Infants undergoing cataract surgery may experience side effects from topical steroids
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The use of topical steroids in infants after cataract surgery can cause changes in the hypothalamic-pituitary-adrenal axis, according to a poster presentation.
Pediatric patients are usually given the same dose of topical steroid eye drops as adults despite having a much lower body weight.
“In our study, the effect of topical steroids was more pronounced in those younger than 6 months, which could be explained by the fact that the cumulative steroid dose per kilogram is higher in younger age groups with lower weight,” co-author Dina El-Fayoumi, MD, of Kasr Alainy School of Medicine, Cairo University, said at the virtual American Association for Pediatric Ophthalmology and Strabismus annual meeting.
The prospective study involved 20 infants (mean age 4.9 months) who underwent bilateral congenital cataract surgery. At the end of surgery, patients were given a subconjunctival injection of 0.5 mL of betamethasone sodium phosphate (4 mg/2 mL). They also received a combination of tobramycin (3 mg/mL) and dexamethasone (1 mg/mL) over a period of 6 weeks with doses tampered.
Follow-up occurred at 1 day, 1 week, 3 weeks, 5 weeks and 8 weeks after surgery. The researchers found a statistically significant increase in infants’ weight (P = .009), systolic blood pressure (P = .005) and diastolic blood pressure (P = .025). There was also a significant reduction in morning (P = .023) and afternoon (P = .014) serum adrenocorticotropic hormone levels. Serum cortisol levels decreased, but the changes were not significant.
The findings indicate subclinical and clinical changes in adrenal suppression that “can easily be overlooked and need careful attention and follow-up” in pediatric patients undergoing cataract surgery, the authors said.
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Aly A, et al Serum cortisol and adrenocorticotrophic hormone (ACTH) in infants receiving topical ocular corticosteroids following cataract surgery. Presented at: American Association for Pediatric Ophthalmology and Strabismus annual meeting; April 9-11, 2021 (virtual meeting).
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