Intranasal corticosteroids do not affect intraocular pressure or lens opacity: a systematic review of controlled trials

Ahmadi, Navid; Snidvongs, Kornkiat; Kalish, Larry; Sacks, Raymond; Tumuluri, Krishna; Wilcsek, Geoff; Harvey, Richard J.

doi:10.4193/rhin15.020

Cited by 25 publications

(12 citation statements)

References 40 publications

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“…A recent Cochrane review found no difference in the reported side effects between topical corticosteroids and placebo (86) , except for an increase in reported epistaxis. Moreover, there seems to be no clinically relevant impact on ocular pressure, glaucoma, lens opacity, or cataract formation (87) .…”

Section: Minimising Risks Of Treatmentmentioning

confidence: 99%

Prevention of chronic rhinosinusitis

Hopkins

Šurda

Bast

et al. 2018

Rhin

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Section: Minimising Risks Of Treatmentmentioning

confidence: 99%

Prevention of chronic rhinosinusitis

Hopkins

Šurda

Bast

et al. 2018

Rhin

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“…Topical corticosteroids are a beneficial treatment for CRS and the adverse effects are minor, with benefits outweighing the risks (19) . Recently in this journal it was demonstrated that nasal corticosteroids do not show a clinically relevant impact on either ocular pressure, glaucoma, lens opacity or cataract formation (20) . For systemic corticosteroids the risk-benefit ratio is less clear and especially when deciding whether to operate or intensify medical treatment (4) proper data concerning safe dosage, number of repetitions per year and relevant safety measurements are missing (21 ).…”

Section: Numerous Other Interventions To Optimize Surgical Visibilitymentioning

confidence: 99%

Sinus surgery: optimal surgery, optimal outcome?

Fokkens¹

2016

Rhin

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Sinus surgery remains an issue of discussion. We lack data on a number of important issues. In this issue of the journal Jiang et al. show that 67 % of their patients who underwent FESS for CRS had OSAS (of which more than half moderate to severe) but only 38% complained of daytime sleepiness irrespective of BMI. The OSAS was also not correlated with the severity of rhinosinusitis, SNOT-20 score, nasal obstruction score, endoscopic score, CT score, and smell function. It could be an argument for FESS although unfortunately the authors did not report whether the OSAS decreased after FESS (1) . In position papers and guidelines like EPOS2012 or ICON it is suggested to perform sinus surgery when "optimal medical treatment" does not result in relevant reduction of symptoms (2,3) . When surgery is considered, usually a minimum period of medical treatment of 3 months is suggested unless the symptoms are very severe, e.g. in massive nasal polyps or when complications, like mucoceles (tend to) occur. In a recent Cochrane review, however, the evidence does not show that surgery is better than medical treatment in terms of patient-reported symptom scores and quality of life measurements (4) . On the other hand there are indications that early surgery (< 12 months after start of the symptoms) improves the outcomes (5,6) . Recent cluster analysis performed in patients eligible for surgery who choose to be operated or not (based on personal preference, not randomization) indicated that based on age, SNOT-22 score, and lost productivity over 90 days patient can be clustered in groups that benefit more from surgery than others (7,8) . When deciding whether FESS is the best option, there is a lot of debate which outcomes are most relevant to measure. In this issue of the Journal Hopkins et. al. report on a survey in which patients and practitioners were asked to list the 3 outcomes from treatments they considered to be most important (9) . Interestingly, 73% suggested symptoms of CRS to be the most important and only 9% concerned quality of life, 4% reducing the need for further treatment and 4% side effects of treatment. The questionswere asked very open: "What results from treatments are most important to you (for patients)?" and "what are the most important outcomes that you want from treatments for people with rhinosinusitis (for health professionals". It would be interes-the hard work of many of us has tremendously increased our knowledge to better inform the patient when FESS is a good option to treat CRS we also still have a lot to learn and I hope to inspire all of you to contribute to the development of our common knowledge.

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“…Furthermore, some of these patients used inhaled corticosteroids in addition to INCS . Despite the overwhelming evidence that INCS does not lead to an increased risk of glaucoma or cataract formation, there have been no meta‐analyses conducted on ocular changes, and only a handful of review articles that discuss the use of INCS and ocular changes …”

Section: Introductionmentioning

confidence: 99%

“…15,16 Despite the overwhelming evidence that INCS does not lead to an increased risk of glaucoma or cataract formation, [17][18][19] there have been no meta-analyses conducted on ocular changes, and only a handful of review articles that discuss the use of INCS and ocular changes. [20][21][22][23][24] The primary objective of this systematic review and meta-analysis was to assess whether the use of INCS leads to an increase in IOP above 20 mm Hg. The secondary objective was to assess whether use of INCS leads to the presence of glaucoma or development of posterior subcapsular cataracts in adult patients with allergic rhinitis.…”

Section: Introductionmentioning

confidence: 99%

Intranasal Corticosteroids Do Not Lead to Ocular Changes: A Systematic Review and Meta‐analysis

et al. 2018

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Use of INCS is not associated with a significant risk of elevating IOP or developing a posterior subcapsular cataract in patients with allergic rhinitis. Presence of glaucoma, however, is the real clinical adverse event of concern. There were zero reported cases of glaucoma at 12 months. Future studies should formally evaluate for glaucoma rather than use IOP measures as a surrogate. Laryngoscope, 2018.

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Intranasal corticosteroids do not affect intraocular pressure or lens opacity: a systematic review of controlled trials

Cited by 25 publications

References 40 publications

Prevention of chronic rhinosinusitis

Prevention of chronic rhinosinusitis

Sinus surgery: optimal surgery, optimal outcome?

Intranasal Corticosteroids Do Not Lead to Ocular Changes: A Systematic Review and Meta‐analysis

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