Do topical ophthalmic corticosteroids suppress the hypothalmic-pituitary-adrenal axis in post-penetrating keratoplasty patients?

Eye (Lond). 2012 May;26(5):699-702. doi: 10.1038/eye.2012.12. Epub 2012 Feb 17.


Purpose: To establish whether hypothalmic-pituitary-adrenal axis suppression is possible secondary to long-term topical ophthalmic corticosteroid use in patients who have undergone penetrating keratoplasty (PKP).

Methods: Patients who had undergone a PKP and had been using corticosteroid-based eye drops continuously for more than 6 months, with no history of concomitant steroid (oral, inhaled, or cutaneous) use, were included within the study. A low-dose short Synacthen (LDSST) test was performed in each patient followed later by a short Synacthen test (SST). The mean SST and LDSST after 30 min were calculated along with their corresponding 95% confidence intervals (CIs). Correlation between both baseline SST and baseline LDSST with duration of treatment was determined using Spearman's correlation.

Results: In all, 20 patients were included within the study. The mean duration treatment was 28.2 months (range 11-96 months). All patients had normal baseline cortisol levels in both SST and LDSST tests. The mean 30 min SST was 753.8 nmol/l (95%CI: 696.6 nmol/l, 811.0 nmol/l) and no patients displayed inadequate adrenal response. The mean 30 min LDSST was 709.8 nmol/l (95%CI: 665.1 nmol/l, 754.5 nmol/l) and only one patient had an inadequate adrenal response. There was no correlation between baseline SST or LDSST and duration of treatment.

Conclusions: This study found no evidence that patients using continuous long-term corticosteroid eye drops after PKP experienced inadequate adrenal response. We did not find any evidence of a negative correlation between length of treatment and SST or LDSST measurements at baseline.

MeSH terms

  • Administration, Topical
  • Adrenal Insufficiency / blood
  • Adrenal Insufficiency / chemically induced
  • Female
  • Fluorometholone / administration & dosage
  • Glucocorticoids / administration & dosage*
  • Glucocorticoids / adverse effects
  • Graft Rejection / prevention & control*
  • Humans
  • Hydrocortisone / blood
  • Hypothalamo-Hypophyseal System / drug effects*
  • Keratoplasty, Penetrating*
  • Male
  • Ophthalmic Solutions
  • Pituitary-Adrenal System / drug effects*
  • Postoperative Period
  • Prednisolone / administration & dosage
  • Pregnadienes / administration & dosage
  • Prospective Studies


  • Glucocorticoids
  • Ophthalmic Solutions
  • Pregnadienes
  • Prednisolone
  • rimexolone
  • Fluorometholone
  • Hydrocortisone