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[Steroid cataracts in children]
J Krásný1, V Kozáková, M Odehnal
1Dĕtská ocní klinika FN Motol a 2. LF UK, Praha.
Insights
Long-term corticosteroid use in children undergoing chronic dialysis can lead to posterior subcapsular cataract (PSC). A daily dose of 0.3 mg/kg Prednisone or equivalent for one year increases PSC risk.
Area of Science:
- Ophthalmology
- Pediatrics
- Pharmacology
Context:
- Pediatric patients undergoing chronic dialysis for conditions like asthma, juvenile chronic arthritis, and leukemia.
- Long-term corticosteroid therapy is a common treatment modality in this cohort.
- Prevalence of posterior subcapsular cataract (PSC) was investigated in this population.
Purpose:
- To assess the incidence of posterior subcapsular cataract (PSC) in children on long-term corticosteroids for chronic dialysis.
- To identify risk factors associated with corticosteroid-induced PSC in pediatric patients.
- To establish a threshold for corticosteroid dosage and duration linked to PSC development.
Summary:
- Posterior subcapsular cataract (PSC) was diagnosed in 23% (23 out of 95) of children on long-term corticosteroids.
- The risk factor identified is the corticosteroid dose relative to body weight, not the absolute dose.
- PSC development is associated with a daily dose of 0.3 mg/kg Prednisone or equivalent for one year.
Impact:
- Highlights the risk of corticosteroid-induced PSC in pediatric patients on chronic dialysis.
- Recommends regular ophthalmic examinations for children on long-term corticosteroid treatment.
- Informs clinical practice regarding corticosteroid management in pediatric chronic diseases.
Abstract:
From a total of 95 children treated on a long-term basis with corticosteroids as part of a chronic dialyzation programme on account of asthma, juvenile chronic arthritis and leukaemia in 23 (24%) posterior subcapsular cataract (PSC) was diagnosed. The authors consider as the risk factor the amount of corticosteroids in relation to body weight rather than the absolute dose. The danger of PSC develops after one year's administration of 0.3 mg/kg/day Prednisone or its equivalent. This fact is documented by two case-histories indicating the chronology of development of PSC in two-year-old patients, from clear lenses to the most severe affection in the group. The absolute amount of Prednisone was 5-10 mg, i. e. 0.5 mg/kg/day. In one of the two patients the cataract of one eye had to be operated. The patients should have dispensary examinations after one year and subsequently after six-month intervals in case of continuing corticosteroid treatment. An interesting finding was the observation of the incipient stage of PSC--a double dissociation in the area of the posterior "Y" seam.