Posterior Subcapsular Cataracts Associated With Nasal or Inhalation Corticosteroids

Fraunfelder, Frederick T.; Meyer, S. Martha

doi:10.1016/s0002-9394(14)74627-6

Cited by 73 publications

(22 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There have been reports of a possible association between the development of posterior subcapsular cataracts and the use of intranasal or inhaled corticosteroids in older patients, 934 but this association has not been confirmed by other studies with inhaled corticosteroids 935 or studies of intranasal corticosteroids. 402,403 Concomitant use of systemic corticosteroids in some patients receiving intranasal corticosteroids confounds interpretation of these studies.…”

Section: Ocular Effectsmentioning

confidence: 96%

The diagnosis and management of rhinitis: An updated practice parameter

Wallace¹,

Dykewicz²,

Bernstein³

et al. 2008

Journal of Allergy and Clinical Immunology

950

953

View full text Add to dashboard Cite

Section: Ocular Effectsmentioning

confidence: 96%

The diagnosis and management of rhinitis: An updated practice parameter

Wallace¹,

Dykewicz²,

Bernstein³

et al. 2008

Journal of Allergy and Clinical Immunology

950

953

View full text Add to dashboard Cite

“…Previous case reports of posterior subcapsular cataracts in patients taking inhaled corticosteroids are often confounded by previous exposure to oral corticosteroid therapy. [135][136][137] Indeed, resolution of posterior subcapsular cataracts has occasionally been observed after conversion from maintenance prednisone to inhaled corticosteroid therapy, suggesting a possible dynamic component in early cases. 138,139 Toogood et al 140 studied 48 patients (mean age, 61 years) receiving long-term inhaled budesonide or beclomethasone dipropionate with a mean dose of 1.5 mg/d, and found a 27% prevalence of posterior subcapsular cataracts as well as a correlation of the dose and duration of prednisone but not inhaled corticosteroid therapy.…”

Section: Ocular Effectsmentioning

confidence: 99%

Systemic Adverse Effects of Inhaled Corticosteroid Therapy

1999

View full text Add to dashboard Cite

Objective: To appraise the data on systemic adverse effects of inhaled corticosteroids.Methods: A computerized database search from January 1, 1966, through July 31, 1998, using MEDLINE, EMBASE, and BIDS and using appropriate indexed terms. Reports dealing with the systemic effects of inhaled corticosteroids on adrenal gland, growth, bone, skin, and eye, and reports on pharmacology and pharmacokinetics were reviewed where appropriate. Studies were included that contained evaluable data on systemic effects in healthy volunteers as well as in asthmatic children and adults. A statistical meta-analysis using regression was performed for parameters of adrenal suppression in 27 studies.Results: Marked adrenal suppression occurs with high doses of inhaled corticosteroid above 1.5 mg/d (0.75 mg/d for fluticasone propionate), although there is a considerable degree of interindividual susceptibility. Metaanalysis showed significantly greater potency for doserelated adrenal suppression with fluticasone compared with beclomethasone dipropionate, budesonide, or triamcinolone acetonide, whereas prednisolone and fluticasone propionate were approximately equivalent on a 10:1-mg basis. Inhaled corticosteroids in doses above 1.5 mg/d (0.75 mg/d for fluticasone propionate) may be associated with a significant reduction in bone density, although the risk for osteoporosis may be obviated by postmenopausal estrogen replacement therapy. Although medium-term growth studies showed suppressive effects with 400-µg/d beclomethasone dipropionate, there was no evidence to support any significant effects on final adult height. Long-term, high-dose inhaled corticosteroid exposure increases the risk for posterior subcapsular cataracts, and, to a much lesser degree, the risk for ocular hypertension and glaucoma. Skin bruising is most likely to occur with high-dose exposure, which correlates with the degree of adrenal suppression.Conclusions: All inhaled corticosteroids exhibit doserelated systemic adverse effects, although these are less than with a comparable dose of oral corticosteroids. Metaanalysis shows that fluticasone propionate exhibits greater dose-related systemic bioactivity compared with other available inhaled corticosteroids, particularly at doses above 0.8 mg/d. The long-term systemic burden will be minimized by always trying to achieve the lowest possible maintenance dose that is associated with optimal asthmatic control and quality of life. Med. 1999;159:941-955 Arch Intern

show abstract

“…The prevalence of cataracts among the studied groups can be attributed to the excess exposure to corticosteroids as environmental pollutants in their work atmosphere as evidenced by the higher plasma cortisol in their sera. The use of corticosteroids by nasal spray and inhalation has been associated with the development of posterior subcapsular cataracts as reported by Fraunfelder and Meyer [4]. Garbe et al [5] similarly concluded that prolonged administration of high doses of inhaled corticosteroids increases the likelihood of undergoing cataract extraction in elderly patients.…”

Section: Discussionmentioning

confidence: 95%

Ocular manifestations of occupational exposure to corticosteroids in the pharmaceutical industry

Metwally¹,

El-Assal²,

Kamel³

2006

WIT Transactions on Biomedicine and Health, Vol 10

View full text Add to dashboard Cite

The therapeutic use of corticosteroids has long been associated with ocular side effects such as the development of cataracts, glaucoma, and retinal and choroidal emboli. This study was conducted to assess ocular disorders, which may occur in workers engaged in manufacturing corticosteroids in the pharmaceutical industry. The study population included 58 workers involved in the manufacturing of corticosteroid preparations. They were subdivided according to duration of exposure into 2 groups: Gr. I of <15 years duration of employment and Gr. II of 15 + years duration of employment. Methods included answering a structured questionnaire enquiring about occupational and medical histories, full ocular and clinical examination, and measurement of certain biochemical parameters, such as plasma cortisol, serum total cholesterol, serum triglycerides, fasting blood sugar and serum calcium. Results showed that 25 cataracts were diagnosed in the studied group with a rate of 21.55 per one hundred eyes. Of Gr.II, 43.75% of eyes had cataracts compared to 5.88% of Gr.I. Odds ratio to develop cataracts was 12.44 for Gr. II compared to Gr.I. Ocular hypertension and open-angle glaucoma were present in 25.00% of the eyes of the studied groups with odds of 5.83 times more when being employed for 15 or more years. Significant +ve correlation was found between intraocular pressure and relevant biochemical parameters. In the present study, a clear relationship was detected between the length of the period of exposure to corticosteroids as environmental pollutants and the development of ocular medical disorders such as cataracts, ocular hypertension and glaucoma. Further research work is needed to study the effects of exposure to corticosteroids as pollutants in the work environment, gaining access into body via unusual routes of entry, and for periods of time not reported in the therapeutic literature.

show abstract

Posterior Subcapsular Cataracts Associated With Nasal or Inhalation Corticosteroids

Cited by 73 publications

References 3 publications

The diagnosis and management of rhinitis: An updated practice parameter

The diagnosis and management of rhinitis: An updated practice parameter

Systemic Adverse Effects of Inhaled Corticosteroid Therapy

Ocular manifestations of occupational exposure to corticosteroids in the pharmaceutical industry

Contact Info

Product

Resources

About