Transient increase in intraocular pressure during a dose-tapering regime of systemic dexamethasone in preterm infants.
OBJECTIVE
To determine the intraocular pressure (IOP) profile during and after systemic dexamethasone treatment in preterm very low birth weight (VLBW; <1500 g) infants.


METHODS
A cohort study at a university-affiliated tertiary neonatal center.


METHODS
Twenty-seven VLBW infants who received a 3-week dose-tapering course of systemic dexamethasone for treatment of bronchopulmonary dysplasia were consecutively enrolled over a period of 32 months.


METHODS
Intraocular pressure was assessed using a handheld tonometer immediately before (week 0), during (weeks 1 and 3), and after (weeks 5, 7, and 9) commencement of the dexamethasone course. The mixed-effects models were used to evaluate the longitudinal IOP measurements at different time points.


METHODS
To assess the magnitude and duration of increase in IOP during systemic corticosteroid treatment.


RESULTS
The IOP at week 1, while the infants were receiving the maximum dose of dexamethasone (0.6 mg/kg/day), was significantly higher than (1) the pretreatment IOP at week 0 (mean [+/- standard deviation]: 19.7 [+/-3.7] vs. 16.4 [+/-3.7] mmHg, respectively) (P<0.0001), (2) the IOP when the infants were receiving the minimum dose of dexamethasone (0.15 mg/kg/day) at week 3 (19.7 [+/-3.7] vs. 15.8 [+/-4.3] mmHg) (P<0.0001), and (3) the IOP after the dexamethasone course had been stopped between week 5 and week 9 (19.7 [+/-3.7] vs. 16.0 [+/-4.0], 15.3 [+/-3.5], and 14.5 [+/-3.3] mmHg for weeks 5, 7, and 9, respectively) (P<0.0001 for all comparisons). In contrast, there was no significant difference between the pretreatment IOP (week 0) and IOP at week 3, 5, 7, or 9 (P = 0.07-0.62) and in the IOP between week 3 and week 5, 7, or 9 (P = 0.27-0.75).


CONCLUSIONS
The use of a dose-tapering regime of dexamethasone is associated with transient increase of IOP. As IOP was significantly raised during the high-dose but not the low-dose treatment period, we speculate that the physiologic or stress dose of corticosteroids commonly advocated for treatment of serious neonatal conditions should be safe and unlikely to cause significant ocular hypertension in preterm infants.
Ng
Pak C
PC
Department of Pediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China. pakcheungng@cuhk.edu.hk
Lee
Cheuk H
CH
Tam
Barbara S M
BS
Wong
Samuel P S
SP
Lam
Hugh S
HS
Kwok
Alvin K H
AK
Fok
Tai F
TF
D001997:Bronchopulmonary Dysplasia / Q000188:drug therapy; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007429:Intraocular Pressure / Q000187:drug effects*; D008297:Male; D014065:Tonometry, Ocular
D005938:Glucocorticoids; D003907:Dexamethasone