The most common side effect of topical corticosteroid use is skin atrophy. All topical steroids can induce atrophy, but higher potency steroids, occlusion, thinner skin, and older patient age increase the risk. The face, the backs of the hands, and intertriginous areas are particularly susceptible. Resolution often occurs after discontinuing use of these agents, but it may take months. Concurrent use of topical tretinoin (Retin-A) % may reduce the incidence of atrophy from chronic steroid applications. 30 Other side effects from topical steroids include permanent dermal atrophy, telangiectasia, and striae.
After the plate is attached to the globe, the tube is laid across the cornea and cut with a sharp scissors to create a beveled edge with the opening toward the cornea. The tube should extend approximately to 3 mm into the anterior chamber to minimize the risk of tube-cornea touch or retraction out of the anterior chamber. A 23-gauge needle is used to create a track through which the tube is inserted into the anterior chamber just anterior and parallel to the iris. The tube may be secured to the sclera a few millimeters anterior to the plate with 7- 0 or 8-0 Vicryl suture. This suture helps to stabilize the tube and should not be tight; otherwise, it will restrict flow in valved devices.
Nadia: Sorry for your troubles. You have just described the course of a steroid responder. Your pressure was fine for the first few weeks, but after being on a corticosteroid for several weeks your pressure began to rise. If inflammation is well controlled, most surgeons stop the steroid or switch to a weaker steroid if the pressure is hard to control. If you are on a non-steroidal anti inflammatory (NSAID), it makes it easer to get off of the steroid since these drops will still help control inflammation when the steroid is stopped. Sometimes it takes several months for the steroid pressure elevation to resolve. During that time, maximum medical management is attempted. If a patient already has weakened nerves from glaucoma, sometimes a glaucoma surgery must be used to lower the pressure and protect vision.