Effect of Corticosteroids on Cataract Formation

Skalka, Harold W.; Prchal, Josef T.

doi:10.1001/archopht.1980.01020040625007

Cited by 114 publications

(49 citation statements)

References 19 publications

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“…45 Systemic corticosteroid-induced cataracts typically are located on the posterior side of the lens and are referred to as posterior subcapsular cataracts.…”

Section: Cataractsmentioning

confidence: 42%

Efficacy and Safety of Inhaled Corticosteroids in Patients With COPD: A Systematic Review and Meta-Analysis of Health Outcomes

Gartlehner¹

2006

The Annals of Family Medicine

110

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PURPOSE We wanted to review systematically the effi cacy, effectiveness, and safety of inhaled corticosteroids with respect to health outcomes in patients with chronic obstructive pulmonary disease (COPD). METHODSWe searched MEDLINE, EMBASE, The Cochrane Library, and the International Pharmaceutical Abstracts to identify relevant articles. We limited evidence to double-blinded randomized controlled trials (RCTs) for effi cacy, but we also reviewed observational evidence for safety. Outcomes of interest were overall mortality, exacerbations, quality of life, functional capacity, and respiratory tract symptoms. When possible, we pooled data to estimate summary effects for each outcome.RESULTS Thirteen double-blinded RCTs determined the effi cacy of an inhaled corticosteroid compared with placebo; 11 additional studies assessed the safety of inhaled corticosteroid treatment in patients with asthma or COPD. Overall, COPD patients treated with inhaled corticosteroids experienced signifi cantly fewer exacerbations than patients taking placebo (relative risk [RR] = 0.67; 95% CI, 0.59-0.77). No signifi cant difference could be detected for overall mortality (RR = 0.81; 95% CI, 0.60-1.08). Evidence on quality of life, functional capacity, and respiratory tract symptoms is mixed. Adverse events were generally tolerable; pooled discontinuation rates did not differ signifi cantly between inhaled corticosteroid and placebo treatment groups (RR = 0.92; 95% CI, 0.74-1.14). Observational evidence, however, indicates a dose-related risk of cataract and open-angle glaucoma. Severe adverse events, such as osteoporotic fractures, are rare; the clinical importance of the additional risk is questionable.CONCLUSIONS Overall, the risk-benefi t ratio appears to favor inhaled corticosteroid treatment in patients with moderate to severe COPD. Existing evidence does not indicate a treatment benefi t for patients with mild COPD. INTRODUCTIONC hronic obstructive pulmonary disease (COPD) is among the leading causes of morbidity and mortality worldwide.1 In 2000 COPD accounted for approximately 20.7 million outpatient visits, 3.4 million emergency department visits, 6.3 million hospitalizations, and 116,513 deaths in the United States. 2 The World Health Organization estimates that by the year 2020, COPD will be the third-leading cause of death and the fi fth-leading cause of disability worldwide. COPD is characterized by a progressive, irreversible limitation of airfl ow associated with an abnormal infl ammatory response to noxious particles or gases. It is caused primarily by smoking. 3,4 Gerald Gartlehner, MD 254 INHALED CORTICOSTEROIDS AND COPDThe benefi cial effect of inhaled corticosteroid treatment for COPD remains controversial, 3,5 in part because only smoking cessation is reliably shown to slow the rate of decline in lung function. 4 Although the Food and Drug Administration (FDA) has not approved inhaled corticosteroids as monotherapy for the treatment of COPD, they are frequently prescribed to reduce or alleviate symptoms...

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“…45 Systemic corticosteroid-induced cataracts typically are located on the posterior side of the lens and are referred to as posterior subcapsular cataracts.…”

Section: Cataractsmentioning

confidence: 42%

Efficacy and Safety of Inhaled Corticosteroids in Patients With COPD: A Systematic Review and Meta-Analysis of Health Outcomes

Gartlehner¹

2006

The Annals of Family Medicine

110

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“…The main problem was cataract (46%). Posterior subcapsular cataract is a well-documented eye complication after transplantation, which is due to systemic steroid therapy [4,5,6,7,81. Its incidence in our study was found to be 46%, which is comparable with the 43% found in the study by Quinlan and Salmon [7].…”

Section: Discussionmentioning

confidence: 42%

The value of routine ophthalmological tests in the screening for lung transplantation

Sere¹,

Ouwens²,

Bij³

et al. 2004

Transplant Int

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We aimed to analyse the results of ophthalmological examinations in the screening before and in the follow-up after lung transplantation. Altogether, 295 consecutive patients who had undergone ophthalmological examination in the screening before lung transplantation were analysed. Preoperatively 27% ocular abnormalities were found; none of them formed a contraindication for the transplantation. Of the 122 patients who underwent transplantation, 24 (20%) had postoperative ocular complaints. We can conclude that, because of the absence of contraindications in all of these patients, routine ophthalmological screening before transplantation is not recommended. Routine postoperative -screening is not required, either.

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“…Some clinicians believe there is no minimal safe dose with respect to this complication, because cataract formation has been reported to occur even in patients using inhaled glucocorticoid preparations (43). Others note, however, that cataracts rarely occur in patients taking less than 10 mg/day for less than 1 year (44,45). Cataracts were detected in 29% of 112 RA patients taking a mean dose of 8 mg/day for an average of 6.9 years compared with 18% of matched controls (P Ͻ 0.05) (22).…”

mentioning

confidence: 37%

Resolved: Low‐dose glucocorticoids are neither safe nor effective for the long‐term treatment of rheumatoid arthritis

Saag

2001

Arthritis & Rheumatism

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Effect of Corticosteroids on Cataract Formation

Cited by 114 publications

References 19 publications

Efficacy and Safety of Inhaled Corticosteroids in Patients With COPD: A Systematic Review and Meta-Analysis of Health Outcomes

Efficacy and Safety of Inhaled Corticosteroids in Patients With COPD: A Systematic Review and Meta-Analysis of Health Outcomes

The value of routine ophthalmological tests in the screening for lung transplantation

Resolved: Low‐dose glucocorticoids are neither safe nor effective for the long‐term treatment of rheumatoid arthritis

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