Severe ocular hypertension secondary to systemic corticosteroid treatment in a child with nephrotic syndrome

Brito, Pedro Quelhas; Estrela-Silva, Sérgio; Cotta, J; Falcão‐Reis, Fernando

doi:10.2147/opth.s36261

Cited by 19 publications

(12 citation statements)

References 19 publications

(21 reference statements)

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“…The precise mechanism of SIG is unclear, but it is assumed to involve mainly trabecular meshwork oedema and increased resistance to aqueous humour drainage. 4 The few studies of SIG in children 19,20 found that they were particularly susceptible, [21][22][23][24][25] exhibiting more severe optic nerve damage with earlier onset and more rapid progression than adults. 7 Notably, increased IOP and glaucoma may occur many years after initiation of GC therapy and have been reported as delayed complications in survivors of childhood cancer.…”

Section: Steroid-induced Oht and Glaucoma In Childrenmentioning

confidence: 99%

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

et al. 2021

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Most childhood acute lymphoblastic leukaemia (ALL) protocols include high-dose steroid therapy. However, the known potential of high-dose steroids to significantly elevate intraocular pressure (IOP) and lead to glaucomatous optic neuropathy has not been intensively investigated in children with ALL. Moreover, as children with ALL do not routinely undergo IOP measurements, the need for IOP monitoring and therapy is unknown. We prospectively measured IOP in 90 children with newly diagnosed ALL attending a tertiary paediatric haematology/oncology centre, at diagnosis and at the middle and end of induction therapy. Ocular hypertension (IOP > 21 mm Hg) at any time point was documented in 64 children (71%), and the prevalence increased during induction. Thirty-six children (40%) had elevated IOP at ALL diagnosis before therapy initiation, and stratification to non-standard ALL was a risk factor. IOP reduction therapy was administered to 13 children (14%); none required surgery. Values normalised in all cases. On multivariate logistic regression analysis, dexamethasone therapy was a significant risk factor for ocular hypertension. High body mass index was an additional risk factor in children with elevated IOP at ALL diagnosis. Routine evaluation of IOP during steroid therapy is very important in children with ALL to ensure early intervention which may prevent permanent ocular damage.

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Section: Steroid-induced Oht and Glaucoma In Childrenmentioning

confidence: 99%

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

et al. 2021

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“…Visual disturbances also translate into a significant socioeconomic burden on family and society due to increased resources needed to raise a visually impaired child [ 9 ]. Early detection and prompt management of the side effects can prevent visual deprivation and eventual amblyopia due to cataracts as well as permanent blindness in cases of optic nerve damage in steroid induced glaucoma [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and predictors of ocular complications among children undergoing nephrotic syndrome treatment in a resource-limited setting

et al. 2021

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Background Nephrotic syndrome is the most common glomerulopathy among children aged 2–18 years and high dose corticosteroids are the backbone of its management. Potentially blinding ocular complications often result from nephrotic syndrome and/or its treatment. We conducted a study to determine the prevalence and predictors of ocular complications among children undergoing nephrotic syndrome treatment at Mulago National Referral Hospital. Methods This was a cross-sectional study conducted for three [3] months at the pediatric renal unit of Mulago National Referral Hospital (MNRH). Data from a consecutive sample of 100 children was collected using a semi-structured questionnaire, entered into Epi-data 4.4.2 and exported to STATA 14 for analysis at univariate, bivariate and multivariate levels. A robust Poisson regression model was used to identify predictors of ocular complications. Results Out of 100 patients examined, 80(80%) had ocular complications. The median age was 10 (IQR: 7–12) and 52 (52%) were girls. The most frequent complications were hypertrichosis and refractive errors in 71% (95%CI 61.1–79.6) and 56% (95%CI 45.7–65.9) of the patients respectively. Age above 10 years was the predictor for ocular complications with a RR = 1.37 (95%CI:1.14–1.64) p = 0.001. Conclusions We found a high prevalence of ocular complications among children with nephrotic syndrome in this tertiary hospital. The predictor of ocular complications was age greater than 10 years. We recommend that all children with nephrotic syndrome undergo a baseline ocular examination prior to commencement of treatment and be reviewed periodically by an ophthalmologist.

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“…Almost all patients described returned to an IOP within normal range after discontinuation of the glucocorticoid alone; only one patient needed IOP-lowering eyedrops. In addition to these examples, multiple other case reports and case series on the subject have been published [ 48 , 49 , 50 , 51 ]. These reports suggest the need for clear clinical guidance regarding the ophthalmological follow-up of glucocorticoid users.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Intranasal, Inhaled and Systemic Glucocorticoids on Intraocular Pressure: A Literature Review

Wijnants

Stalmans

Vandewalle

2022

JCM

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Topical glucocorticoids are a well-known risk factor of intraocular pressure (IOP) elevation in one third of the general population and in up to 90% of glaucomatous patients. Whether this steroid response is caused by intranasal, inhaled or systemic glucocorticoids, is less known. This study presents an overview of the current literature on the topic, thereby providing guidance on when ophthalmological follow-up is indicated. A literature study was performed in Medline, and 31 studies were included for analysis. Twelve out of fourteen studies discussing intranasal glucocorticoids show no significant association with an elevated IOP. Regarding inhaled glucocorticoids, only three out of twelve studies show a significant association. The observed increase was either small or was only observed in patients treated with high inhaled doses or in patients with a family history of glaucoma. An elevated IOP caused by systemic glucocorticoids is reported by four out of the five included studies, with one study reporting a clear dose–response relationship. This review concludes that a steroid response can be triggered in patients treated with systemic glucocorticoids. Inhaled glucocorticoids may cause a significant IOP elevation when administered in high doses or in patients with a family history of glaucoma. At present, there is no evidence for a clinically significant steroid response caused by intranasally administered glucocorticoids.

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Severe ocular hypertension secondary to systemic corticosteroid treatment in a child with nephrotic syndrome

Cited by 19 publications

References 19 publications

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

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

Prevalence and predictors of ocular complications among children undergoing nephrotic syndrome treatment in a resource-limited setting

The Effects of Intranasal, Inhaled and Systemic Glucocorticoids on Intraocular Pressure: A Literature Review

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