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Ocular toxicity of prednisone in pediatric patients with inflammatory bowel disease
R C Tripathi1, M A Kipp, B J Tripathi
1Visual Sciences Center, University of Chicago, IL 60637.
Insights
Corticosteroid treatment for pediatric inflammatory bowel disease (IBD) can cause posterior subcapsular cataracts (PSC) and elevated intraocular pressure (IOP). Regular ophthalmologic monitoring is crucial for children receiving these medications.
Area of Science:
- Ophthalmology
- Pediatrics
- Pharmacology
Background:
- Corticosteroids are commonly used to manage pediatric inflammatory bowel disease (IBD).
- Ocular side effects of corticosteroid therapy in children are a significant concern.
- Previous studies have indicated potential links between corticosteroid use and ocular changes.
Purpose of the Study:
- To investigate the prevalence of posterior subcapsular cataracts (PSC) and elevated intraocular pressure (IOP) in pediatric patients with IBD treated with corticosteroids.
- To identify potential correlations between corticosteroid dosage, duration, and the development of ocular complications.
- To assess the reversibility of ocular changes upon corticosteroid dose reduction.
Main Methods:
- Ocular examinations were conducted on 58 pediatric patients with IBD receiving corticosteroids and 58 age-matched controls.
- Intraocular pressure (IOP) was measured, and patients were categorized as "IOP responders" if IOP met specific criteria.
- Statistical analyses were performed to correlate ocular findings with corticosteroid treatment parameters.
Main Results:
- Posterior subcapsular cataracts (PSC) were detected in 20.7% of treated patients, compared to none in controls.
- Mean intraocular pressure (IOP) was significantly higher in the corticosteroid-treated group (15.89 mmHg) versus controls (13.63 mmHg).
- Elevated IOP correlated with the average daily dose of corticosteroids 30 days prior to examination.
- Reduction of corticosteroid dose led to regression of PSC in some patients and decreased IOP in responders.
- Only 5.2% of patients exhibited both PSC and raised IOP.
Conclusions:
- Corticosteroid therapy for pediatric IBD is associated with a significant risk of developing posterior subcapsular cataracts (PSC) and elevated intraocular pressure (IOP).
- The mechanisms underlying steroid-induced PSC and raised IOP may be distinct.
- Close ophthalmologic monitoring is recommended for pediatric patients on corticosteroid therapy for IBD or other conditions due to the high prevalence of ocular side effects.
Abstract:
We performed ocular examinations on 58 corticosteroid-treated pediatric patients with inflammatory bowel disease (IBD) and on 58 age-matched controls. Posterior subcapsular cataracts (PSC) were detected in 12 of the 58 treated patients (20.7%) and in none of the controls. The difference in mean intraocular pressure (IOP) between the treated patients (15.89 +/- 4.11 mm Hg) and control subjects (13.63 +/- 2.35 mm Hg) was significant statistically (P < 0.001). Twenty-one patients (36.2%) were characterized as "IOP responders" (IOP > or = 20 mm Hg, change in IOP > or = 6 mm Hg between visits, or a difference in IOP > or = 6 mm Hg between the two eyes). Formation of PSC was not correlated significantly (P > 0.05) with the total dose of prednisone, duration of treatment, average daily dose, or number of days on high doses (> or = 25 mg). Raised IOP was correlated (P = 0.005) only with average daily dose (12.4 +/- 10.9 mg/day; range, 0-47 mg/day) 30 days before examination. When the dose of corticosteroid was reduced to < 10 mg/day, 2 patients manifested regression of PSC, and 12 IOP responders showed a decrease in IOP to within 2 SD of the mean control IOP. Only 3 of the 58 treated patients (5.2%) manifested both PSC and raised IOP. A significant inverse correlation (P = 0.02) was established between IOP at first examination and formation of PSC. We propose that the mechanisms for steroid-induced lens opacities and raised IOP do not share the same genetic basis. Because 52% of these children developed either PSC or raised IOP with prednisone therapy, we advocate careful ophthalmologic monitoring of pediatric patients receiving corticosteroids for IBD or any other condition.