title: Severe vernal keratoconjunctivitis requiring trabeculectomy with mitomycin C for corticosteroid-induced glaucoma.
abstract: BACKGROUND
  To describe clinical features of severe vernal keratoconjunctivitis with steroid response in Asian children and risk factors for glaucoma filtration surgery.
  
  
  METHODS
  Retrospective non-controlled, comparative case series.
  
  
  METHODS
  Patients with severe vernal keratoconjunctivitis seen at a single centre over 6 years.
  
  
  METHODS
  Clinical features, symptoms and treatment modalities were recorded for patients (i) diagnosed with severe VKC (clinical grade ≥ 3); (ii) had >2 recordings of increased intraocular pressures of >21 mmHg; (iii) and a minimum follow-up period of 1 year post-presentation.
  
  
  METHODS
  Corticosteroid-induced glaucoma requiring trabeculectomy with mitomycin-C.
  
  
  RESULTS
  Six patients (eight eyes) of 36 patients required trabeculectomy/mitomycin-C. All were male. Mean age of disease onset was 9.3 ± 4.5 years for a mean duration of 6.08 ± 3.5 years. Mean intraocular pressures increase from baseline was 29.0 ± 8.2 mmHg and all required >2 anti-glaucoma medications. The main risk factor for trabeculectomy was a greater increase in intraocular pressures from baseline (odds ratio 1.3; 95% confidence interval, 1.0-1.5; P = 0.011), which was independent of potential confounders such as type and duration of corticosteroid use. Comparing eyes pre- and post-trabeculectomy, all improved in clinical severity of vernal keratoconjunctivitis (mean clinical grade improvement 2.1; 95% confidence interval, 1.3-3.0; P < 0.001) and reduced dependence on topical corticosteroids for mean duration of 22.5 ± 15.3 months.
  
  
  CONCLUSIONS
  In our study, patients with a 'greater steroid response', that is, higher increase in intraocular pressures from baseline are associated with a 30% higher risk toftrabeculectomy.
authors.affiliation: Singapore National Eye Centre, Singapore.
authors.forename: Marcus
authors.initials: M
authors.lastname: Ang
authors.forename: Ching-Lin
authors.initials: CL
authors.lastname: Ho
authors.forename: Donald
authors.initials: D
authors.lastname: Tan
authors.forename: Cordelia
authors.initials: C
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D000477:Alkylating Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003233:Conjunctivitis, Allergic / Q000188:drug therapy*; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use; D005469:Fluorometholone / Q000009:adverse effects / Q000627:therapeutic use; D005902:Glaucoma, Open-Angle / Q000139:chemically induced / Q000601:surgery*; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage*; D011239:Prednisolone / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D014065:Tonometry, Ocular; D014130:Trabeculectomy; D014792:Visual Acuity
chemical_list: D000477:Alkylating Agents; D005938:Glucocorticoids; D016685:Mitomycin; D003907:Dexamethasone; C009935:prednisolone acetate; D011239:Prednisolone; D005469:Fluorometholone