Risk factors for steroid response among cataract patients

To evaluate the age and ocular axial length (AL) of topical steroid responders after uneventful cataract surgery.

Private practice, Los Altos, California, USA.

Case-control study.

This retrospective chart review comprised consecutive patients from a single-surgeon practice who had cataract surgery during a 2-year period. All patients routinely received topical prednisolone acetate 1.0% postoperatively. In addition to AL and patient age, the intraocular pressure (IOP) was recorded preoperatively, 1 day postoperatively, and at least 1 additional time in the first postoperative month while the patient was taking a topical corticosteroid agent. A steroid response was defined as an IOP increase greater than 25% while on topical prednisolone (minimum 28 mm Hg) followed by a decrease of more than 25% after topical prednisolone was discontinued. The age and AL were compared between steroid responders with nonresponders.

Of the 1642 patients, 39 were diagnosed as steroid responders. Younger age and a longer AL were associated with a higher risk for steroid response, particularly in patients younger than 65 years with an AL of at least 29.0 mm. These patients had a 39-fold increased risk for an IOP higher than 28 mm Hg and a 35-fold increased risk for an IOP higher than 35 mm Hg than patients older than 65 years with a normal AL.

Younger patients with high myopia had a higher risk for a postoperative steroid response after uneventful cataract surgery and may require more frequent IOP monitoring or alternative topical antiinflammatory medications.

No author has a financial or proprietary interest in any material or method mentioned.