Steroid-induced cataract and glaucoma in pediatric patients with nephrotic syndrome

ABSTRACT

Objective@#This study investigated ocular complications, such as cataract and glaucoma, arising from prolonged corticosteroid therapy in children.@*Methods@#A cross-sectional study involving pediatric patients with nephrotic syndrome was conducted in a tertiary hospital. Comprehensive ophthalmic assessments including best-corrected visual acuity (BCVA), intraocular pressure (IOP), slitlamp and fundus examination were performed. Standard automated perimetry (SAP) was also performed on patients suspected of having glaucoma. Information on renal histological diagnosis and treatment regimen in each patient was noted. Data were analyzed statistically.@*Results@#A total of 22 patients were evaluated. The median age at the time of examination was 9.5 years (range, 2 to 17 years). The mean age of onset was 6.9 ± 4.3 years. Twelve of the 22 patients had relapses with a mean of 1.86. The mean duration of steroid use was 28 ± 28.9 months. Eleven patients (50%) were given combined therapy (prednisone with either cyclosporine or cyclophosphamide) and 11 were given oral prednisone alone. The mean dose of steroid at the time of examination was 27 ± 26.2 mg/m2 /day. Among the 22 patients, 3 (13.6%) developed posterior subcapsular cataracts. One patient developed steroidinduced glaucoma with a scotoma encroaching the central 10o visual field. There was a significant association between the duration of corticosteroid treatment and cataract formation (p = 0.04), but no significant association between the duration of therapy and development of glaucoma (p = 0.45).@*Conclusions@#Cataract formation was a more common complication of prolonged oral corticosteroid therapy with a prevalence rate of 13.6%. Pediatric patients with a longer duration of steroid therapy are at greater risk of cataract formation. Hence, pediatricians are advised to refer these patients to ophthalmologists for proper evaluation.