity than topical. Endogenous hypercortisolism is an uncommon cause of steroid induced glaucoma with few reported cases due to adrenal adenoma, ectopic ACTH production in para-neoplastic syndromes, and pituitary adenomas. We report a case of steroid induced glaucoma occurring due to adrenal hyperplasia with confounding feminizing features which caused a diagnostic dilemma.

This article briefly reviews the literature of steroid-induced ocular hypertension and glaucoma. An insight in the prevalence, risk factors and pathophysiology of this entity can help the clinicians prevent, monitor and treat this secondary form of glaucoma.

M Selim Kocabora, Cemil Yilmazli, Muhittin Taskapili, Gokhan Gulkilik, Sahan DurmazVakif Gureba Education and Research Hospital, Istanbul, TurkeyPurpose: This study evaluates intraocular pressure (IOP) elevation secondary to intravitreal injection of triamcinolone acetonide (IVTA) and discusses its management.Methods: The records of 175 patients who underwent IVTA treatment and regular eye examinations in the period 2003–2006 were reviewed. One hundred and twenty-two of these patients were included in the study, of which 147 eyes that received IVTA (4 mg/0.1 ml) were followed for at least 9 months. Mean IOPs observed after IVTA injection as well as IOP elevations defined as moderate (≥5 mm Hg), important (≥10 mm Hg) and severe (>25 mm Hg) during the follow-up period were evaluated and compared statistically.Results: Overall, the mean IOPs following IVTA injection were statistically significantly higher than the preinjection IOP (15.8 ± 2.6), after the first hour (17.7 ± 2.9), the first week (18.7 ± 4.1), the first month (19.6 ± 6.2), the second month (19.1 ± 6.1), the third month (18.0 ± 4.1), the sixth month (17.3 ± 4.0), and the ninth month (17.0 ± 2.7), but not after the first day (16.3 ± 7.6). Important IOP elevations were observed mostly in the first (17.7%) and second months (10.2%). In 40 (27.7%) eyes, topical antiglaucomatous therapy was needed and 7 later required surgical intervention to lower the IOP. Of the remaining 33 eyes, topical treatment was continued in 14 (9.5%) because of IOPs ≥20 mm Hg.Conclusion: The persistence of IOP elevation beyond the IVTA clearance period and the development of intractable secondary glaucoma requiring surgical intervention substantiate the need for careful consideration of IVTA indication and follow-up.Keywords: intravitreal triamcinolone, intraocular pressure, steroid-induced glaucoma

To study the effect of monotherapy with latanoprost 0.005% on intraocular pressure (IOP) in a prospective nonrandomized clinical trial of patients newly diagnosed with steroid-induced secondary open-angle glaucoma.Eight patients (16 eyes) with newly diagnosed steroid-associated secondary open-angle glaucoma were prescribed latanoprost 0.005% once a day in each eye. The initial IOP before treatment served as an internal control for each eye. Intraocular pressure was remeasured after 1 month of monotherapy with latanoprost. Investigators (WJS) were blinded to initial IOP at the time of remeasurement. After discontinuation of steroids, IOP was rechecked. If IOP was stable, latanoprost was discontinued. Intraocular pressure was rechecked 2 to 4 weeks later to confirm an association with steroid use.Intraocular pressure was significantly decreased after treatment with latanoprost (18.3 +/- 2.8 mm Hg) compared with initial IOP (25.3 +/- 9.1 mm Hg). This change represented a 28% decrease in IOP compared with baseline levels. Average IOP after discontinuation of steroids and latanoprost (17.3 +/- 1.4 mm Hg) did not differ from IOP measured during treatment with latanoprost, but it was significantly less than the initial IOP before treatment. No adverse effects were noted.Monotherapy with latanoprost is safe and effective in patients with steroid-induced glaucoma. Advantages include lack of systemic side effects and convenient once-daily dosing.

PURPOSE To report steroid-induced glaucoma after photorefractive keratectomy (PRK). METHODS A 50-year-old Japanese woman was referred for end-stage glaucoma 9 months after PRK. Topical fluorometholone 0.1% was administered for corneal subepithelial haze in both eyes for 9 months after PRK. Pneumatic non-contact tonometry values of intraocular pressure (IOP) remained normal (range: 11 to 17 mmHg), until she was diagnosed with end-stage steroid-induced glaucoma with extensive restriction in visual fields. At the patient’s initial examination in our hospital, IOP measured by Goldmann applanation tonometry was 34 mmHg in the right eye and 32 mmHg in the left eye, but the estimated IOP as corrected by central corneal thickness measurement was > 40 mmHg in both eyes. RESULTS The patient underwent uneventful bilateral trabeculectomies, resulting in reduction of IOP to CONCLUSIONS The underestimation of IOP after PRK led to advanced visual field loss. Careful evaluation of IOP, optic disc, and visual field tests are indispensable to avoid such a devastating outcome after PRK. [J Refract Surg. 2008;24:413-415.] ABOUT THE AUTHORS From the Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan. The authors have no financial or proprietary interest in the materials presented herein. Correspondence: Takefumi Yamaguchi, MD, Dept of Ophthalmology, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. Tel: 81 33353 1211; Fax: 81 33359 8302; E-mail: yama19770614@hotmail.com Received: February 20, 2007 Accepted: September 5, 2007 Posted online: December 28, 2007

Purpose: The aim of this study was to evaluate the retinal nerve fiber layer (RNFL) thickness in vernal keratoconjunctivitis (VKC) patients who were under long-term topical corticosteroid therapy. Methods: Thirty-six eyes of 36 VKC patients with clear cornea and normal videokeratography and 40 eyes of 40 age-and gender-matched normal children were included in the study. Clinical and demographic characteristics of the patients were noted and detailed ophthalmological examination was performed. Visual acuity (VA), spherical equivalent (SE), axial length (AL) and RNFL thickness measurements were compared between the groups. To correct ocular magnification effect on RNFL, we used Littmann's formula. Results: All VKC patients had history of topical corticosteroid use and the mean duration of the topical corticosteroid use was 23.8 +/- 9.09 months. There was no significant difference between the groups in terms of intraocular pressure (IOP). VKC group had significantly worse VA, greater SE and AL and thinner mean global, superior and inferior RNFL thickness. There were significant negative correlations between the duration of topical corticosteroid use and the mean global, superior and temporal RNFL thickness in VKC group. After correction of magnification effect, VKC group still had thinner mean global, superior and inferior RNFL thickness, and significant difference between the groups in inferior RNFL thickness did not disappear. Conclusion: Significant RNFL thickness difference between the groups suggests a possible effect of long-term corticosteroid use in VKC patients. Because visual field (VF) analysis in pediatric patients is difficult to perform and IOP may be illusive, RNFL thickness measurements in addition to routine examinations in VKC patients may help clinicians in their practice.

Purpose: To evaluate the effect of 0.125% verapamil and 0.5% diltiazem eye drops on intraocular pressure (IOP) in steroid-induced glaucoma in rabbit eyes. Methods: A total of 18 rabbits with steroid-induced glaucoma were divided into three groups (A, B and C; n = 6 each). Right eyes in groups A, B and C received 0.5% diltiazem, 0.125% verapamil and 0.5% timolol eye drops twice daily for 12 days, respectively; whereas, left eyes received distilled water. IOP was measured with Tono-pen XL at baseline, day 4, day 8, and day 12 of treatment. Results: Both 0.5% diltiazem and 0.125% verapamil eye drops significantly reduced IOP compared to control eyes (p < 0.05). Reduction of IOP by 0.5% diltiazem, 0.125% verapamil eye drops were comparable to 0.5% timolol. No surface toxicity or systemic side effects were noted during the study period. Conclusion: Calcium channel blockers, verapamil, and diltia-zem significantly reduced IOP in rabbiteyes. This group of drugs may have a potential role in treatment of glaucoma How to cite this article: Ganekal S, Dorairaj S, Jhanji V, Kudlu K. Effect of Topical Calcium Channel Blockers on Intraocular Pressure in Steroid-induced Glaucoma. J Current Glau Prac 2014;8(1):15-19.

Increased intraocular pressure and glaucoma following corticosteroid therapy are well known issues for the ophthalmologist for more than 50 years. Corticosteroids use has gained popularity in ophthalmology as anti-inflammatory and anti-allergic agents but can have important consequences and should be used only with judicious monitoring. The therapeutic use of corticosteroids can lead to the development of ocular hypertension and iatrogenic open-angle glaucoma in susceptible individuals. It can occur in any age group, either gender and from steroid therapy for any ocular or systemic disease and by any route of administration: topical, systemic or inhaled.

Objective: To assess the efficacy of surgical excision of sub-Tenon triamcinolone acetonide (TA) deposits in the control of steroid-induced glaucoma. Design: Prospective, nonrandomized, interventional case series. Participants: Eighteen eyes of 14 subjects with increased IOP within 6 months of sub-Tenon TA injection who did not respond to medical antiglaucomatous treatment were included in the study. Methods: Under topical anaesthesia, steroid deposits were completely excised and placed in ethyl alcohol for the determination of the TA amount using high-performance liquid chromatography. The patients were followed up for 6 months and a paired-sample t test was used to compare mean IOP before and after excision of sub-Tenon TA deposits. Results: The mean IOP levels before and after the sub-Tenon steroid injections were 15.9 (SD 2.9) mm Hg and 36.4 (SD 8.4) mm Hg, respectively (p < 0.001). IOP levels decreased significantly after the removal of the deposits (mean 15.3 [SD 2.1] mm Hg) (p < 0.001). Within 6 months of follow-up, all glaucoma medications were stopped in 9 subjects without further IOP increase, whereas IOP control in 5 subjects necessitated using glaucoma medications. The median TA amount was found to be 7.35 mg (range 3.3–29.68 mg). IOP decrease after the excision showed no correlation with the amount of TA (p = 0.8). Conclusions: Surgical excision of the sub-Tenon steroid deposit should be considered as the primary treatment for steroid-induced glaucoma refractory to medical treatment.

1981年当初より1990年末までの間,自験例125人の膠原病患者に対して20mg/日以上のプレドニゾロンを使用した.その中で,眼圧上昇と眼症状をきたした12例と紹介例2例の計14例に認められた15エピソードを対象とし,ステロイド投与と眼症状との関連性を検討した. SLEは12例, 13エピソードを占めた.緑内障にとって最も特徴的な症状は目のかすみであり,患者は“霧の中にいるようだ”と訴えた.視力の異常は多くが訴えたが,この症状は緑内障に特異的な症状とは考えられなかった.眼痛や吐き気は長期にわたる眼圧の上昇の後に観察されており,これらはより重篤な症状と考えるべきであると思われた.眼圧の上昇は, 11エピソードではステロイド投与開始より2ヵ月以内に観察されたが,その他の4エピソードでは100日を経過して寛解中に生じた. Acetazolamide (Diamox)あるいはその他の眼科的処方に対する反応は, 10エピソードでは良好であったが, 5症例では減圧術を要した.結論として,今回の検討では,ステロイド投与による眼圧の上昇はSLEに最も多く認められたが, SLEに特異的な副作用ではなかった.また,重篤な眼障害は注意深い眼圧の測定とステロイドを服用中の膠原病患者に対してその危険性を教育しておくことで予防できると思われた.

To evaluate the ocular hypertensive response to repetitive cycles of high-dose systemic corticosteroid in young patients with acute lymphoblastic leukemia (ALL).Five patients up to 6 years of age with ALL who received chemotherapy between November 2003 and March 2005 were examined. As maintenance therapy, they received oral or intravenous dexamethasone 6 to 12 mg/m²/day for 2 weeks, followed by 1-week taparing and 5 weeks break were used in 1 cycle. The duration of maintenance therapy was 15 cycles for 2.5 to 3 years. Comprehensive ophthalmic check-up, including best-corrected visual acuity, intraocular pressure (IOP), and slit-lamp and fundus examinations, were performed.All patients were followed up until final cycle. Symmetrical IOP rise21 mm Hg was observed in all patients. Right IOP increased to a maximum of mean 39.6 ± 7.2 mm Hg. (range: 28 to 47). The range of cycle to reach a maximal IOP was 5th to 11th. All patients were maintained IOP control with antiglaucoma medications. However, 1 patient already had severe glaucomatous optic atrophy at the time of consultation.Systemic corticosteroid in childhood-ALL treatment has a risk for IOP elevation. Periodical and careful ophthalmic check-up is necessary, especially in patients with dexamethasone.

An eight-week general practice based prospective study was carried out to determine the incidence and prevalence of various eye conditions and the frequency of prescription of different topical eye preparations. The most frequently diagnosed eye conditions were infectious conjunctivitis (35%), glaucoma (16%), allergic conjunctivitis (11%), and keratoconjunctivitis sicca (9%). Betamethasone was the fourth most commonly prescribed preparation (9%). Eye preparations containing steroids accounted for 14% of prescriptions. Two cases of steroid induced glaucoma are presented as an illustration of the potential hazards of these preparations. The pathogenesis of steroid induced glaucoma is discussed.

A 3-week-old infant developed buphthalmos and glaucoma after a 1-week course of topical steroid drops. The glaucoma resolved after cessation of the medication. This report underscores the sensitivity of infants and very young children to steroid-related intraocular pressure rises.

Purpose To report a case of severe corticosteroid-induced glaucoma after intravitreal injection of triamcinolone acetate in a 34-year-old man without a history of glaucoma. Design Observational case report. Methods Retrospective review of a clinical case. Results A 34-year-old man acquired visual field defects and severe vision loss in both eyes after intravitreal injection of triamcinolone for diabetic macular edema. Conclusions Intravitreal injection of triamcinolone is a commonly performed treatment for many retinal conditions. This treatment has the potential to cause severe vision loss as a result of intractable corticosteroid-induced glaucoma.

Purpose: To present a case of a unilateral diffuse retinal hemorrhage in a 15-year-old girl, who underwent bilateral trabeculectomy for steroid induced glaucoma. Methods: Despite the maximally tolerable medical treatment, IOP in the right eye remained above 50 mmHg for four months, and was simultaneously elevated in the left eye. So we performed bilateral trabeculectomy. Results: On the first postoperative day, diffuse retinal hemorrhages were observed in the right eye; however, no retinal hemorrhage was found in the left eye. The hemorrhages resolved completely without consequences two months later. Conclusions: In the case of high IOP for a long period, sudden lowering of IOP may acutely increase the blood flow and consequently rupture multiple retinal capillaries because of altered autoregulatory function. Special care is therefore needed to prevent an abrupt fall in IOP before, during, and after surgery, especially when IOP has been highly elevated for an extended period.

Results: Anti-glaucoma eye drops were used in 312 eyes (38%). The anti-glaucoma eye drops were started before 4 weeks postoperatively in 105 eyes (13%) and postoperatively at 5-8 weeks in 86 eyes (10%), at 9-12 weeks in 83 eyes (10%), at 13-16 weeks in 25 eyes (3%) and after 17 weeks in 13 eyes (2%). Conclusions: The overall incidence of increased IOP when treated with 0.1% fluorometholone for 3-6 months after PRK was approximately 38%. The incidence of increased IOP in each month for the first 3 months was almost identical implying that the longer 0.1 fluorometholone was used, the higher incidence of increased IOP occurred. These results can be helpful in educating patients regarding the risk of increased IOP and determining the follow-up period after PRK. J Korean Ophthalmol Soc 2015;56(7):985-991

Purpose To investigate the effect of external trabeculotomy on eyes with steroid-induced glaucoma. Methods We retrospectively analyzed the surgical results of 14 eyes of seven patients that underwent trabeculotomy for the first surgical procedure. All patients had the history of receiving topical or systemic corticosteroids before the rise of intraocular pressure had been noted. Results After an average follow-up of 60.6 +/- 33.5 months, in all of the 14 eyes, intraocular pressure was well controlled below or equal to 21 mm Hg at the final examinations. Conclusions Surgical results of external trabeculotomy remain effective for a long time. It has been shown that the trabeculotomy can be a useful and effective surgical treatment of patients with steroid-induced glaucoma.