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group 12

group 12. Case presentation. 30 YO female Myopia -8.00 RE, -7.5 LE BE PRK 5 w Dexamethazone X 4 / d Visual deterioration, headache IOP 36 RE, 42 LE Haze +1 Treat elevated IOP and STOP topical steroidal treatment. Visual disturbance - why?. Corneal edema d/t acute IOP elevation. Haze +1.

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group 12

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  1. group 12

  2. Case presentation • 30 YO female • Myopia -8.00 RE, -7.5 LE • BE PRK • 5 w Dexamethazone X 4 / d • Visual deterioration, headache • IOP 36 RE, 42 LE • Haze +1 Treat elevated IOP and STOP topical steroidal treatment

  3. Visual disturbance - why? • Corneal edema d/t acute IOP elevation • Haze +1 • Myopic regression • Retinal complications

  4. Post PRK glaucoma • Steroid induced – higher rate of steroid responders in myopia • POAG – higher risk in myopia • Shields “Textbook of Glaucoma”, 4th Edition

  5. The working diagnosis Steroid induced Glaucoma

  6. Is it really that bad? • Myopia -8.0 – ablation of ~100 micron • For 10 micron -> +0.5 mmHg to IOP read • Each 1.0 D -> +0.63 mmHg1 • Estimated IOP RE (36+5)= 41 mmHg LE (42+5)= 47 mmHg • 1. Refractive Surgery, AAO 2004-2005

  7. It is even worse!

  8. Post PRK CS Treatment • Common practice – 4-8w post op • CS -> IOP elevation during 3 month after PRK – 15% • Refractive Surgery, AAO 2004-2005

  9. Treatment options Steroids STOP CONTINUE Anti glaucoma Tx. NSAIDS No treatment

  10. Continue Steroids • Treat haze • Prevent regression • Refractive Surgery, AAO 2004-2005

  11. Treatment options Steroids STOP CONTINUE Anti glaucoma Tx. NSAIDS No treatment

  12. Discontinue Steroids • Haze spontaneous regression 1 • Minimal haze does not require Tx. • The effect of CS on regression & haze is controversial 2 • The patient has already completed 5w Tx. • Refractive Surgery, AAO 2004-2005 • Aras C.” Ophthalmic Surg Lasers” 1998

  13. CS side effects • Glaucoma • Cataract • Microbial keratitis • Keratomycosis • Herpetic keratitis • Delayed wound healing

  14. STOP Steroids • Treat the disease by eliminating its cause • Even less potent CS (FML, Rimexolone) may elevate IOP Nagy ZZ. J Cataract Refract Surg. 2001

  15. Alternatives to steroids • No anti inflammatory treatment at all 1,2 • NSAIDS - more effective in treating haze and regression 3,4 • Other: oral vit.A\E 5 • Tengroth B. Refract Corneal Surg. 1993 • Choi SY. Korean J Opthalmol. 1998 • Nassaralla BA. Opthalmology 1995 • Ferrari M. J Refract Corneal Surg.1994 • Vetrugno M, BJO 2001

  16. Conclusions • Discontinuation of the steroids is mandatory • Continuation of the steroids will result in irreversible damage to the patient as well as to his doctor

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