Glaucoma and Systemic Steroids
Glaucoma and Systemic Steroids
Risks of ocular hypertension and open-angle glaucoma during administration of ocular glucocorticoids are sufficiently well known that primary care clinicians today generally rely on subspecialty colleagues to direct their use. Whether systemic glucocorticoids are associated with an increased risk of these same consequences has been uncertain.
In this report, 9793 persons with a new diagnosis of ocular hypertension or open-angle glaucoma (or newly prescribed medications for these same diagnoses) were compared with 38,325 control cases from the same ophthalmology patient base. Case-control analysis was done adjusted for age, sex, systemic hypertension, diabetes, topical ophthalmic glucocorticoids, and parenteral glucocorticoids.
Compared with non-users, current glucocorticoid users (defined as having received medication within the prior 14 days) had an odds ratio of 1.41 for ocular hypertension or open-angle glaucoma; the higher the glucocorticoid dose, the greater the risk, so that the odds ratio increased to 1.88 for doses of prednisone 80 mg/d or greater. In a similar fashion, greater duration of use was associated with a larger odds ratio.
The authors conclude that systemic glucocorticoid use is associated with an increased odds ratio of ocular sequelae and suggest that monitoring intra-ocular pressure during long-term glucocorticoid treatment may be justified.
Garbe E, et al. Lancet 1997;350: 979-982.
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