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ARTICLES
Year : 1973  |  Volume : 21  |  Issue : 3  |  Page : 108-111

Topical corticosteroids and intraocular pressure in high myopia. II. Study relationship of pressure response to age, diopteric power, degenerative changes in eye and scleral rigidity


Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
I S Jain
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


PMID: 4500000

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How to cite this article:
Jain I S, Amba S K, Gupta S D. Topical corticosteroids and intraocular pressure in high myopia. II. Study relationship of pressure response to age, diopteric power, degenerative changes in eye and scleral rigidity. Indian J Ophthalmol 1973;21:108-11

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Jain I S, Amba S K, Gupta S D. Topical corticosteroids and intraocular pressure in high myopia. II. Study relationship of pressure response to age, diopteric power, degenerative changes in eye and scleral rigidity. Indian J Ophthalmol [serial online] 1973 [cited 2021 May 8];21:108-11. Available from: https://www.ijo.in/text.asp?1973/21/3/108/31399

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Table 2

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Table 1

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Table 1

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Higher prevalence of chronic simple glaucoma in high myopes has been suggested by various authors. (GOLDMAN [6] LEHRFELD AND ROBER [8] ). The raised intraocular pressure has been blamed by many authors to cause stretching of the eye ball leading to myopia. DIAZ[4] on the other hand suggested that the increased intraocular tension had been due to degenerative changes similar to those occuring in choroid and retina, in the filtration angle resulting in increased resistance to outflow. Later DIAZ [5] suggested that the two entities may be genetically determined and transmitted by separate or allied genes.

It is quite often seen that degenera­tive changes in the fundus of myopes do not run parallel to the dioptric power of the eyes. There may be marked degenerative changes in mild to moderate degrees of myopia and there may be no degenerative changes in high degrees of myopia. This led various authors. [1],[5],[7] to believe that degenerative changes are governed by separate gene other than that govern­ing the state of refraction. It was thought that the study of steroid response may help to locate this gene in association with chronic simple glaucoma. Further study of relation­ship of steroid response with age, dioptric power, degenerative changes in the fundus, family history of myopia and scleral rigidity may help to throw some light on the progression of myopia and possible prediction of the development of progressive myopia and degenerative changes in the eye.


  Material and Methods Top


Fifty subjects of high myopia with refractive error of more than 6 D were selected. They had clinically normal eyes, and were not suffering from chronic simple glaucoma. The age of the patients varied from 14 to 80 years, majority of them below 30 years of age. The refractive error varied from 6 to 22 D, family history of myopia was forthcoming in 44% of the subjects, 28 eyes showed degenerative changes of various degrees in the fundus.

The intraocular pressure was taken with Schiotz tonometer using the two weight method. The calculation of intraocular pressure, and scleral rigidity was made from Friedenwald's nomogram (1955). Intraocular pres­sure was taken on two occasions at about the same time usually in the mornings between 9 AM to 12 noon and an average of two readings was taken as base pressure. The mean intraocular pressure was 16.24 mm Hg with S. D. 2.69 and mean scleral rigidity was 0.0163. The 28 eyes with degenerative changes showed mean intraocular pressure of 15.63 mm Hg.

These subjects were instructed to use betamethasone 0.1% (Betnesol­`n' eye drops - Glaxo) four times a day in one or both eyes and the tension was checked once a week for a period of 6 weeks. Three subjects who showed sharp rise of tension early during the study were instructed to stop medication. Subjects showing pressure response were followed after stoppage of medicine till the pressure came to normal. Thus 77 eyes were subjected to steroid provocative test.


  Observations Top


The mean intraocular pressure after 6 weeks of treatment was 22.95 mm Hg with S. D. 6.34 showing a significant rise in intraocular pressure of 6.12 mm Hg (p < 0.01). The scleral rigidity fell to 0.0129. The pressure difference at four and six weeks interval is shown in Bar diagram [Figure 1]. The intraocular pressure in the 28 eyes showing degenerative changes was 22.94 showing a mean rise of 7.60 mm Hg as compared to 5.03 shown by eyes without degenera­tive changes, indicating three levels of response. When this response was categorized on the basis of magnitude of rise of tension, 48%, showed a rise of 6-15 mm (moderate), and 12% showed a rise of 16 mm or above (High responders) [Table - 1].

[Table - 2] shows the preponderance of steroid responders in different age groups showing a distinct higher preponderance of responders in the older age groups.

[Table - 3] shows the relationship of steroid responders to dioptric power. The higher refractive error groups are showing a distinct higher value.

[Table - 4] shows the relationship of steroid responders to degenerative changes in the fundus. Eighty-nine percent of the eyes have shown a positive response.

[Table - 5] shows that the presence of family history of myopia in the family did not produce any difference on the steroid response.


  Discussion Top


The higher preponderance of responders (60%) in high myopes as against 30% responders in the general population [2],[3](BECKER AND MILLS; [3] ARMALY [2] ) indicates a definite rela­tionship of high myopia to chronic simple glaucoma. The presence of 12% high responders is 3 times more as compared to 4% in normal population. [2],[3] Although the incidence of chronic simple glaucoma may not be that high as compared to normal population, it certainly indicates a greater risk to chronic simple glaucoma in high myopes.

This preponderance of responders is significantly higher in the older age group, higher refractive error group and in eyes showing degenerative changes in the fundus. The maximum effect had been in eyes showing degenerative changes in the fundus. This could mean an association of glaucoma gene with the gene deter­mining degenerative changes in a myopic eye. Both may be present on the same chromosome as suggest­ed by DIAZ [4] It is unlikely that degenerative changes occur due to the increase in intraocular pressure because the mean intraocular pressure in such eyes was 15.63 mm Hg which is rather on the lower side of 16.24 mm Hg for the whole group. So it is most likely that degenerative changes are determined by a separate gene other than determining refractive error and this gene could be detected by study of the steroid provocative test due to its association with glaucoma gene. The value of this test to forecast degenerative changes in myopia can be strongly postulated. Further con­firmation of this hypothesis will come when such cases are followed over a number of years.


  Conclusions Top


The study of intraocular pressure response to topical corticosteroids in high myopes reveals significantly higher response in older age groups, in higher refractive error groups and in eyes showing degenerative changes. Maximum responders were found in eyes with degenerative changes. The steroid provocative test may predict the development of degenerative changes in a myopic eye and progres­sive myopia by showing significant pressure response.

 
  References Top

1.
Agarwal, L. P.; Khosla, P. K. and Angra, S. K.: Aetiopathogenesis of Developmental Myopia. Oriental Arch. of Ophth. 5: 85-93, 1967.  Back to cited text no. 1
    
2.
Armaly, M. F.: Statistical attributes of the steroid hypertensive response in the clinically normal eye I. The demonstration of three levels of response. Invest. Ophth. 4: 187, 1965.  Back to cited text no. 2
    
3.
Becker, B.; and Mills, D. W.: Corticosteroids and intraocular pres­sure. Arch. Ophth. 70: 500, 1963.  Back to cited text no. 3
    
4.
Diaz, D. D.: Quoted by Podos et al (1966). High myopia and primary open angle glaucoma. Amer. J. Ophth. 62: 1039, 1961.  Back to cited text no. 4
    
5.
Diaz, D. D.: Abstract. Excerpta Medica Ophth. 21: 112 (962), 1967.  Back to cited text no. 5
    
6.
Goldmann, H.: Quoted by Black, R. K. (1965). Glaucomatous disc in degenerative myopia. Trans Ophth. Soc. U. K., 85: 161, 1963.  Back to cited text no. 6
    
7.
Jain, I. S. and Singh, Kapalmit.: A clinical study of High Myopia II. Orient Arch. of Ophth. 5: 78-78 (1967).  Back to cited text no. 7
    
8.
Lehrfeld, L. and Rober, J.: Glau­coma at Wills' Hospital. Arch. Ophth., (Chicago) 18: 712.  Back to cited text no. 8
    



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]



 

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Material and Methods
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