Cataract Induced by Glucocorticoids

Area of Science:

• Ophthalmology and Pharmacology
• Molecular Biology and Genetics
• Epidemiology and Public Health

Background:

• Glucocorticoids (GCs) are essential for treating noninfectious uveitis and autoimmune conditions.
• Chronic GC administration frequently leads to sight-threatening complications, notably glucocorticoid-induced cataracts (GIC).
• GIC significantly impairs visual acuity, photophobia, and overall quality of life.

Purpose of the Study:

• To provide a comprehensive review of the molecular pathogenesis, epidemiology, and clinical management of GIC.
• To synthesize current evidence to resolve the GC therapeutic paradox.
• To establish robust frameworks for future clinical management of GIC.

Main Methods:

• Systematic review and synthesis of current scientific evidence.
• Epidemiological analysis of ocular complications in patients receiving systemic corticosteroids.
• Review of histopathological findings and molecular mechanisms of GIC.
• Analysis of risk stratification models for cataractogenesis.

Main Results:

• Over 50% of patients on systemic corticosteroids for >60 days experience ocular complications, with cataracts (36%) and glaucoma (16%) being most common.
• GIC involves posterior subcapsular opacities linked to oxidative stress, EMT, vimentin dysregulation, Na+/K+-ATPase inhibition, apoptosis, and ER stress.
• Key risk factors for GIC include cumulative GC dose, treatment duration, and route of administration (oral > topical > intravitreal).

Conclusions:

• GIC is a prevalent and debilitating complication of essential GC therapy.
• Understanding the molecular pathogenesis and epidemiological patterns is crucial for effective management.
• Future interventions should focus on antioxidants, targeted therapies, advanced drug delivery, and GC-sparing agents.