Conflict/competing interest: None declared.
Severe vernal keratoconjunctivitis requiring trabeculectomy with mitomycin C for corticosteroid-induced glaucoma
Article first published online: 26 JUL 2011
© 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists
Clinical & Experimental Ophthalmology
Volume 40, Issue 4, pages e149–e155, May/June 2012
How to Cite
Ang, M., Ho, C.-L., Tan, D. and Chan, C. (2012), Severe vernal keratoconjunctivitis requiring trabeculectomy with mitomycin C for corticosteroid-induced glaucoma. Clinical & Experimental Ophthalmology, 40: e149–e155. doi: 10.1111/j.1442-9071.2011.02591.x
Funding sources: None declared.
- Issue published online: 14 JUN 2012
- Article first published online: 26 JUL 2011
- Accepted manuscript online: 17 MAY 2011 02:10AM EST
- Received 23 December 2010; accepted 26 April 2011.
- vernal keratoconjunctivitis
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.