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Steroids in uveitis increase risk for ocular hypertension
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Patients with noninfectious uveitis are at a high risk of IOP elevation, according to a large retrospective study.
Among risk factors, corticosteroid use was consistently present and highly significant, suggesting that alternative ways of controlling inflammation should be pursued.
The presence of ocular hypertension (OHT) at presentation and over the follow-up time was assessed among adult patients with uveitis in the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) cohort study, including 11,452 uveitic eyes of 7,062 patients seen between 1979 and 2007.
Of the 4,843 eyes that were without OHT at presentation, one-third developed IOP greater than 21 mm Hg, and one out of seven developed IOP greater than 30 mm Hg within 2 years of follow-up. The incidence of OHT continued to increase significantly over at least 10 years.
The large scale of the study allowed investigation of a wide range of risk factors for OHT, among which systemic hypertension, low vision, vitrectomy, peripheral anterior synechiae and previously developed OHT in the contralateral eye were found to be significant. Daily use of topical corticosteroids, even with only one drop per day, increased the risk by more than twofold. The highest, 10-fold increase, was related to fluocinolone acetonide intravitreal implants. Systemic corticosteroids had a lower, but still significant impact, with the exception of prednisone or equivalent at a dosage of less than 7.5 mg/day.
“All eyes under active treatment with corticosteroids should be continuously monitored for elevated IOP,” the authors suggested, and added that “efforts should be made to minimize the use of corticosteroid therapy while maintaining control of inflammation using corticosteroid-sparing methods when indicated, particularly over the long term.” – by Michela Cimberle
Disclosure: Daniel reports no financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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