Elevated intraocular pressure associated with steroid treatment for infantile spasms.
OBJECTIVE
To evaluate the ocular changes and medical and surgical therapy after high-dose systemic steroid treatment in babies with infantile spasm and hypsarrhythmia.


METHODS
Retrospective, noncomparative, interventional case series.


METHODS
In 5 of the 9 (55%) babies with infantile spasm exposed to systemic corticosteroid treatment, an increase in intraocular pressure (IOP) and optic disc cupping was observed.


METHODS
Ophthalmic examination under mild sedation was conducted 3 to 4 weeks after initiation of systemic therapy. Antiglaucoma treatment was given to the patients found to have high IOPs and cup-to-disc ratio changes. Routine follow-up was continued until systemic therapy was completed.


METHODS
Controlled IOP with a decrease in cupping damage after antiglaucoma therapy.


RESULTS
Five patients required antiglaucoma treatment; one also underwent augmented trabeculectomy. Mean IOP decreased in this subgroup from 30.1 +/- 9.5 mmHg to 15.4 +/- 4.2 mmHg in the right eye (P = 0.043) and from 32.6 +/- 7.4 mmHg to 15.2 +/- 1.8 mmHg in the left eye (P = 0.043). Mean cup-to-disc ratio improved from 0.53 +/- 0.2 to 0.37 +/- 0.04 in the right eye (P = 0.06) and from 0.57 +/- 0.12 to 0.35 +/- 0.05 in the left eye (P = 0.042).


CONCLUSIONS
The rapid onset of IOP and cup-to-disc ratio changes in patients with infantile spasm and hypsarrhythmia treated by high-dose corticosteroids necessitates early and intensive monitoring to prevent anatomic ocular damage and visual impairment in the future.
Friling
Ronit
R
Pediatric Ophthalmology Unit, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.
Weinberger
Dov
D
Zeharia
Abraham
A
Lusky
Moshe
M
Mimouni
Marc
M
Gaaton
Dan
D
Snir
Moshe
M
D000284:Administration, Oral; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003366:Cosyntropin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D007429:Intraocular Pressure / Q000187:drug effects*; D008297:Male; D009798:Ocular Hypertension / Q000139:chemically induced* / Q000188:drug therapy; D009898:Optic Disk / Q000187:drug effects; D009901:Optic Nerve Diseases / Q000139:chemically induced; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D013036:Spasms, Infantile / Q000188:drug therapy*; D014065:Tonometry, Ocular
D000959:Antihypertensive Agents; D005938:Glucocorticoids; D003366:Cosyntropin; C006418:adrenocorticotropin zinc; D011241:Prednisone