Risk factors for the development of posterior subcapsular cataracts in patients with cystic fibrosis and allergic bronchopulmonary aspergillosis treated with corticosteroids

Abstract

Posterior subcapsular cataracts (PSCC) occur in a high percentage of patients treated with long-term systemic corticosteroids (Naumann Gott, Apple DJ, eds: Pathology of the Eye. New York: Springer-Verlag, 1986). Fifteen patients with cystic fibrosis treated at Duke University Medical Center between January 1982 and October 1987 required prednisone for treatment of allergic bronchopulmonary aspergillosis (ABPA). Two of these patients (13.3%) were noted to have PSCC during prednisone therapy. We retrospectively examined factors associated with steroid administration that may have been predictive of the development of PSCC in these patients including: 1) steroid therapy for longer than 2 years, 2) steroid dose of 10 mg/day or greater for longer than 6 months, 3) steroid dose of 40 mg/day or greater for longer than 2 months, and 4) change in linear growth pattern during steroid therapy. None of these factors predicted the risk of developing PSCC. Therefore, we recommend that all patients with cystic fibrosis who receive steroids for the treatment of a concomitant condition such as ABPA should undergo careful examination for opacities of the ocular lens at each clinical visit regardless of the duration or dose of steroids.

Cataracts in neutrophil donors stimulated with adrenal corticosteroids

“…Although our data are not conclusive, the doses of prednisone given before each leukapheresis seem to be the most likely pathogenetic factor inducing PSCs in PMN donors. The association of PSCs with corticosteroids is clear, with most investigators agreeing that the dose and duration of steroid therapy are poorly predictive of PSC development 4–15 . Compared to patients given pharmacologic doses of prednisone (1‐2 mg/kg/day for several weeks to months), our PMN donors took relatively modest doses at intermittent intervals—60 mg for only 1 day, with individual doses often separated by many weeks.…”

“…In agreement, Pavlin et al 5 found a positive correlation between PSCs and the dose of prednisone taken, particularly with regard to the number of days with a dose >100 mg. In contrast, several other studies failed to find an association between the dose or duration of steroid usage and the development of PSCs 4,7,9,10,12–14 . Individual patient traits, such as histocompatibility (HLA) type, may play an important role in the susceptibility to PSC formation 13,14…”

“…This presumption of safety is supported by few reports of adverse steroid effects in PMN donors, other than occasional insomnia and the expected transient changes in blood WBC counts. However, there is a well‐established relationship 4–15 between the use of corticosteroids and the development of posterior subcapsular cataracts (PSCs), although findings are likely to be occult unless sought by a systematic ophthalmologic examination, because vision may not be impaired by mild PSCs, 4,8 and PSCs occasionally resolve spontaneously 8,9,12 . Thus, the true risk, if any, of steroid‐induced cataracts in PMN donors is unknown.…”

“…Corticosteroids are widely used to treat many disorders, and the underlying medical circumstances seem not to be of critical importance in determining the risk for developing PSCs 4–15 . Although the relationship between corticosteroids and PSCs is well established, the development of PSCs is not inevitable, as not all steroid recipients develop them—generally, <50 percent do, but up to 97 percent may 14 .…”

Allergic Bronchopulmonary Aspergillosis in Cystic Fibrosis—State of the Art: Cystic Fibrosis Foundation Consensus Conference

“…Adverse effects commonly associated with corticosteroid use include gastric discomfort, mental changes, unmasking diabetes, cataracts, weight gain, osteoporosis, and decreased growth [31,37,321]. A decreased immune response may be responsible for disseminated disease in some case reports [322].…”