Ocular Complications of Immunosuppressive Therapy in Renal Transplant Recipients

Cataracts in neutrophil donors stimulated with adrenal corticosteroids

“…Fryer et al 6 stated that significant risk factors for PSC development were steroid dose after a 1‐year treatment and cumulative time on steroids—significant variables were prednisone dose at 1 year of >0.15 mg per kg per day (10.5 mg/day or 3833 mg/year for a 70‐kg patient) and a cumulative time on steroids of >5 years. In agreement, Pavlin et al 5 found a positive correlation between PSCs and the dose of prednisone taken, particularly with regard to the number of days with a dose >100 mg. In contrast, several other studies failed to find an association between the dose or duration of steroid usage and the development of PSCs 4,7,9,10,12–14 .…”

“…Although our data are not conclusive, the doses of prednisone given before each leukapheresis seem to be the most likely pathogenetic factor inducing PSCs in PMN donors. The association of PSCs with corticosteroids is clear, with most investigators agreeing that the dose and duration of steroid therapy are poorly predictive of PSC development 4–15 . Compared to patients given pharmacologic doses of prednisone (1‐2 mg/kg/day for several weeks to months), our PMN donors took relatively modest doses at intermittent intervals—60 mg for only 1 day, with individual doses often separated by many weeks.…”

“…Thus, many donors may be given corticosteroids and placed, potentially, at risk for PSCs. The clinical importance of PSC development in PMN donors is unclear, because the susceptibility of persons to steroid‐induced PSCs varies, and the relationship of steroid dose and duration is imprecise 4–15 . Moreover, PSCs often do not diminish vision when they are small and not in the visual axis, 4,8 and they may resolve spontaneously after drug withdrawal 8,9,12 .…”

“…This presumption of safety is supported by few reports of adverse steroid effects in PMN donors, other than occasional insomnia and the expected transient changes in blood WBC counts. However, there is a well‐established relationship 4–15 between the use of corticosteroids and the development of posterior subcapsular cataracts (PSCs), although findings are likely to be occult unless sought by a systematic ophthalmologic examination, because vision may not be impaired by mild PSCs, 4,8 and PSCs occasionally resolve spontaneously 8,9,12 . Thus, the true risk, if any, of steroid‐induced cataracts in PMN donors is unknown.…”

“…Corticosteroids are widely used to treat many disorders, and the underlying medical circumstances seem not to be of critical importance in determining the risk for developing PSCs 4–15 . Although the relationship between corticosteroids and PSCs is well established, the development of PSCs is not inevitable, as not all steroid recipients develop them—generally, <50 percent do, but up to 97 percent may 14 .…”