Prospective, long-term evaluation of steroid-induced glaucoma

Purpose To evaluate the intraocular pressure (IOP) after cessation of steroid use in steroid-induced glaucoma and its control with medication or surgery. Methods Thirty-four eyes of 34 patients having steroid-induced glaucoma were prospectively evaluated after cessation of steroid for IOP, visual acuity, and optic disc status at 3 months, and every 3 months for 18 months. Results Topical steroid use (73.5%) was the most frequent cause for glaucoma. The baseline IOP was 35.47 +/- 12.59 mmHg. The baseline vertical cup-disc ratio correlated with duration of steroid use (P=0.014) and the baseline IOP (P < 0.0001). In 25 patients ( 73.5%), IOP could be controlled by topical medications alone, whereas nine patients (26.5%) required surgery. The mean baseline IOP in eyes requiring surgery was 49.67 +/- 13.28 mmHg and in eyes managed medically, 30.36 +/- 7.51 mmHg (P=0.002). The vertical cup-disc ratio in surgically treated patient was 0.87 +/- 0.13:1 as compared to 0.71 +/- 0.15:1 (P=0.012) in the medically treated group. At 6, 12, and 18 months follow-up, 22 (64.7%), 33 (97.1%), and all 34 (100%) patients were off treatment, respectively. Conclusions Patients with steroid-induced glaucoma, who were <= 20 years old, with a higher IOP, and greater glaucomatous optic neuropathy, were more likely to need surgery. After cessation of steroid therapy, all eyes were off treatment at 18 months.