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Steroid-induced protracted severe ocular hypertension in a 14-year-old girl

David Cordeiro Sousa1,2, Inês Leal1,2, Luis Abegão Pinto1,2

  • 1Ophthalmology Department, Hospital de Santa Maria, Lisboa, Portugal.

BMJ Case Reports
|June 29, 2018
PubMed

Insights

Steroid-induced ocular hypertension (SIOH) in children can be difficult to treat. Minimally invasive glaucoma surgery (MIGS) with XEN gel stents effectively lowered intraocular pressure in a pediatric patient refractory to medical therapy.

Area of Science:

  • Ophthalmology
  • Glaucoma Surgery
  • Pediatric Ophthalmology

Background:

  • Steroid-induced ocular hypertension (SIOH) poses a significant challenge in pediatric patients, often proving refractory to medical management.
  • Limited literature exists regarding surgical interventions for SIOH in pediatric populations.
  • A 14-year-old female presented with bilateral uveitis and macular edema, treated with intravitreal and subconjunctival triamcinolone acetonide injections.

Observation:

  • The steroid treatment successfully resolved macular edema but led to severe ocular hypertension, with intraocular pressure (IOP) reaching approximately 40 mm Hg in the right eye and 34 mm Hg in the left eye.
  • Despite maximal medical therapy for IOP reduction, the patient exhibited progressive structural changes.
  • A conservative approach was initially considered due to the patient's age and the typically transient nature of SIOH.

Findings:

  • Bilateral sequential minimally invasive glaucoma surgery (MIGS) using XEN gel stents was performed.
  • At a 6-month follow-up, the patient was free from IOP-lowering medications, maintaining an IOP of around 14 mm Hg in both eyes.
  • MIGS demonstrated significant efficacy in managing SIOH refractory to medical treatment in this pediatric case.

Implications:

  • This case highlights the potential role and efficacy of MIGS as a viable surgical option for pediatric SIOH.
  • The findings suggest that MIGS can be a safe and effective alternative for young patients with steroid-induced glaucoma unresponsive to conventional therapies.
  • Further research into MIGS for pediatric SIOH is warranted to establish its long-term safety and effectiveness.

Keywords:
glaucomamaculaophthalmology

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