The Use of Acth and Cortisone in Ophthalmology*

Gordon, Dan M.; McLean, John M.; Koteen, H; Bousquet, Franklyn P.; McCusker, Wilfred D.; Baras, Irving; Wetzig, Paul C.; Norton, Edward W.D.

doi:10.1016/0002-9394(51)90032-3

Cited by 43 publications

(18 citation statements)

References 5 publications

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“…Furthermore, research has shown that the post-injection IOP fluctuations can also be damaging to the RNFL 18 . Steroids are also notorious for their steroid-induced increase in IOP 19 .…”

Section: Introductionmentioning

confidence: 99%

The effects of intravitreal injections on intraocular pressure and retinal nerve fiber layer: a systematic review and meta-analysis

Vries

Bassil

Ramdas

2020

Sci Rep

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The number of eye diseases treated with intravitreal injections is increasing. Obviously, an injection of fluid into the eye results in an increase of intraocular pressure (IOP), the main risk factor for glaucoma. However, the effect of these repeated IOP increases on the eye is unclear. Therefore, we performed a systematic review with meta-analyses. PubMed, Embase and Clinical Trials Registries were searched for articles investigating the relationship between intravitreal injections (anti-vascular endothelial growth factor [anti-VEGF] or steroids) and either IOP, retinal nerve fiber layer (RNFL)thickness and glaucoma. Multiple meta-analyses were performed, combining data on intravitreal injection of anti-VEGF medication and dexamethasone implants. A total of 74 articles were eligible for meta-analyses. The short-term effect of an intravitreal injection of anti-VEGF showed a statistically significant increase in IOP. One day after injection of anti-VEGF, however, IOP was significantly lower than baseline. The long-term time-intervals showed no significant difference in IOP. After intravitreal injection of a dexamethasone implant, IOP was significantly higher than baseline 1 month postinjection. RNFL-thickness was significantly reduced 6 and 12 months post-injection of anti-VEGF, as well as at end of follow up. Caution is advised when using intravitreal medication, especially when treating patients with advanced glaucoma; in these cases, prophylactic IOP-lowering medication may be considered.

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“…Furthermore, research has shown that the post-injection IOP fluctuations can also be damaging to the RNFL 18 . Steroids are also notorious for their steroid-induced increase in IOP 19 .…”

Section: Introductionmentioning

confidence: 99%

The effects of intravitreal injections on intraocular pressure and retinal nerve fiber layer: a systematic review and meta-analysis

Vries

Bassil

Ramdas

2020

Sci Rep

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“…16 Individuals susceptible to the latter side effect may require treatment for glaucoma. The phenomenon of glucocorticosteroid-induced ocular hypertension has been recognized for decades, 17 and a number of predisposing risk factors have been identified among patients receiving various corticosteroid treatments. 18,19 In general, it is recognized that the mechanisms by which glucocorticosteroids induce the IOP elevation involve a reduced trabecular aqueous humor outflow associated with morphologic and biochemical changes in the TM.…”

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confidence: 99%

Reduction of Steroid-Induced Intraocular Pressure Elevation in Sheep by Tissue Plasminogen Activator

Gerometta

Kumar

Shah

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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“…Corticosteroids, first introduced for ophthalmic use in 1951,1 remain a mainstay of treatment for ocular inflammation 2. However, dose dependent side-effects from chronic use (particularly with systemic corticosteroids) and sometimes inadequate response are limitations of such therapy 3.…”

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confidence: 99%

Cyclophosphamide for Ocular Inflammatory Diseases

et al. 2010

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Purpose-To evaluate the outcomes of cyclophosphamide therapy for non-infectious ocular inflammation. Design-Retrospective cohort studyParticipants-Two hundred fifteen patients with non-infectious ocular inflammation observed from initiation of cyclophosphamide.Methods-Patients initiating cyclophosphamide, without other immunosuppressive drugs (other than corticosteroids), were identified at four centers. Dose of cyclophosphamide, response to therapy, corticosteroid-sparing effects, frequency of discontinuation and reasons for discontinuation were obtained by medical record review of every visit.Main Outcome Measures-Control of inflammation, corticosteroid-sparing effects, discontinuation of therapy. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptOphthalmology. Author manuscript; available in PMC 2011 February 1. Published in final edited form as:Ophthalmology. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptResults-The 215 patients (381 involved eyes) meeting eligibility criteria carried diagnoses of uveitis (20.4%), scleritis (22.3%), ocular mucous membrane pemphigoid (45.6%) or other forms of ocular inflammation (11.6%). Overall, approximately 49.2% (95% confidence interval (CI): 41.7%-57.2%) gained sustained control of inflammation (for at least 28 days) within 6 months, and 76% (95% CI: 68.3%-83.7%) within 12 months. Corticosteroid-sparing success (sustained control of inflammation while tapering prednisone to 10 mg or less among those not meeting success criteria initially) was gained by 30.0% and 61.2% by six and 12 months respectively. Disease remission leading to discontinuation of cyclophosphamide occurred at the rate of 0.32/person-year (95% CI: 0.24 -0.41), and the estimated proportion with remission at or prior to 2 years was 63.1% (95% CI: 51.5%-74.8%). Cyclophosphamide was discontinued by 33.5% of patients within one year because of side effects-usually of a reversible nature.Conclusions-Our data suggest that cyclophosphamide is effective for the majority of patients for controlling inflammation and allowing tapering of systemic corticosteroids to 10 mg of prednisone or less, although a year of therapy may be needed to achieve these goals. Unlike with most other immunosuppressive drugs, disease remission was induced by treatment in the majority of patients who were able to tolerate therapy. In order to titrate therapy properly and to minimize the risk of serious potential side effects, a systematic program of laboratory monitoring is required. Judicious use of cyclophosphamide appears bene...

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The Use of Acth and Cortisone in Ophthalmology*

Cited by 43 publications

References 5 publications

The effects of intravitreal injections on intraocular pressure and retinal nerve fiber layer: a systematic review and meta-analysis

The effects of intravitreal injections on intraocular pressure and retinal nerve fiber layer: a systematic review and meta-analysis

Reduction of Steroid-Induced Intraocular Pressure Elevation in Sheep by Tissue Plasminogen Activator

Cyclophosphamide for Ocular Inflammatory Diseases

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