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Elevated intraocular pressure in children with acute lymphoblastic leukaemia: A prospective study
Shlomit Barzilai-Birenboim1,2, Sarah Elitzur1,2, Ronit Nirel3
1Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Insights
High-dose steroids in childhood acute lymphoblastic leukemia (ALL) treatment frequently cause ocular hypertension. Regular intraocular pressure monitoring is crucial for early intervention to prevent potential vision loss in these young patients.
Area of Science:
- Ophthalmology
- Pediatric Oncology
- Hematology
Background:
- Childhood acute lymphoblastic leukemia (ALL) treatment commonly involves high-dose steroids.
- The impact of high-dose steroids on intraocular pressure (IOP) and risk of glaucomatous optic neuropathy in pediatric ALL patients is not well-understood.
- Routine IOP monitoring is not standard practice in children undergoing ALL therapy.
Purpose of the Study:
- To prospectively evaluate intraocular pressure (IOP) in children with newly diagnosed ALL during induction therapy.
- To determine the prevalence of ocular hypertension and identify associated risk factors.
- To assess the need for IOP monitoring and therapeutic intervention in this population.
Main Methods:
- Prospective measurement of IOP in 90 children with newly diagnosed ALL at diagnosis, mid-induction, and end-induction.
- Ocular hypertension defined as IOP > 21 mm Hg.
- Multivariate logistic regression analysis to identify risk factors for elevated IOP.
Main Results:
- Ocular hypertension was observed in 71% of children at any time point, increasing during induction.
- 40% had elevated IOP at diagnosis before therapy initiation; non-standard ALL was a risk factor.
- Dexamethasone therapy and high body mass index were significant risk factors for ocular hypertension.
Conclusions:
- High-dose steroid therapy in pediatric ALL significantly increases the risk of ocular hypertension.
- Routine IOP evaluation during steroid therapy is essential for early detection and intervention.
- Timely intervention can prevent permanent ocular damage in children with ALL.
Abstract:
Most childhood acute lymphoblastic leukaemia (ALL) protocols include high-dose steroid therapy. However, the known potential of high-dose steroids to significantly elevate intraocular pressure (IOP) and lead to glaucomatous optic neuropathy has not been intensively investigated in children with ALL. Moreover, as children with ALL do not routinely undergo IOP measurements, the need for IOP monitoring and therapy is unknown. We prospectively measured IOP in 90 children with newly diagnosed ALL attending a tertiary paediatric haematology/oncology centre, at diagnosis and at the middle and end of induction therapy. Ocular hypertension (IOP > 21 mm Hg) at any time point was documented in 64 children (71%), and the prevalence increased during induction. Thirty-six children (40%) had elevated IOP at ALL diagnosis before therapy initiation, and stratification to non-standard ALL was a risk factor. IOP reduction therapy was administered to 13 children (14%); none required surgery. Values normalised in all cases. On multivariate logistic regression analysis, dexamethasone therapy was a significant risk factor for ocular hypertension. High body mass index was an additional risk factor in children with elevated IOP at ALL diagnosis. Routine evaluation of IOP during steroid therapy is very important in children with ALL to ensure early intervention which may prevent permanent ocular damage.
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