title: Do topical ophthalmic corticosteroids suppress the hypothalmic-pituitary-adrenal axis in post-penetrating keratoplasty patients?
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Ophthalmology, Royal Victoria Infirmary, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: S S
authors.initials: SS
authors.lastname: Sandhu
authors.forename: J M
authors.initials: JM
authors.lastname: Smith
authors.forename: M
authors.initials: M
authors.lastname: Doherty
authors.forename: A
authors.initials: A
authors.lastname: James
authors.forename: F C
authors.initials: FC
authors.lastname: Figueiredo
mesh_terms: D000287:Administration, Topical; D000309:Adrenal Insufficiency / Q000097:blood / Q000139:chemically induced; D005260:Female; D005469:Fluorometholone / Q000008:administration & dosage; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects*; D015948:Keratoplasty, Penetrating; D008297:Male; D009883:Ophthalmic Solutions; D010913:Pituitary-Adrenal System / Q000187:drug effects*; D011184:Postoperative Period; D011239:Prednisolone / Q000008:administration & dosage; D011245:Pregnadienes / Q000008:administration & dosage; D011446:Prospective Studies
chemical_list: D005938:Glucocorticoids; D009883:Ophthalmic Solutions; D011245:Pregnadienes; D011239:Prednisolone; C013769:rimexolone; D005469:Fluorometholone; D006854:Hydrocortisone