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Risk factors of pediatric steroid-induced ocular hypertension
Fumio Takano1, Kaori Ueda2, Yuko Yamada-Nakanishi1
1Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Insights
Steroid-induced ocular hypertension (SIOH) in children is linked to younger age, male sex, and higher steroid doses. Monitoring intraocular pressure and white blood cell counts is crucial during treatment.
Area of Science:
- Pediatric Ophthalmology
- Endocrinology
- Pharmacology
Background:
- Steroid-induced ocular hypertension (SIOH) is a known complication of corticosteroid therapy.
- Limited research exists on risk factors for pediatric SIOH.
Purpose of the Study:
- To identify risk factors associated with SIOH in children.
- To analyze variables predicting steroid responsiveness in pediatric patients.
Main Methods:
- Retrospective data collection from 78 children under 20 receiving systemic steroids.
- Analysis of age, gender, primary disease, intraocular pressure (IOP) changes, steroid dose, and blood cell counts.
- Multivariate and receiver operating characteristic (ROC) analyses to determine risk factors and cutoff values.
Main Results:
- 38.5% of patients developed SIOH.
- Younger age, male sex, primary disease, increased white blood cell (WBC) count, and higher total monthly steroid dose per body weight were significant risk factors.
- ROC analysis identified cutoff values for age (11.0 years), total monthly steroid dose (40.7 mg/kg), and WBC increase (3.40 × 10²/µl).
Conclusions:
- High-dose steroid administration in younger, male pediatric patients requires vigilant IOP monitoring.
- Monitoring WBC count alongside IOP is recommended during follow-up assessments.
- Identifying at-risk children can guide the frequency of ophthalmologic examinations during systemic steroid therapy.
Purpose:
Steroid-induced ocular hypertension (SIOH) is a significant ocular complication of pediatric steroid administration. In this study, we analyzed the risk factors associated with pediatric SIOH.
Methods:
We retrospectively collected data from 78 children under 20 years of age who received systemic steroids during hospitalization. The data included age, gender, primary disease, intraocular pressure (IOP) before and one month after administration, total monthly steroid dose adjusted for body weight (BW), and one-month changes in red blood cell, white blood cell, and platelet counts. A multivariate analysis was used to identify risk factors related to steroid responsiveness.
Results:
Thirty patients (38.5%) were classified as steroid responders, and 48 as non-responders. The median IOP during the first month of steroid treatment was 24.0 mmHg (IQR; 23.0-28.3) for responders and 15.0 mmHg (IQR; 12.3-18.0) for non-responders. The Generalized Estimating Equations analysis revealed that younger age, male sex, primary disease, increase the amount of white blood cell (WBC) and total steroid dose per BW in one month were independently associated variables. The receiver operating characteristic analysis also revealed that the cutoff values for age, total monthly steroid dose, the increase amount of WBC were 11.0 years, 40.7 mg/kg and 3.40 × 10²/µl respectively.
Conclusion:
High-dose steroid administration, especially in male, younger patients, necessitates careful monitoring for IOP changes during treatment. WBC count also needs to be monitored during IOP follow-ups.
Key Messages:
What is known Steroid-induced ocular hypertension (SIOH) is one of the essential complications during steroid administration, but only limited analyses have been performed in children. What is new A comprehensive analysis of multiple factors was performed that are predicted to be associated with pediatric SIOH from previous literature. Younger age, male sex, primary disease, increase the amount of WBC, and higher total monthly steroid dose were extracted as risk factors of SIOH. This study can contribute to the prediction of cases in which ophthalmologic examinations are particularly important during systemic steroid administration in children.
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