Risk factors for steroid response among cataract patients

Abstract

Purpose: To evaluate the age and ocular axial length (AL) of topical steroid responders after uneventful cataract surgery.

Setting: Private practice, Los Altos, California, USA.

Design: Case-control study.

Methods: This retrospective chart review comprised consecutive patients from a single-surgeon practice who had cataract surgery during a 2-year period. All patients routinely received topical prednisolone acetate 1.0% postoperatively. In addition to AL and patient age, the intraocular pressure (IOP) was recorded preoperatively, 1 day postoperatively, and at least 1 additional time in the first postoperative month while the patient was taking a topical corticosteroid agent. A steroid response was defined as an IOP increase greater than 25% while on topical prednisolone (minimum 28 mm Hg) followed by a decrease of more than 25% after topical prednisolone was discontinued. The age and AL were compared between steroid responders with nonresponders.

Results: Of the 1642 patients, 39 were diagnosed as steroid responders. Younger age and a longer AL were associated with a higher risk for steroid response, particularly in patients younger than 65 years with an AL of at least 29.0 mm. These patients had a 39-fold increased risk for an IOP higher than 28 mm Hg and a 35-fold increased risk for an IOP higher than 35 mm Hg than patients older than 65 years with a normal AL.

Conclusion: Younger patients with high myopia had a higher risk for a postoperative steroid response after uneventful cataract surgery and may require more frequent IOP monitoring or alternative topical antiinflammatory medications.

Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned.