Steroid-induced ocular hypertension in Asian children with severe vernal keratoconjunctivitis

Marcus Ang,¹ Seng-Ei Ti,¹ Raymond Loh,¹ Sonal Farzavandi,¹ Rongli Zhang,² Donald Tan,¹ Cordelia Chan<sup>1

1</sup>Singapore National Eye Centre, Singapore; ²Singapore Eye Research Institute, Singapore

Background: We describe clinical characteristics and risk factors for corticosteroid response in children with severe vernal keratoconjunctivitis (VKC).
Design: Retrospective, noncontrolled, comparative case series.
Participants: Patients from three tertiary centers in Singapore.
Methods: We reviewed patients with severe VKC (clinical grade > 2) who were on topical steroid therapy, with a minimum follow-up period of 1 year post-presentation. Logistic regression was used to determine risk factors for corticosteroid response.
Main outcome measure: Corticosteroid response was defined as intraocular pressure (IOP)>21 mmHg (three consecutive readings), or a rise of more than 16 mmHg from baseline, after commencement of steroid therapy in the absence of other possible causes of raised IOP.
Results: Forty-one of 145 (28.3%) patients developed a corticosteroid response, of which eight (5.5%) progressed to glaucoma. The overall mean age of onset of VKC was 9.9 ± 4.4 years. Longer duration of corticosteroid use (OR, 5.06; 95% CI: 1.04–25.56; P = 0.45) and topical dexamethasone 0.01% (OR, 2.25; 95% CI: 1.99–5.08; P = 0.40) were associated with corticosteroid response. Mixed type of VKC (OR, 9.76; 95% CI: 3.55–26.77; P < 0.001), the presence of limbal neovascularization of ≥ three quadrants (OR, 6.33; 95% CI: 2.36–16.97; P < 0.001), and corneal involvement (OR, 3.51; 95% CI: 1.31–9.41; P = 0.012) were significant clinical risk factors after adjusting for potential confounders such as age, sex, ethnicity, duration, and type of corticosteroid used.
Conclusion: Children on long-term oral corticosteroids with severe, mixed-type VKC and corneal involvement are more likely to develop corticosteroid response, and may require early treatment to prevent progression to glaucoma.

Keywords: vernal keratoconjunctivitis, glaucoma, steroids