Severe Corticosteroid-Induced Ocular Hypertension Requiring Bilateral Trabeculectomies in a Patient with Takayasu’s Arteritis

Abstract

We present a rare case of severe corticosteroid-induced ocular hypertension (OHT) after prolonged systemic corticosteroid use in a young woman with Takayasu's arteritis. As she did not sufficiently respond to ocular antihypertensive therapies, bilateral enhanced trabeculectomies were required to normalize her intraocular pressures. The systemic side effects of corticosteroids are well known, yet steroid-induced OHT and glaucoma remain silent causes of ocular morbidity. This case highlights the importance of IOP-monitoring in visually asymptomatic patients on systemic corticosteroids. It further emphasizes the need to raise awareness of the potential ocular side effects of steroids amongst physicians, in particular those looking after patients with autoimmune and inflammatory diseases.

Reversal of Peripheral Anterior Synechiae After Trabeculectomy With Argon Laser Synechiolysis

“…Topical ophthalmic corticosteroids usually lead to a rise in IOP after three to six weeks of continuous administration. However, a rise in IOP may be observed within one week of initiating treatment [ 2 ]. Intervention and early treatment are required in patients with ocular hypertension as 9.5% of these patients eventually develop glaucomatous optic neuropathy and associated visual field loss versus 4.4% in those receiving IOP-lowering medication 5 years later [ 2 ].…”

“…In steroid-induced ocular hypertension and steroid-induced glaucoma, augmented trabeculectomy and tube shunts become the surgery of choice in patients in refractive conditions [ 2 , 3 ]. Reduction of IOP and maintaining it within the target IOP range is the main aim of trabeculectomy.…”

Incidence, Risk Factors, Treatment, and Outcome of Ocular Hypertension following Intravitreal Steroid Injections: A Comparative Study

“…But a rise in intraocular pressure (IOP), termed steroid-induced ocular hypertension (SI-OHT), is a major concern upon administration of these intravitreal injections [2]. SI-OHT is observed in 20–40% of steroid-treated subjects, which may lead to optic nerve damage and irreversible vision loss when left untreated [3].…”