Steroid-induced glaucoma: Epidemiology, pathophysiology, and clinical management

Roberti, Gloria; Oddone, Francesco; Agnifili, Luca; Katsanos, Andreas; Michelessi, Manuele; Mastropasqua, Leonardo; Quaranta, Luciano; Riva, Ivano; Tanga, Lucia; Manni, Gianluca

doi:10.1016/j.survophthal.2020.01.002

Cited by 135 publications

(151 citation statements)

References 156 publications

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“…The absence of previous signs of uveitis in the anterior and posterior segments, associated with mean tonometry varying from 12.00 to 14.37 mmHg, reinforces a few ocular inflammation cases associated with COVID-19 that only occasionally leave eye sequelae 24 , 25 . The mild but statistically significant increase in the intraocular pressures observed between severe and critical cases might be associated with the systemic use of corticosteroids in a large portion of patients (48.3% used it in this sample) 26 .…”

Section: Discussionmentioning

confidence: 69%

Ocular findings among patients surviving COVID-19

Costa

Bonifácio

Bellíssimo-Rodrigues

et al. 2021

Sci Rep

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To describe the medium-term ophthalmological findings in patients recovering from COVID-19. Patients recovered from the acute phase of COVID-19 underwent a complete ophthalmological evaluation, including presenting and best-corrected visual acuity (BCVA), refractometry, biomicroscopy, tonometry, break-up time and Schirmer tests, indirect ophthalmoscopy, color fundus picture, and retinal architecture evaluation using optical coherence tomography. Socio-demographic data and personal medical history were also collected. According to the severity of systemic manifestations, patients were classified into mild-to-moderate, severe, and critical. Sixty-four patients (128 eyes) were evaluated 82 ± 36.4 days after the onset of COVID’s symptoms. The mean ± SD duration of hospitalization was 15.0 ± 10.7 days. Seven patients (10.9%) had mild-to-moderate, 33 (51.5%) severe, and 24 (37.5%) critical disease. Median [interquartile ranges (IQR)] presenting visual acuity was 0.1 (0–0.2) and BCVA 0 (0–0.1). Anterior segment biomicroscopy was unremarkable, except for dry eye disease, verified in 10.9% of them. The mean ± SD intraocular pressure (IOP) in critical group (14.16 ± 1.88 mmHg) was significantly higher than in severe group (12.51 ± 2.40 mmHg), both in the right (p 0.02) and left eyes (p 0.038). Among all, 15.6% had diabetic retinopathy, and two patients presented with discrete white-yellowish dots in the posterior pole, leading to hyporreflective changes at retinal pigment epithelium level, outer segment, and ellipsoid layers. The present study identified higher IOP among critical cases, when compared to severe cases, and discrete outer retina changes 80 days after COVID-19 infection. No sign of uveitis was found.

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Section: Discussionmentioning

confidence: 69%

Ocular findings among patients surviving COVID-19

Costa

Bonifácio

Bellíssimo-Rodrigues

et al. 2021

Sci Rep

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“…Stimulation of Trabecular Meshwork Cells by dexamethasone (a prototypical GC) is among the most studied experimental models of glaucoma in vitro. This research tool mirrors the existence of a severe acute clinical form of glaucoma, sustained by a progressive and relevant IOP increase, diagnosed in a subset of subjects who adhere to a GCs-based therapy for pre-existing pathologies [ 2 , 3 , 11 , 12 ]. GCs are supposed to induce a dysregulation of TMCs metabolism and a pathological remodeling of TM microarchitecture, which offers resistance to the drainage of aqueous humor.…”

Section: Discussionmentioning

confidence: 99%

“…The rationale behind the scheme and dosage of Dexa administration adopted in this study (with particular reference to the 6-day stimulation with daily 0.1 µM Dexa, i.e., Dexa-6d* cells) relies upon the clinical evidence that subjects develop increased IOP after being treated daily for at least 1 week with GC, often at high doses [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…A progressive IOP increase is observed in steroid-induced glaucoma, a severe clinical form of the disease, which is diagnosed in a subset of subjects who adhere to glucocorticoids (GC) therapy [ 10 , 11 , 12 ]. Steroid-induced glaucoma commonly affects young individuals, runs asymptomatically until the late stage, and may easily lead to impaired visual function and irreversible blindness before being diagnosed [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Dexamethasone Downregulates Autophagy through Accelerated Turn-Over of the Ulk-1 Complex in a Trabecular Meshwork Cells Strain: Insights on Steroid-Induced Glaucoma Pathogenesis

Sbardella

Tundo

Coletta

et al. 2021

IJMS

Self Cite

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Steroid-induced glaucoma is a severe pathological condition, sustained by a rapidly progressive increase in intraocular pressure (IOP), which is diagnosed in a subset of subjects who adhere to a glucocorticoid (GC)-based therapy. Molecular and clinical studies suggest that either natural or synthetic GCs induce a severe metabolic dysregulation of Trabecular Meshwork Cells (TMCs), an endothelial-derived histotype with phagocytic and secretive functions which lay at the iridocorneal angle in the anterior segment of the eye. Since TMCs physiologically regulate the composition and architecture of trabecular meshwork (TM), which is the main outflow pathway of aqueous humor, a fluid which shapes the eye globe and nourishes the lining cell types, GCs are supposed to trigger a pathological remodeling of the TM, inducing an IOP increase and retina mechanical compression. The metabolic dysregulation of TMCs induced by GCs exposure has never been characterized at the molecular detail. Herein, we report that, upon dexamethasone exposure, a TMCs strain develops a marked inhibition of the autophagosome biogenesis pathway through an enhanced turnover of two members of the Ulk-1 complex, the main platform for autophagy induction, through the Ubiquitin Proteasome System (UPS).

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“…The management of patients with acute OH after SO injection must be conducted according to the clinical setting. The pathologic mechanisms behind early IOP elevation are multiple and not yet clearly known; potential causes could be related to the exacerbation of a pre-existing undetected glaucoma [ 54 ], the severe intraocular inflammation induced by the surgery and the tamponade [ 38 , 49 ], the response to the postoperative steroid therapy [ 55 , 56 , 57 ], the migration of SO into the anterior chamber with consequential pupillary block, or massive infiltration of trabecular meshwork [ 42 , 50 , 52 , 58 , 59 , 60 , 61 , 62 , 63 ]. There is evidence that elevated levels of hydrogen peroxide and free radicals after vitrectomy may cause damage to trabecular meshwork cells [ 64 , 65 ].…”

Section: Early Post-operative Ocular Hypertensionmentioning

confidence: 99%

Intraocular Pressure Rise Linked to Silicone Oil in Retinal Surgery: A Review

Nicolai

Lassandro

Franceschi

et al. 2020

Vision

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Silicone oil represents the main choice for intraocular tamponade in cases of complicated retinal detachment surgery. The intraocular pressure of an eye filled with silicone oil could increase, driven by a variety of different forces, according to several mechanisms. Two main conditions have been highlighted, depending on the onset: early hypertension or late glaucoma. The different types of silicone oils and their physico-chemical properties are varied and may play a role in the determination of intraocular pressure rise. The current body of literature allows for the illustration and categorization of the incidence and risk factors, as well as the pathogenesis and the management of the early postoperative hypertension subtended by an open- and closed-angle, along with the late onset silicone oil-induced glaucoma. Understanding the leading actors on the stage of ocular pressure elevation concurrently with silicone oil application for retinal surgery could help in guiding the timely and appropriate course of treatment.

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Steroid-induced glaucoma: Epidemiology, pathophysiology, and clinical management

Cited by 135 publications

References 156 publications

Ocular findings among patients surviving COVID-19

Ocular findings among patients surviving COVID-19

Dexamethasone Downregulates Autophagy through Accelerated Turn-Over of the Ulk-1 Complex in a Trabecular Meshwork Cells Strain: Insights on Steroid-Induced Glaucoma Pathogenesis

Intraocular Pressure Rise Linked to Silicone Oil in Retinal Surgery: A Review

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