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Intraocular pressure in patients with Cushing's disease
J B Jonas1, O Huschle, G Koniszewski
1Universitäts-Augenklinik, Universität Erlangen-Nürnberg, Federal Republic of Germany.
Summary
Endogenously elevated cortisol in Cushing's disease slightly increases intraocular pressure, unlike topical steroids. This study found minimal risk of glaucoma, with pressure decreasing post-surgery in patients achieving remission.
Area of Science:
- Endocrinology
- Ophthalmology
Background:
- Topical corticosteroids are known to elevate intraocular pressure (IOP) in a significant portion of the population.
- Endogenous hypercortisolism, such as in Cushing's disease, presents a unique model to study cortisol's effect on IOP.
Purpose of the Study:
- To evaluate the impact of endogenously elevated serum cortisol levels on intraocular pressure in patients with Cushing's disease.
- To assess the risk of glaucomatous changes associated with hypercortisolism.
Main Methods:
- Retrospective analysis of 62 patients with hypothalamic pituitary-dependent Cushing's disease.
- Measurement of intraocular pressure pre- and post-transsphenoidal microsurgical sella exploration.
- Biomorphometry of optic disc topography and retinal nerve-fiber layer in a subset of patients.
Main Results:
- Preoperative mean IOP was 14.9 +/- 3.5 mm Hg, with only a few eyes exceeding 21 mm Hg.
- Postoperative mean IOP was 14.3 +/- 2.8 mm Hg.
- Patients achieving remission showed a significant decrease in IOP post-surgery (P = 0.04).
- No glaucomatous changes were detected in optic nerve or retinal nerve fiber layers.
Conclusions:
- Endogenously elevated cortisol in Cushing's disease has a minimal effect on intraocular pressure compared to externally applied corticosteroids.
- There is a low risk of developing glaucomatous optic nerve damage in patients with Cushing's disease.
- Surgical remission of Cushing's disease may lead to a reduction in intraocular pressure.