Steroid Response After Cataract Surgery Higher for Patients With Glaucoma

In eyes with and without glaucoma, researchers say the incidence of steroid response with prednisolone acetate 1% is low. However, the Journal of Glaucoma investigation also shows those with glaucoma are 3.72 times more likely to have a response than those without the disease.

The researchers evaluated incidence and risk factors for topical steroid response after uneventful cataract surgery. Steroid response, defined as intraocular pressure (IOP) at least 50% above the baseline measurement in the weeks following cataract surgery, was the main outcome. The study included 472 nonglaucoma eyes and 191 glaucoma eyes of patients undergoing cataract surgery between 2007 and 2016. All patients had postoperatively received topical prednisolone acetate 1% on a routine basis.

The study shows 2.1% (n=10) of nonglaucoma eyes and 8.4% (n=16) of glaucoma eyes were diagnosed as steroid responders (P <.001). Also, longer axial length (AL) and younger age were associated with a higher incidence of steroid response in patients without glaucoma (P <.003), whereas in patients with glaucoma, longer AL and more preoperative medications were associated with steroid response (P <.03). For both groups, steroid response was associated with an AL of 26 mm or larger (P <.024).

The incidence of a steroid response after uneventful phacoemulsification with topical prednisolone acetate 1% use postoperatively was only 2.1%, while in glaucoma eyes, it was 8.4%. The researchers note that, while this number is higher than that of nonglaucoma eyes, it was still lower than in previous findings. Additionally, they explain that the use of percentages to show these values is for the sake of consistency with past glaucoma literature.

“It also accounts for the severity of the patient’s glaucoma,” the study explains. “Previously we have shown that among 4 IOP spike definitions, the percentage change criteria included >70% of patients that had fulfilled one of the IOP spike definitions, primarily omitting some eyes with IOP elevation >5mm Hg, which is the most conservative definition.”

Study limitations included its retrospective nature and long timespan, which may have accounted for inaccuracies in data availability and changes in equipment. Another limitation was its generalizability due to the fact that more than 50% of participants were White. 

Reference

Bojikian KD, Nobrega P, Roldan A, Forrest SL, Tsukikawa M, Chen PP. Incidence of and risk factors for steroid response after cataract surgery in patients with and without glaucoma. J Glaucoma. 2021;30(4):e159-e163. doi:10.1097/IJG.0000000000001785