Ocular toxicity of prednisone in pediatric patients with inflammatory bowel disease.
We performed ocular examinations on 58 corticosteroid-treated pediatric patients with inflammatory bowel disease (IBD) and on 58 age-matched controls. Posterior subcapsular cataracts (PSC) were detected in 12 of the 58 treated patients (20.7%) and in none of the controls. The difference in mean intraocular pressure (IOP) between the treated patients (15.89 +/- 4.11 mm Hg) and control subjects (13.63 +/- 2.35 mm Hg) was significant statistically (P < 0.001). Twenty-one patients (36.2%) were characterized as "IOP responders" (IOP > or = 20 mm Hg, change in IOP > or = 6 mm Hg between visits, or a difference in IOP > or = 6 mm Hg between the two eyes). Formation of PSC was not correlated significantly (P > 0.05) with the total dose of prednisone, duration of treatment, average daily dose, or number of days on high doses (> or = 25 mg). Raised IOP was correlated (P = 0.005) only with average daily dose (12.4 +/- 10.9 mg/day; range, 0-47 mg/day) 30 days before examination. When the dose of corticosteroid was reduced to < 10 mg/day, 2 patients manifested regression of PSC, and 12 IOP responders showed a decrease in IOP to within 2 SD of the mean control IOP. Only 3 of the 58 treated patients (5.2%) manifested both PSC and raised IOP. A significant inverse correlation (P = 0.02) was established between IOP at first examination and formation of PSC. We propose that the mechanisms for steroid-induced lens opacities and raised IOP do not share the same genetic basis. Because 52% of these children developed either PSC or raised IOP with prednisone therapy, we advocate careful ophthalmologic monitoring of pediatric patients receiving corticosteroids for IBD or any other condition.
Tripathi
R C
RC
Visual Sciences Center, University of Chicago, IL 60637.
Kipp
M A
MA
Tripathi
B J
BJ
Kirschner
B S
BS
Borisuth
N S
NS
Shevell
S K
SK
Ernest
J T
JT
D000293:Adolescent; D000328:Adult; D002386:Cataract / Q000139:chemically induced* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D007903:Lens Capsule, Crystalline / Q000187:drug effects / Q000473:pathology; D008297:Male; D008991:Monitoring, Physiologic; D009798:Ocular Hypertension / Q000139:chemically induced; D011239:Prednisolone / Q000009:adverse effects* / Q000627:therapeutic use
D011239:Prednisolone