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Ocular hypertensive response to topical dexamethasone in children: a dose-dependent phenomenon
1Department of Ophthalmology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, New Territories, Hong Kong.
Insights
Topical dexamethasone eye drops can cause ocular hypertension in children, with higher doses leading to a more severe response. Even lower doses significantly increase intraocular pressure (IOP), necessitating careful monitoring.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Pharmacology
Background:
- Topical corticosteroids like dexamethasone are frequently used postoperatively.
- Ocular hypertension is a known side effect of topical steroid use.
- Data on dexamethasone's ocular hypertensive effects in pediatric populations is limited.
Purpose of the Study:
- To evaluate the dose-dependent ocular hypertensive response to topical dexamethasone in Chinese children.
- To compare the intraocular pressure (IOP) changes between twice-daily and four-times-daily dexamethasone regimens.
Main Methods:
- Prospective, randomized clinical trial involving 31 children under 10 years old undergoing strabismus surgery.
- Bilateral eyes received different dexamethasone (0.1%) regimens: twice daily vs. four times daily.
- Intraocular pressure (IOP) was serially measured for at least 4 weeks post-surgery.
Main Results:
- Both twice-daily and four-times-daily dexamethasone significantly increased peak IOP compared to preoperative levels.
- The four-times-daily regimen resulted in a significantly higher peak IOP and net IOP increase.
- The time to exceed an IOP of 20 mmHg was shorter with the four-times-daily regimen.
Conclusions:
- Topical dexamethasone induces a dose-dependent ocular hypertensive response in children.
- Higher frequency of administration leads to a quicker and more severe IOP elevation.
- Dexamethasone use in children warrants caution, with potential need for frequent IOP monitoring.
Objective:
To investigate the ocular-hypertensive response to different dosages of topical dexamethasone eye drops in Chinese children.
Design:
Prospective, randomized clinical trial.
Participants:
Thirty-one consecutive children undergoing bilateral strabismus surgery.
Intervention:
Topical dexamethasone (0.1%) was administered to children undergoing bilateral strabismus surgery. They were all less than 10 years of age. One eye was randomized to receive a regimen of four times daily, and another received a twice daily regimen. Intraocular pressure (IOP) was serially measured in the postoperative period for 4 weeks or more. Topical steroids were discontinued if IOP was 30 mmHg or more.
Main Outcome Measures:
Intraocular pressure was measured on the day before the surgery, on postoperative days 1, 3, 5, 8, 12, 15, 22, 29, and 2 weeks thereafter until the IOP reached preoperative levels. Peak IOP, IOP net increase, and time to reach an IOP more than 20 mmHg in the two study groups were analyzed.
Results:
A total of 31 patients (20 male, 11 female) were examined. The mean age was 5.8 +/- 2.0 years (range, 2-10 years). Preoperative IOP in groups treated twice daily and four times daily were similar. After topical dexamethasone treatment, both groups showed a significant rise in peak IOP compared with preoperative values (twice daily, 25.2 +/- 6.8 mmHg vs. 14.3 +/- 2.4 mmHg, P < 0.001; four times daily, 28.7 +/- 6.9 mmHg vs. 14.3 +/- 2.9 mmHg, P < 0.001). The peak IOP was significantly higher in the four times daily group (P < 0.001), as was the net increase in IOP (twice daily, 10.9 +/- 5.8 mmHg vs. four times daily, 14.5 +/- 6.4 mmHg; P < 0.001). There was no difference in time for both groups to achieve the peak IOP, but the time to exceed its upper normal value (20 mmHg) was shorter in the four times daily group (twice daily, 12.3 +/- 9.1 days vs. four times daily, 10.0 +/- 7.4 days; P < 0.05).
Conclusions:
In children treated with topical dexamethasone, ocular hypertension occurs in a dose-dependent manner. Children in the four times daily group had a quicker onset and more severe ocular hypertensive response than the twice daily group. Nevertheless, even the twice daily regimen produced significant IOP rise, suggesting that dexamethasone use in children should be avoided if possible, and it would be desirable to monitor the IOP twice weekly when it is administered to children.