title: Steroid-induced ocular hypertension in Asian children with severe vernal keratoconjunctivitis.
abstract: BACKGROUND
  We describe clinical characteristics and risk factors for corticosteroid response in children with severe vernal keratoconjunctivitis (VKC).
  
  
  METHODS
  Retrospective, noncontrolled, comparative case series.
  
  
  METHODS
  Patients from three tertiary centers in Singapore.
  
  
  METHODS
  We reviewed patients with severe VKC (clinical grade > 2) who were on topical steroid therapy, with a minimum follow-up period of 1 year post-presentation. Logistic regression was used to determine risk factors for corticosteroid response.
  
  
  METHODS
  Corticosteroid response was defined as intraocular pressure (IOP) >21 mmHg (three consecutive readings), or a rise of more than 16 mmHg from baseline, after commencement of steroid therapy in the absence of other possible causes of raised IOP.
  
  
  RESULTS
  Forty-one of 145 (28.3%) patients developed a corticosteroid response, of which eight (5.5%) progressed to glaucoma. The overall mean age of onset of VKC was 9.9 ± 4.4 years. Longer duration of corticosteroid use (OR, 5.06; 95% CI: 1.04-25.56; P = 0.45) and topical dexamethasone 0.01% (OR, 2.25; 95% CI: 1.99-5.08; P = 0.40) were associated with corticosteroid response. Mixed type of VKC (OR, 9.76; 95% CI: 3.55-26.77; P < 0.001), the presence of limbal neovascularization of ≥ three quadrants (OR, 6.33; 95% CI: 2.36-16.97; P < 0.001), and corneal involvement (OR, 3.51; 95% CI: 1.31-9.41; P = 0.012) were significant clinical risk factors after adjusting for potential confounders such as age, sex, ethnicity, duration, and type of corticosteroid used.
  
  
  CONCLUSIONS
  Children on long-term oral corticosteroids with severe, mixed-type VKC and corneal involvement are more likely to develop corticosteroid response, and may require early treatment to prevent progression to glaucoma.
authors.affiliation: Singapore National Eye Centre, Singapore.
authors.forename: Marcus
authors.initials: M
authors.lastname: Ang
authors.forename: Seng-Ei
authors.initials: SE
authors.lastname: Ti
authors.forename: Raymond
authors.initials: R
authors.lastname: Loh
authors.forename: Sonal
authors.initials: S
authors.lastname: Farzavandi
authors.forename: Rongli
authors.initials: R
authors.lastname: Zhang
authors.forename: Donald
authors.initials: D
authors.lastname: Tan
authors.forename: Cordelia
authors.initials: C
authors.lastname: Chan