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

Diana Chabané Schmidt*, Torben Martinussen, Ameenat Lola Solebo, Dorte Ancher Larsen, Daniella Bach-Holm, Line Kessel

*Corresponding author for this work

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Abstract

Purpose: Treatment with glucocorticoids following paediatric cataract surgery is crucial to prevent inflammation, but may lead to secondary glaucoma, and hypothalamic–pituitary–adrenal axis suppression. We wish to compare glaucoma outcomes following high-dose and low-dose glucocorticoid treatment after paediatric cataract surgery. Methods: This cohort study included Danish children undergoing cataract surgery before 10 years of age, receiving either a low-dose or high-dose postoperative glucocorticoid treatment. Case identification and collection of a standardized dataset were retrospective, from 1 January 2010 to 31 December 2016, and prospective thereafter, until 31 December 2021. High-dose treatment included 0.5–1.0 mg subconjunctival depot dexamethasone or methylprednisolone, followed by 6–8 drops of dexamethasone for 1 week, tapered by one drop weekly. Low-dose treatment included 6 drops for 3 days, followed by 3 drops for 18 days. Sustained (>3 months) ocular hypertension or glaucoma was compared between the two groups. Results: Overall, 267 children (388 eyes) were included in the study. Ninety-five children (133 eyes) had received high-dose treatment and had a median follow-up time of 89 months (IQR: 57.2–107.4), while 173 children (255 eyes) had received the low-dose treatment and had a median follow-up time of 40.5 months (IQR: 22.9–60.4). Survival curves showed a lower risk of glaucoma in the low-dose group for children with axial lengths ≥18 mm. Conclusion: Low-dose glucocorticoid treatment was associated with a lower risk of glaucoma in children with axial lengths ≥18 mm. The same effect was not observed in children with shorter eyes. High-dose glucocorticoid should be limited in children undergoing cataract surgery.

Original languageEnglish
JournalActa Ophthalmologica
Number of pages7
ISSN1755-375X
DOIs
Publication statusAccepted/In press - 2024

Bibliographical note

Publisher Copyright:
© 2024 The Author(s). Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.

Keywords

  • congenital cataract
  • glaucoma
  • glucocorticoid
  • ocular hypertension
  • paediatric cataract
  • secondary glaucoma
  • steroid

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