Evaluation and management of systemic corticosteroids-induced ocular hypertension in children with non-Hodgkin lymphoma

Abstract

PurposeTo investigate the effect of systemic corticosteroids (CSs) on ocular hypertension (OHT) and to evaluate the management of OHT in children with non-Hodgkin lymphoma (NHL).MethodsMedical records of children with NHL treated in our institution between October 2016 and October 2019 were reviewed. The enrolled patients were divided into the mature B-cell lymphoma (MBL) group and lymphoblastic lymphoma (LBL) group based on pathology. Data on routine ophthalmic examinations and management of OHT were recorded.ResultsOf the 54 recruited patients, 38 patients (70.4%) had LBL, and 16 (29.6%) had MBL. Thirty-one patients (57.4%) developed OHT, 24 patients (77.4%) in the LBL group, and 7 (22.6%) in the MBL group. Twelve patients (38.7%) were identified as high responders (10 with LBL and 2 with MBL). Symptomatic patients had a higher mean peak IOP than asymptomatic patients (p=0.006). A total of 74.2% of OHT was controlled with antiglaucoma medications (100% in the MBL group vs. 66.7% in the LBL group, significant variation, p < 0.001). In total, 8 patients (25.8%) underwent tapering of the CSs dose. The duration of OHT was shorter in the MBL group than in the LBL group (p = 0.003). No patients were found to have glaucomatous damage or cataracts.ConclusionsPatients receiving systemic CSs had a higher risk of developing OHT, but the pattern of CSs administration might be a critical factor in the risk and severity of OHT. Tapering of CSs dose should be considered the first line for the management of OHT during high-dose CSs therapy.

Corticosteroid-Induced Ocular Hypertension in Children and Adolescents With Acute Lymphocytic Leukemia and Non-Hodgkin Lymphoma: A Systematic Review

“…Of these, 6 were excluded 6,[11][12][13][14][15] . The 8 articles [16][17][18][19][20][21][22][23] remaining met the criteria and were included in the systematic review (Figure 1).…”

“…The 8 articles reviewed were a case report in abstract form 16 , published at the 25th Annual Meeting of the American Society of Pediatric Hematology/Oncology, 2012, New Orleans, Louisiana; and 7 complete studies, two case reports 17,18 , a series of 5 cases 19 , two prospective observational cohort studies -one with 55 patients20 and one with 90 patients 21 -and two retrospective observational studies -one with 54 22 and one with 12 patients 23 . All included studies were published in English and the presence of ocular hypertension was the assessed outcome.…”

“…The seventh article selected was a retrospective observational study by Chang et al 22 which evaluated 54 children diagnosed with non-Hodgkin's lymphoma -16 with mature B-cell lymphoma (MBL) and 38 with lymphoblastic lymphoma (LBL) -, aged between 1 and 15 years, 14 female patients and 40 male patients, without previous eye pathologies. The MBL group received oral dexamethasone at a dosage of 10 mg/m2/day for 5 days in cycles A and B, and 20 mg/m 2 / day for 5 days in cycle C, totaling 6 monthly cycles.…”

“…In, Barzilai-Birenboim et al 21 , with the exception of a child with IOP extreme (64 mm Hg), who complained of headache, all diagnosed children were asymptomatic. E, Chang et al 22 reported that only 7 of the 31 patients with OH developed symptoms during the evaluations. Thus, it is inferred that pediatric patients with ALL or NHL receiving corticosteroids may remain asymptomatic despite severe ocular hypertension.…”

“…In the study carried out by Yamashita et al 19 , IOP was measured by air puff, non-contact tonometry (Topcon CT-80),without confirmation by other methods, which does not have the reliability of contact tonometry, resulting in possible overestimation of values in children. Thus, controlled studies with IOP assessment by applanation tonometry become necessary to ensure more accurate diagnoses and treatment decisions, as shown by Mendonca et al20, Barzilai-Birenboim et al 21 and Chang et al 22 .…”