Steroid‐induced ocular hypertensive response in children and adolescents with acute lymphoblastic leukemia and non‐hodgkin lymphoma

Mendonça, Cléverton de Oliveira; Souza, Cleonilson Protásio de; Martins-Filho, Paulo Ricardo; Viana, Simone Santana; Leal, Bruno Campelo; Cipolotti, Rosana

doi:10.1002/pbc.25070

Cited by 18 publications

(17 citation statements)

References 13 publications

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“…Typically, these patients are administered relatively high doses of corticosteroid during chemotherapy. Importantly, several authors reported corticosteroid‐induced glaucoma in pediatric patients with hematological malignancies . de Queiroz Mendonca et al reported 12 patients with hematological malignancies who were administered 40 mg/m 2 prednisolone or 6 mg/m 2 dexamethasone for 28 days; two of the patients required topical treatment with eye drops for glaucoma.…”

Section: Discussionmentioning

confidence: 51%

“…Importantly, several authors reported corticosteroid‐induced glaucoma in pediatric patients with hematological malignancies . de Queiroz Mendonca et al reported 12 patients with hematological malignancies who were administered 40 mg/m 2 prednisolone or 6 mg/m 2 dexamethasone for 28 days; two of the patients required topical treatment with eye drops for glaucoma. Yamashita et al reported that IOP exceeded 21 mmHg in five Japanese children with ALL and that one of the patients developed optic neuropathy.…”

Section: Discussionmentioning

confidence: 54%

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Corticosteroid‐induced glaucoma in pediatric patients with hematological malignancies

Sugiyama

Terashita

Hara

et al. 2019

Pediatric Blood & Cancer

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Background Corticosteroids, especially dexamethasone, play a critical role in chemotherapy for pediatric hematological malignancies. We previously observed that patients with complaints of headache or photophobia during corticosteroid administration had high intraocular pressure (IOP). Procedure We measured IOP during corticosteroid administration in 15 patients with acute leukemia or lymphoma undergoing treatment at our institution from January 2016 to December 2018. IOP was measured by an ophthalmologist within seven days of the initiation of standard dose of corticosteroid, which was defined as 60 mg/m2/day for prednisolone and 10 mg/m2/day for dexamethasone. Results Fifteen patients received 52 courses of chemotherapy containing corticosteroids. IOP exceeded 21 mmHg among 13 patients in 28 courses. Twelve of the 13 patients were administered topical treatment, and six of the 12 patients needed additional diuretic agents. IOP during the chemotherapy courses containing dexamethasone was significantly higher compared with IOP during the chemotherapy courses containing prednisolone. Only two patients complained of symptoms, such as headache and photophobia, and one of the two patients underwent trabeculotomy. Funduscopic findings were normal in all patients. There was a dose‐associated decrease in IOP with reduction of dexamethasone dose. Conclusions IOP should be measured during administration of substantial corticosteroid doses even in patients with no symptoms. Further investigations regarding the level of IOP for intervention need to be conducted.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 54%

Corticosteroid‐induced glaucoma in pediatric patients with hematological malignancies

Sugiyama

Terashita

Hara

et al. 2019

Pediatric Blood & Cancer

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“…2,3 Cessation of the systemic corticosteroid typically results in the lowering of IOP to normal levels. 2,4 However, most of the diseases that necessitate systemic corticosteroid therapy in children, such as acute lymphoblastic leukemia, nephrotic syndrome, kidney transplantation, and inflammatory bowel disease, are chronic and/or potentially fatal, so any possible adverse effects from long-term systemic corticosteroid use are minor compared with the prospective benefit. Treatment consequently turns to topical antiglaucoma therapy to maintain IOP at normal levels.…”

Section: Discussionmentioning

confidence: 99%

“…5 The ocular hypertensive response has further been shown to be greater with oral dexamethasone than with oral prednisone. 4 This may be due to the fact that oral dexamethasone better penetrates the central nervous system and has a longer halflife, which is why it is the steroid of choice in the treatment of acute lymphoblastic leukemia. 6 It is conceivable that our patient's IOP was elevated for 14 days before his initial visit, as he had been symptomatic for headache for 14 days.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Steroid-induced Ocular Hypertension in a 6-year-old Boy

Tasaki

2021

Optom Vis Sci

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SIGNIFICANCE: Systemic corticosteroid use in children is rare because of known risks of adverse effects. The increased prevalence of multisystem inflammatory syndrome associated with COVID-19 may change this. It is critical for eye care providers to be aware of potential severe and rapid ocular hypertensive response to prevent irreversible vision loss. PURPOSE:The purpose of this study was to report the importance of early monitoring of intraocular eye pressure in pediatric patients on systemic steroid medication.CASE REPORT: A 6-year-old White boy presented with a complaint of headache for 2 weeks. He was on his 19th day of treatment for acute lymphoblastic leukemia with oral dexamethasone and chemotherapy. IOP at presentation was 65 mmHg in both eyes measured with iCare tonometry. Treatment with maximum topical glaucoma therapy reduced IOP to normal levels and eliminated the symptom of headache.CONCLUSIONS: This case reminds eye care providers to be aware of the potential ocular hypertensive response to systemic steroid treatment and the importance of establishing early monitoring. With the emergence of multisystem inflammatory syndrome in children during the current COVID-19 pandemic, eye care providers may encounter more pediatric patients on systemic corticosteroid treatment than previously and should adjust their examinations appropriately.

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“…Importantly, children with glaucoma require timely intervention to avoid optic nerve damage. Children with cancer often receive glucocorticoid therapy, and thus have an increased risk of glaucoma . The discontinuation of glucocorticoid therapy, or the use of a lower dose, is the preferred approach for management of steroid‐induced glaucoma.…”

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confidence: 99%