Corticosteroids and glaucoma risk.

Area of Science:

• Ophthalmology
• Endocrinology
• Pharmacology

Background:

• Corticosteroids (glucocorticoids) are potent anti-inflammatory drugs with significant ocular side effects.
• Exogenous or endogenous corticosteroid use can elevate intraocular pressure (IOP), posing a risk for glaucoma development.
• A notable percentage of the population, particularly those with primary open-angle glaucoma (POAG), are sensitive to corticosteroid-induced IOP elevation.

Purpose of the Study:

• To review the mechanisms and risk factors associated with corticosteroid-induced glaucoma.
• To highlight the prevalence of corticosteroid responsiveness in the general population and POAG patients.
• To discuss strategies for minimizing the risk and potential new treatment avenues.

Main Methods:

• Literature review of studies on corticosteroid effects on intraocular pressure.
• Analysis of epidemiological data on corticosteroid responsiveness and glaucoma.
• Examination of in vitro studies on trabecular meshwork cells exposed to corticosteroids.

Main Results:

• 18-36% of the general population are corticosteroid responders, with this figure rising to 46-92% in POAG patients.
• Increased vulnerability to corticosteroid-induced glaucoma is observed in individuals over 40, those with diabetes, high myopia, or a family history of POAG.
• Corticosteroid-induced glaucoma shares pathological similarities with POAG, involving changes in the trabecular meshwork and increased production of myocilin.

Conclusions:

• Corticosteroid-induced ocular hypertension is a significant concern, influenced by drug specifics, dosage, and patient susceptibility.
• Judicious corticosteroid use, patient/practitioner education, and development of IOP-sparing alternatives are crucial for risk mitigation.
• Further research into risk factors and novel therapeutic agents is warranted to address corticosteroid-induced glaucoma effectively.