Corticosteroid‐induced glaucoma in pediatric patients with hematological malignancies

Abstract

Background Corticosteroids, especially dexamethasone, play a critical role in chemotherapy for pediatric hematological malignancies. We previously observed that patients with complaints of headache or photophobia during corticosteroid administration had high intraocular pressure (IOP). Procedure We measured IOP during corticosteroid administration in 15 patients with acute leukemia or lymphoma undergoing treatment at our institution from January 2016 to December 2018. IOP was measured by an ophthalmologist within seven days of the initiation of standard dose of corticosteroid, which was defined as 60 mg/m2/day for prednisolone and 10 mg/m2/day for dexamethasone. Results Fifteen patients received 52 courses of chemotherapy containing corticosteroids. IOP exceeded 21 mmHg among 13 patients in 28 courses. Twelve of the 13 patients were administered topical treatment, and six of the 12 patients needed additional diuretic agents. IOP during the chemotherapy courses containing dexamethasone was significantly higher compared with IOP during the chemotherapy courses containing prednisolone. Only two patients complained of symptoms, such as headache and photophobia, and one of the two patients underwent trabeculotomy. Funduscopic findings were normal in all patients. There was a dose‐associated decrease in IOP with reduction of dexamethasone dose. Conclusions IOP should be measured during administration of substantial corticosteroid doses even in patients with no symptoms. Further investigations regarding the level of IOP for intervention need to be conducted.

Elevated intraocular pressure in children with acute lymphoblastic leukaemia: A prospective study

“…Since all children with ALL, regardless of their ALL phenotype, receive high‐dose dexamethasone therapy during the delayed intensification period, these findings raise grave concerns about the potential development of OHT. Our results are in line with previous reports indicating a higher prevalence of OHT in children treated with dexamethasone compared to prednisone 33 …”

“…Our results are in line with previous reports indicating a higher prevalence of OHT in children treated with dexamethasone compared to prednisone. 33 Other factors that were associated with OHT in our cohort, in agreement with previous reports, were elevated BMI 36 and a family history of glaucoma. In addition, we report three novel findings associated with OHT in this setting.…”

“…Studies of prolonged systemic GC therapy focused mainly on children with nephrotic syndrome, with a reported OHT incidence of 2–20% 27–30 . The limited number that evaluated children treated for haematological malignancies were all conducted on small, heterogeneous patient groups and yielded inconsistent results 31–33 . Overall, prevalence rates of OHT associated with systemic GC therapy in children are assumed to be underreported, 8,19 possibly because of the asymptomatic nature of even clinically significant OHT 31,34,35 …”

“…[27][28][29][30] The limited number that evaluated children treated for haematological malignancies were all conducted on small, heterogeneous patient groups and yielded inconsistent results. [31][32][33] Overall, prevalence rates of OHT associated with systemic GC therapy in children are assumed to be underreported, 8,19 possibly because of the asymptomatic nature of even clinically significant OHT. 31,34,35 Our study includes the largest cohort of children with newly diagnosed ALL to date in whom IOP was prospectively and uniformly measured at diagnosis and thereafter at 15 and 33 days of high-dose steroid administration.…”

Risk of ocular hypertension in children treated with systemic glucocorticoid

“…Young age has been shown to be a considerable risk factor for ocular hypertension in children treated with topical steroid, and was also, in the present study, found to be a risk factor for systemic treatment since steroid responders were significantly younger than nonresponders. A similar observation was made by Sugiyama et al (2019) but not found by Hayasaka et al (2006).…”