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Clinical science
Steroid-induced glaucoma and blindness in vernal keratoconjunctivitis
  1. Sirisha Senthil1,
  2. Monica Thakur1,
  3. Harsha Laxmana Rao2,
  4. Ashik Mohamed3,
  5. Ganesh Babu Jonnadula1,
  6. Virender Sangwan4,
  7. Chandra Sekhar Garudadri1
  1. 1 VST Glaucoma Center, L V Prasad Eye Institute, Hyderabad, India
  2. 2 Department of Glaucoma, Narayana Nethralaya, Bangalore, India
  3. 3 Department of Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
  4. 4 Department of Cornea, L V Prasad Eye Institute, Hyderabad, India
  1. Correspondence to Dr Sirisha Senthil, VST Glaucoma Center, L V Prasad Eye Institute, Hyderabad 500034, India; sirishasenthil{at}lvpei.org

Abstract

Purpose To report the clinical features, treatment outcomes and blindness associated with steroid-induced glaucoma in vernal keratoconjunctivitis (VKC).

Materials and methods Records of patients with VKC, who visited our tertiary centre from 1992 and 2009, were reviewed and those with steroid-induced glaucoma were included in the study. Glaucoma was diagnosed based on intraocular pressure (IOP) ≥22 mm Hg on two consecutive visits (ocular hypertension) and/or glaucomatous optic disc damage. Blindness was defined as best corrected visual acuity of ≤20/400 or visual field <10°.

Results Of the 4062 VKC subjects, 91 (157 eyes) had steroid-induced glaucoma (SIG), showing a prevalence of 2.24%. Of these 87% were men. The median (IQR) age at onset of VKC was 12 years (7–17). At presentation, the median duration of VKC was 48 months (24–72) and the median duration of steroid usage was 24 months (12–36). The median cup-to-disc ratio (CDR) was 0.9 (0.7–0.9) and median mean deviation was −21.9 dB (−30.0 to –10.2). IOP was medically controlled in 66% eyes (104/157) and 34% eyes (53/157) needed glaucoma surgery. High presenting IOP (OR: 1.04; p=0.05) and increased duration of steroid usage (OR: 1.07; p=0.02) were significantly associated with need for glaucoma surgery. At presentation, 29/91 subjects (31.8%) were bilaterally blind due to SIG. Higher CDR at presentation was significantly associated with blindness in this cohort (p=0.02).

Conclusion In this cohort of VKC with SIG, the disease predominantly affected adolescent males. Glaucoma was severe with one-third needing surgery and one-third blind due to SIG.

  • vernal keratoconjunctivitis
  • steroid induced glaucoma
  • steroid responsiveness
  • glaucoma in children
  • glaucoma blindness

https://doi.org/10.1136/bjophthalmol-2019-313988

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    Footnotes

    • Contributors SS contributed in conception, design, acquisition, analysis, interpretation of data, drafting the manuscript and critically revising it. MT contributed in data collection and in writing the manuscript. HLR, AM and GBJ helped with data analysis and interpretation of data. VS contributed in the conception of the study. CSG contributed in revising it critically for important intellectual content to getthe article published.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available in a public, open access repository. There are no data in this work. Data are available upon request. Data may be obtained from a third party and are not publicly available. No data are available. All data relevant to the study are included in the article or uploaded as supplementary information.

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