Cataract and Ocular Hypertension in Children on Inhaled Corticosteroid Therapy

Abstract

Purpose: To ascertain the incidence of posterior subcapsular cataract and ocular hypertension in a cohort of children ⩽ 12 years on inhaled steroid therapy. Patients and Methods: In this prospective study, a detailed history regarding corticosteroid therapy was obtained for children attending an asthma clinic. The presence and type of lens changes (cataract) was recorded and intraocular pressure (IOP) was measured. The children underwent another eye examination 2 years later. Results: Ninety-five patients were enrolled in the study. Mean patient age was 7±3 years, and mean duration of inhaled steroid therapy was 2±1 years. Thirty-six percent of patients received inhaled steroids exclusively, 61% received inhaled steroids with a short course of oral steroids, and 3% received inhaled steroids with a long course of oral steroids. Only 3 (3%) patients had cortical changes that were not visually significant, and none had posterior subcapsular or nuclear cataract. There was no significant differences between children with cataract and those without cataract with respect to age; duration of asthma; and duration, average daily dose, and cumulative dose of inhaled steroids. IOP ranged from 11 to 20 mm Hg (mean, 16±3 mm Hg). None of the children had ocular hypertension or glaucoma. Ninety patients underwent eye examination 2 years later; none was found to develop posterior subcapsular cataract or increased IOP. Conclusion: This study indicates the use of inhaled steroids in children with asthma is probably safe as far as not inducing posterior subcapsular cataract or ocular hypertension. J Pediatr Ophthalmol Strabismus 2005;42:23–27.

Effects of inhaled fluticasone on intraocular pressure and central corneal thickness in asthmatic children without a family history of glaucoma

“…This could be due to the fact that the subjects were not followed for a longer period. Nevertheless, 7 (10%) of the subjects enrolled in Group 1 had been using ICS for ≥ 6 years and showed no evidence of cataract on ophthalmological evaluation, further confirming the report of previous studies 21 23 27 30 which have demonstrated the lack of association of ICS with posterior sub-capsular cataract.…”

“… 35 The mean IOP observed in our study is similar to that reported by other studies that evaluated a pediatric study cohort. 20 21 32 Three (4%) children in our study group had an unexplained IOP reading above 20 mmHg and mean CCT values of 512, 571, and 542 μ m, respectively, which did not vary on the second measurement session after 1 week. No optic disc changes were noticed in these patients on ophthalmological evaluation.…”

A systematic review of adverse drug events associated with administration of common asthma medications in children

“…The titles and abstracts of 8,026 studies were screened, with 7,328 studies excluded. The full texts of 698 articles were reviewed, with 35 articles [ 13 – 47 ] meeting all inclusion criteria. Our repeated database search generated 3077 results, with 431 duplicates removed and an additional 44 articles removed as they were duplicates from the overlapping search period from November 2012 to January 2013.…”

“…Amongst the 46 included studies ( Table 1 ), six types of study design were noted: 24 randomized control trials (17–19, 21, 23–26, 28–30, 33, 36–43, 45–47,[ 57 ], 15 (33%) cohort studies [ 13 – 15 , 20 , 22 , 27 , 48 , 49 , 51 – 56 , 58 ], 4 pooled analyses of open-label RCT [ 31 , 32 , 35 , 44 ], 1 case-control study[ 50 ], 1 open-label trial [ 16 ] and 1 quasi-experimental study [ 33 ]. The authors of 29 studies declared pharmaceutical industry funding; 29 studies were conducted in North America and 33 studies in a clinic setting.…”

Bioengineered glaucomatous 3D human trabecular meshwork as an in vitro disease model

“…The administration of steroids, such as corticosteroids, used to treat inflammation either topically or systematically, has long been linked to primary open‐angle glaucoma (POAG) (Behbehani et al, ; Bernstein et al, ; Cubey, ; Garbe et al, ; Garrott and Walland, ; Kalina, ). In susceptible patients, steroids can lead to the development of ocular hypertension and POAG (Becker and Mills, ; Bernstein et al, ; Jones and Rhee, ; Kersey and Broadway, ).…”