Incidence of steroid-induced ocular hypertension following collagen cross-linking in patients with keratoconus

Abstract Purpose: Collagen cross-linking (CXL) is commonly performed to halt/delay the progression of keratoconus (KC). Topical steroid drops are used at relatively high doses post-CXL to prevent postprocedure corneal scarring. Many factors have been previously identified for steroid response, including family history of glaucoma, age, steroid type, route of administration, and duration of use. This study determines the incidence of steroid-induced ocular hypertension in patients with KC after the use of topical steroids following CXL. Materials and Methods: This was a retrospective study done on patients who underwent CXL from June 2013 to August 2019 at a tertiary eye care institution in South India. Preoperative and postoperative intraocular pressure (IOP) measurement, type, and duration of steroid use were analyzed. Results: Ninety-four eyes were studied. Of the 94 eyes, 32 (34%) were steroid responders (SRs, post-CXL IOP rise >5 mmHg or absolute IOP >21 mmHg). Among the SRs, 24 patients (25.5%) had an increase in IOP (compared to pre-CXL value) between 6 and 10 mmHg, 7 (7.4%) had an increase in IOP between 10 and 15 mmHg, and only one (1.1%) had a marked increase in IOP (>15 mmHg). Only 11.7% of the 94 subjects had IOP >21 mmHg and were started on antiglaucoma medications. There was no difference in steroid response post-CXL based on age, gender, type of steroid, type of riboflavin, or type of protocol used for CXL. Conclusion: We found that there is no increased incidence of SRs over that of the normal population in patients with KC following CXL.