Steroid-induced glaucoma in children with acute lymphoblastic leukemia: a possible complication.
OBJECTIVE
To evaluate the ocular hypertensive response to repetitive cycles of high-dose systemic corticosteroid in young patients with acute lymphoblastic leukemia (ALL).


METHODS
Five patients up to 6 years of age with ALL who received chemotherapy between November 2003 and March 2005 were examined. As maintenance therapy, they received oral or intravenous dexamethasone 6 to 12 mg/m²/day for 2 weeks, followed by 1-week taparing and 5 weeks break were used in 1 cycle. The duration of maintenance therapy was 15 cycles for 2.5 to 3 years. Comprehensive ophthalmic check-up, including best-corrected visual acuity, intraocular pressure (IOP), and slit-lamp and fundus examinations, were performed.


RESULTS
All patients were followed up until final cycle. Symmetrical IOP rise >21 mm Hg was observed in all patients. Right IOP increased to a maximum of mean 39.6 ± 7.2 mm Hg. (range: 28 to 47). The range of cycle to reach a maximal IOP was 5th to 11th. All patients were maintained IOP control with antiglaucoma medications. However, 1 patient already had severe glaucomatous optic atrophy at the time of consultation.


CONCLUSIONS
Systemic corticosteroid in childhood-ALL treatment has a risk for IOP elevation. Periodical and careful ophthalmic check-up is necessary, especially in patients with dexamethasone.
Yamashita
Takehiro
T
Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. take1@m.kufm.kagoshima-u.ac.jp
Kodama
Yuichi
Y
Tanaka
Minoru
M
Yamakiri
Keita
K
Kawano
Yoshifumi
Y
Sakamoto
Taiji
T
D000284:Administration, Oral; D002386:Cataract / Q000139:chemically induced; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005901:Glaucoma / Q000139:chemically induced* / Q000175:diagnosis; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007275:Injections, Intravenous; D007429:Intraocular Pressure / Q000187:drug effects*; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors
D005938:Glucocorticoids; D003907:Dexamethasone