Risk factors and critical thresholds for glucocorticoid-induced ocular adverse reactions in children: implications for muscle and neuromuscular disease management
Related Experiment Videos
You Li1, Tingxin Cui1, Zhilang Lin1
1Zhongshan Ophthalmic Center, Sun Yat-sen University, WHO Collaborating Centre for Eye Care and Vision, State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou.
Insights
Systemic glucocorticoid (GC) therapy in children risks ocular adverse drug reactions (ADRs) like cataracts and hypertension. Identifying risk factors and exposure thresholds is key to preventing vision loss in pediatric patients.
Area of Science:
- Ophthalmology
- Pediatrics
- Pharmacology
Background:
- Systemic glucocorticoid (GC) therapy is essential for pediatric inflammatory and neuromuscular diseases.
- Prolonged GC use in children carries risks of severe ocular adverse drug reactions (ADRs), including posterior subcapsular cataract (PSCC) and steroid-induced ocular hypertension (SIOH).
- These ADRs can cause irreversible vision impairment, adding to the burden of chronic conditions in children.
Purpose of the Study:
- To identify specific risk factors and quantitative exposure thresholds for ocular ADRs in pediatric patients receiving GC therapy.
- To guide optimized GC treatment strategies and timely ophthalmic monitoring in children.
Main Methods:
- A retrospective case-control study involving 305 children with kidney disease treated with GCs (December 2020 - December 2022).
- Participants were categorized into PSCC, SIOH, or control groups.
- Logistic regression and Receiver Operating Characteristic (ROC) analysis were employed to identify risk factors and critical exposure thresholds.
Main Results:
- Seven significant risk factors for PSCC were identified: younger age, longer GC duration, hypertension, growth retardation, vitamin D deficiency, immunosuppressant use, and oral methylprednisolone.
- Critical thresholds for PSCC onset were GC treatment duration >5.6 months or cumulative dose >5,888 mg.
- Higher daily GC dosage (>0.59 mg/kg/day), oral methylprednisolone, and growth retardation were significant risk factors for SIOH.
Conclusions:
- This study elucidates key risk factors and establishes quantitative GC exposure thresholds for ocular ADRs in children.
- Findings provide evidence-based guidance for ophthalmic screening and intervention timing in pediatric patients requiring long-term GC therapy.
- Proactive monitoring and tailored GC management are crucial for mitigating vision-threatening complications and improving long-term outcomes.
Abstract:
Systemic Glucocorticoid (GC) therapy is integral to managing various paediatric conditions, including inflammatory muscle and neuromuscular diseases. However, prolonged GC use in children poses a significant risk for severe ocular Adverse Drug Reactions (ADRs), notably Posterior Subcapsular Cataract (PSCC) and Steroid-Induced Ocular Hypertension (SIOH). These ADRs can lead to irreversible visual impairment, creating a substantial burden, particularly for paediatric patients already managing chronic conditions. Identifying specific risk factors and precise exposure thresholds is crucial for optimizing GC treatment and guiding timely ophthalmic monitoring. This retrospective case-control study analyzed data from 305 children with kidney disease, who received oral or intravenous GCs between December 2020 and December 2022. Participants were grouped into PSCC, SIOH, or control (no ocular ADRs). Logistic regression assessed risk factors, and Receiver Operating Characteristic (ROC) analysis determined critical thresholds for cumulative dose and duration. Results indicated seven significant risk factors for PSCC: younger age, longer GC duration, hypertension, growth retardation, vitamin D deficiency, immunosuppressant use, and oral methylprednisolone. Critical thresholds for cataract onset were identified as GC treatment duration >5.6 months or a cumulative dose >5,888 mg. For SIOH, higher daily GC dosage (>0.59 mg/kg/day), oral methylprednisolone, and growth retardation were significant risk factors. These findings elucidate key risk factors and establish quantitative GC exposure thresholds for ocular ADRs in children. They provide evidence-based guidance for ophthalmic screening and intervention timing, particularly relevant for paediatric patients with muscle and neuromuscular diseases requiring long-term GC therapy. Proactive monitoring and tailored GC management are essential to mitigate vision-threatening complications and improve long-term patient outcomes.
Related Concept Videos
01:28Disorders of the Skeletal Muscle
Musculoskeletal disorders
Musculoskeletal disorders involve injuries and conditions affecting the skeletal muscles and associated connective tissues. These disorders can arise from acute biomechanical stresses or chronic overuse and can occur across different age groups. Common injuries include sprains, fractures, and muscular strains, often resulting from...
01:25Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
01:17Accessory Structures of the Eye
01:24Drug Toxicity: Risk factors
01:21Skeletal Muscle Relaxants: Adverse Effects
Unlike...
01:20Myasthenia Gravis: Overview and Treatment
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which leads...