Corticosteroid-induced intraocular pressure elevation in keratoconus is common following uncomplicated penetrating keratoplasty

Aims To determine the incidence of postkeratoplasty intraocular pressure (IOP) elevation in the eyes of subjects with keratoconus and establish the relationship between IOP and corticosteroid administrations in this population. Methods Following strict inclusion/exclusion criteria, a retrospective analysis was performed on a consecutive series of penetrating keratoplasties performed for keratoconus observing a standardised surgical and postoperative regimen in Auckland, New Zealand. Patient demographics, ocular, medical, and family history, and pre- and postoperative data were recorded until 12 months postkeratoplasty. Results In all, 57 eyes of 48 patients were included-31% New Zealand Europeans, 42% Pacific people, 15% Maori, and 12% other. Eighteen eyes (32%) of 17 patients (35%) exhibited elevated IOP and 12 (21%) eyes exhibited moderate-to-severe elevation of IOP. IOP elevation occurred 3-6 months postkeratoplasty in 78% of eyes. Elevated IOP was significantly less common in Maori and Pacific peoples (P = 0.02). All eyes except one required reduction/cessation of corticosteroids to normalise IOP. Conclusions The incidence of presumed steroid-related postkeratoplasty IOP elevation, in 35% of subjects with keratoconus, is markedly higher in this New Zealand study than previously reported in the US and UK studies. Further clinical and genetic analysis of associations between keratoconus and steroid-induced IOP elevation and glaucoma might improve our current understanding of this condition. Eye (2009) 23, 2056-2062; doi:10.1038/eye.2008.413; published online 20 March 2009