Ocular-hypertensive Response to Topical Steroids in Children

Kwok, Alex Pak Ki; Lam, Dennis S.C.; Ng, Joan S.K.; Fan, Dorothy S. P.; Chew, Sek-Jin; Tso, Mark O.M.

doi:10.1016/s0161-6420(97)30052-9

Cited by 144 publications

(83 citation statements)

References 16 publications

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“…One of the patients had glaucomatous optic neuropathy on the first exam. In their study on children below 10 years, Kwok et al [61] concluded that the ocular hypertensive response to topical dexamethasone in children occurs more frequently, more severely, and more rapidly than that reported in adults. Although older patients are at increased risk, the frequency of steroid responsiveness with age may occur in a bimodal distribution and children should be monitored closely.…”

Section: Agementioning

confidence: 96%

Steroid-Induced Iatrogenic Glaucoma

Lj²

2011

Ophthalmic Res

217

160

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Steroids in susceptible individuals can cause a clinical condition similar to primary open-angle glaucoma. Five percent of the population are high steroid responders and develop an intraocular pressure (IOP) elevation of more than 15 mm Hg above baseline. IOP elevation may occur as early as 1 day to as late as 12 weeks after intravitreal triamcinolone in 20–65% of patients. On average, 75% of eyes with steroid implants require IOP-lowering therapy at some point within 3 years of follow-up. The exact mechanism of steroid-induced glaucoma is not totally understood, but decreased trabecular meshwork outflow is regarded as the main cause of IOP elevation. High-risk patients who receive steroids should be monitored closely and if they develop elevated IOP, steroids with lower potency or steroid-sparing agents should be used. The IOP usually returns to normal within 2–4 weeks after stopping the steroid. About 1–5% of patients do not respond to medical therapy and need surgery. Trabeculectomy, trabeculotomy, shunt surgery, and cyclodestructive procedures are among the methods employed. Removal of residual sub-Tenon or intravitreal steroids may help hasten the resolution of the steroid response. Early results with anecortave acetate, an analog of cortisol acetate with antiangiogenic activity, in controlling IOP have been promising.

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Section: Agementioning

confidence: 96%

Steroid-Induced Iatrogenic Glaucoma

Lj²

2011

Ophthalmic Res

217

160

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“…Certain topical drops and ointments have been developed and shown to have a reduced IOP elevating effect (e.g. fluorometholone, rimexolone, loteprednol) [14,15]. We have not noted an increase in IOP with our regimen of periocular steroid injections.…”

Section: Discussionmentioning

confidence: 65%

Effect of Intraorbital Steroid Injections on Intraocular Pressure in Thyroid Eye Disease

Carrasco¹

2014

Thyroid Disorders Ther

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Purpose: To study the effect of orbital steroid injections administered in the treatment of thyroid eye disease (TED) on intraocular pressure (IOP). Methods:Retrospective chart review of consecutive patients over 70 months with active thyroid eye disease (TED) seen in a referral oculoplastic practice who underwent orbital steroid injections. Results:The clinical records of 56 patients were included in the study. There were 51 females and 5 males; 43 (77%) were Caucasian; the average age was 50 years old. A mean number of 3.5 injections (range 1-12) were given per patient resulting in 91 encounters being examined. Injections consisted of dexamethasone in all cases with addition of betamethasone in 49 cases, methylprednisolone in 3 cases and triamcinolone in 3 cases. Pre-injection intraocular pressure (IOP) was recorded in 42 instances and post-injection IOP was recorded in 26 instances. The average time interval to next follow up was 9.4 weeks and the average time interval to next injection was 17.75 weeks There was no increase in the mean pre-injection vs. post-injection IOP (short-term effect), nor in the firstrecorded vs. last recorded IOP (long-term effect). In 73 instances, subjective response to injections with respect to swelling was recorded: in 46/73 (63%) cases swelling was noted to be reduced, in 19/73 no change was recorded and a worsening of swelling was reported in 8 cases. Diplopia improved in 13 cases and worsened in 4 (n=17). Conclusions:No statistically significant rise in intraocular pressure was observed following orbital steroid injections.

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“…IOP elevation in response to topical dexamethasone occurs more frequently, more severely and more rapidly in children compared with adults [40]; this response was also found to be dose and age dependent [41,42]. Younger aged children had a higher peak of IOP and attained the peak IOP earlier.…”

Section: Reviewmentioning

confidence: 90%

“…Fluoromethalone alcohol 0.1% causes an IOP elevation between 2.6 and 5.8 mmHg, with the peak IOP being between 17.1 and 20.6 mmHg after a mean duration of 6-15 days in children [30][31][32]. Its IOP-elevating potential is also low in adults who are known to be steroid responders and comparable to that of rimexolone 1.0% [33].…”

Section: Reviewmentioning

confidence: 95%