Reduced steroid regimen maintains effect in pediatric patients

Br J Ophthalmol. 2011;95(11):1531-1533.

The ocular hypertensive effects of fluorometholone, a steroid that has led to dose-dependent increases in IOP in children, were maintained in younger patients despite reduced regimens, according to a study.

The retrospective case-note review examined 107 cases that received fluorometholone for ocular surface disease. Patients had a median age of 6 years (range: 3 months to 17 years), and dosages of fluorometholone were reduced from as frequently as four times per day to once per week in cases of long-term treatment.

IOP after fluorometholone use was formally documented as less than 19 mm Hg in 51 cases. In the other 56 cases, IOP was not measured, but none met the glaucoma definition of IOP greater than 21 mm Hg.

"Reducing regimens of [fluorometholone] proved to be a safe anti-inflammatory treatment, in terms of avoiding steroid-induced glaucoma," the study authors wrote. "This is important because ocular surface disease such as blepharokeratoconjunctivitis can have a significant ocular morbidity especially in children under the age of 8 years, and a prolonged low-dose [fluorometholone] may be needed to control the inflammation seen in this condition."

The study's primary weakness was that not all patients had IOP measured, and those who did were not always measured using the same instruments or at the same time of day.