Topical corticosteroids, essential to prevent graft rejection after keratoplasty, raise intraocular pressure in a proportion of patients, sometimes within weeks. A steroid response can damage the optic nerve silently, and corneal changes after surgery can make applanation readings less reliable.
Measuring pressure at each visit, and considering a lower-potency steroid when it rises, catches most problems before the nerve is harmed.
- Measure intraocular pressure at every postoperative visit while topical steroids continue.
- Consider switching to a lower-potency steroid if pressure rises, balancing rejection risk.
- Interpret applanation readings cautiously on an oedematous or irregular cornea.
- Examine the optic disc periodically, not just the pressure.
Why it matters
Steroid-induced pressure rise is silent and treatable, but only if it is measured.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for ophthalmology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free