Ocular complications of paediatric patients with nephrotic syndrome.
OBJECTIVE
To investigate ocular complications arising from nephrotic syndrome and/or its treatments in children.


METHODS
A cross-sectional study was conducted in a teaching hospital. A total of 31 paediatric patients with nephrotic syndrome were studied. Comprehensive ophthalmic assessments on best-corrected visual acuity, intraocular pressure, slit-lamp and fundus examination were taken. Information regarding histological diagnosis of nephrotic syndrome and its treatment regimen in each patient was reviewed and analysed.


RESULTS
Bilateral posterior subcapsular cataracts were detected in three of 29 patients (10.3%) who received steroid therapy. Two had normal vision while one had visual acuity reduced to 6/15 in both eyes. The age of onset of the nephrotic syndrome in these three patients was 2 years, which was significantly younger than those without cataract (5.4 +/- 3.2 years, P < 0.001). Three patients (9.7%) had isolated asymptomatic fundal findings of tortuous and dilated retinal vessels. Hypertensive retinopathy was found in one patient (3.2%). No steroid-induced glaucoma, uveitis, ocular infection, or other eye complications related to the use of steroids or other immunosuppressive agents were noted.


CONCLUSIONS
Children who have nephrotic syndrome often require prolonged, intermittent high dose of systemic corticosteroid therapy. Paediatricians should be aware of the potential risk of developing steroid-related complications, especially posterior subcapsular cataract. It appears to have a higher risk when steroid therapy is used in very young patients. Early detection would help to prevent amblyopia development, particularly in the group of immature eyes.
Ng
J S
JS
Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT. ngsk@ha.org.hk
Wong
W
W
Law
R W
RW
Hui
J
J
Wong
E N
EN
Lam
D S
DS
D000293:Adolescent; D002386:Cataract / Q000139:chemically induced; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005128:Eye Diseases / Q000209:etiology*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D007908:Lens, Crystalline / Q000187:drug effects; D008297:Male; D009404:Nephrotic Syndrome / Q000150:complications*; D009798:Ocular Hypertension / Q000209:etiology; D011239:Prednisolone / Q000009:adverse effects; D012164:Retinal Diseases / Q000209:etiology; D012171:Retinal Vessels / Q000473:pathology; D012307:Risk Factors
D005938:Glucocorticoids; D011239:Prednisolone