Minu George, P (2020) A Historical Prospective Observational study of patients with Keratoconus to determine the incidence of steroid induced ocular hypertension following collagen crosslinking. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: Steroids are routinely used after ocular surgeries to reduce the postoperative inflammation. Steroid use however, has been associated with complications like cataract, ocular hypertension and glaucoma. Some eyes have been found to have an increased tendency for steroid response compared to others. 5-6% of the normal population has been found to be high steroid responders (Intraocular Pressure (IOP) elevation of more than 15mmHg) and about 30% to be moderate responders (IOP elevation of 6-15mmHg). Many factors have been identified for steroid response, which includes patient risk factors like family history of glaucoma, primary open angle glaucoma, children, type of steroid used, route of administration and duration of steroid use. Collagen cross linking is a commonly performed procedure to slow the rate of progression of keratoconus. Keratoconus is a progressive degenerative disease of the cornea which can result in loss of vision and need for corneal transplant. Topical steroid drops are always used for a duration of about 3 months following the procedure to prevent post procedure corneal scarring. OBJECTIVES: 1. To determine the incidence of steroid induced ocular hypertension in patients with keratoconus after use of topical steroids following collagen crosslinking (CXL). 2. To study the effect of CXL on Keratometry reading, central corneal thickness, visual acuity 3. To study the complications and outcome of CXL. METHODS: This was a historical prospective study done on patients with keratoconus who had undergone CXL in our department. The data from June, 2013 to August, 2019 was collected from the hospital records and the variables noted included preoperative and postoperative IOP measurement, Keratometry reading, central corneal thickness and visual acuity. Outcomes and complications of CXL were also recorded. Data entry was done in Microsoft Excel and analysis done by SPSS software 21 version. RESULTS: Incidence of steroid induced ocular hypertension in keratoconus patients post CXL was 34% and is comparable with the incidence of steroid response in normal population. There were no associations between rise in IOP with age, gender, type of steroid, type of riboflavin or type of protocol used for CXL. Keratometry readings and CCT were stable/reduced after CXL in 80% and 72% respectively. Complications with CXL were corneal subepithelial scar / haze (33%) and corneal infiltrate(2%). Glasses were most preferred (65%) among the patients post CXL. RoseK lenses and RGP s gave almost all patients vision of 6/9 or better. CONCLUSION: 1. There is no increased incidence of steroid induced hypertension, or steroid response over that of the normal population in patients with keratoconus on topical steroids following had Collagen Crosslinking. 2. The keratometry readings reduced or remained stable for the time duration following CXL that was studied. 3. The major complications following CXL was Corneal subepithelial scarring . This however, did not affect the vision in any patient.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221813303 |
| Uncontrolled Keywords: | Keratoconus, Corneal collagen crosslinking, steroid induced ocular hypertension, Keratometry, central corneal thickness. |
| Subjects: | MEDICAL > Ophthalmology |
| Depositing User: | Subramani R |
| Date Deposited: | 14 Feb 2021 14:54 |
| Last Modified: | 14 Feb 2021 14:54 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14196 |
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