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Comparing glaucoma risk in children receiving low-dose and high-dose glucocorticoid treatment after cataract surgery

Diana Chabané Schmidt1, Torben Martinussen2, Ameenat Lola Solebo3,4

  • 1Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark.

Acta Ophthalmologica
|August 12, 2024
PubMed

Insights

Low-dose glucocorticoid treatment after pediatric cataract surgery reduced glaucoma risk in children with longer eyes. High-dose glucocorticoids should be used sparingly in this population to minimize adverse effects.

Area of Science:

  • Ophthalmology
  • Pediatric Surgery
  • Endocrinology

Background:

  • Glucocorticoid treatment is vital post-pediatric cataract surgery to manage inflammation.
  • However, high-dose glucocorticoids may increase risks of secondary glaucoma and hypothalamic-pituitary-adrenal axis suppression.

Purpose of the Study:

  • To compare glaucoma outcomes between high-dose and low-dose postoperative glucocorticoid regimens in children undergoing cataract surgery.

Main Methods:

  • A cohort study of Danish children (under 10 years) who had cataract surgery between 2010-2021.
  • Compared sustained ocular hypertension or glaucoma (>3 months) between low-dose and high-dose glucocorticoid groups.
  • High-dose: subconjunctival depot dexamethasone/methylprednisolone plus topical dexamethasone; Low-dose: topical dexamethasone with a shorter duration and lower frequency.

Main Results:

  • 267 children (388 eyes) were analyzed; 95 received high-dose and 173 received low-dose treatment.
  • Survival analysis indicated a reduced risk of glaucoma in the low-dose group for children with axial lengths ≥18 mm.
  • No significant difference in glaucoma risk was observed for children with shorter eyes.

Conclusions:

  • Low-dose glucocorticoid therapy is associated with a lower risk of glaucoma in pediatric cataract surgery patients with axial lengths ≥18 mm.
  • High-dose glucocorticoid use should be minimized in pediatric cataract surgery.
  • Further research may explore optimal glucocorticoid dosing strategies based on ocular parameters.
Abstract

Keywords:
congenital cataractglaucomaglucocorticoidocular hypertensionpaediatric cataractsecondary glaucomasteroid

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