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Posterior subcapsular cataracts, associated with long-term corticosteroid therapy. Prednisolone versus 6
Insights
Ultralan, a corticosteroid, caused posterior subcapsular cataracts in children more frequently and rapidly than prednisolone. This highlights potential risks of Ultralan in long-term pediatric corticosteroid therapy.
Area of Science:
- Pediatric Endocrinology
- Ophthalmology
- Pharmacology
Background:
- Long-term corticosteroid therapy is common for nephrotic syndrome and collagen diseases in children.
- Assessing the comparative side effect profiles of different corticosteroids is crucial for patient safety.
Purpose of the Study:
- To evaluate the incidence and speed of posterior subcapsular cataract (PSC) development in children receiving long-term alternate-day corticosteroid therapy.
- To compare the ocular side effects of Ultralan versus prednisolone and combination steroid regimens.
Main Methods:
- A study involving 50 children on long-term corticosteroid treatment.
- Patients received either prednisolone, Ultralan (6 alpha-fluor-16 alpha-methyl-1-dehydrocorticosterone), or a combination of steroids (methylprednisolone, dexamethasone) on an alternate-day basis.
- Therapy duration and dosage were standardized across all groups.
Main Results:
- Ultralan therapy was associated with a significantly higher incidence of posterior subcapsular cataracts (10 out of 15 patients).
- Cataract development occurred more rapidly in the Ultralan group, with cumulative doses of 5.0-10.0 g/m2 body surface area over 1-2 years.
- Prednisolone monotherapy and mixed steroid therapy showed a lower rate and slower progression of cataracts.
Conclusions:
- Ultralan poses a greater risk for developing posterior subcapsular cataracts in children undergoing long-term corticosteroid treatment compared to prednisolone.
- The findings suggest careful monitoring for ocular side effects, particularly cataracts, in pediatric patients treated with Ultralan.
Abstract:
The side effects of corticosteroid therapy were studied in 50 children on long-term therapy for nephrotic syndrome or various collagen diseases. The treatment consisted of prednisolone given to 24 children, and Ultralan (6 alpha-fluor-16 alpha-methyl-1-dehydrocorticosterone) given to 15 patients, both in an alternate-day fashion. Both drugs as well as methylprednisolone and dexamethasone were given successively to 11 children. Duration of therapy and doses were equivalent in all patients studied. The patients on Ultralan therapy developed posterior subcapsular cataracts to a significant higher degree (10 out of 15) and more rapidly (after a cumulative dose of 5.0-10.0 g/m2 body surface area on 1-2 years duration of therapy) than on prednisolone monotherapy or on mixed steroid therapy.