Severe Corticosteroid-Induced Ocular Hypertension Requiring Bilateral Trabeculectomies in a Patient with Takayasu's Arteritis.

Anna Maria Gruener,Sally Ameen,Pranev Sharma,Faisal Ahmed

doi:10.1155/2016/5253029

Abstract

We present a rare case of severe corticosteroid-induced ocular hypertension (OHT) after prolonged systemic corticosteroid use in a young woman with Takayasu's arteritis. As she did not sufficiently respond to ocular antihypertensive therapies, bilateral enhanced trabeculectomies were required to normalize her intraocular pressures. The systemic side effects of corticosteroids are well known, yet steroid-induced OHT and glaucoma remain silent causes of ocular morbidity. This case highlights the importance of IOP-monitoring in visually asymptomatic patients on systemic corticosteroids. It further emphasizes the need to raise awareness of the potential ocular side effects of steroids amongst physicians, in particular those looking after patients with autoimmune and inflammatory diseases.

Highlights

Corticosteroid-induced ocular hypertension (OHT) and glaucoma are underreported, sight-threatening complications of corticosteroid use
Glucocorticoids alter the organization of the actin cytoskeleton and induce the formation of socalled cross-linked actin networks (CLANs) in trabecular meshwork (TM), leading to increased outflow resistance [5]
This is compounded by increased matrix metalloproteinase (MMP) activity and an accumulation of extracellular matrix (ECM) in the juxtacanalicular connective tissue underlying the inner wall of s canal (SC) [6]

Summary

Introduction

Corticosteroid-induced ocular hypertension (OHT) and glaucoma are underreported, sight-threatening complications of corticosteroid use. Patients may be asymptomatic despite very high intraocular pressures (IOPs) and advanced visual field loss. We discuss the presentation of corticosteroid-induced OHT in a patient with Takayasu’s arteritis to highlight the issues of steroid responsiveness and IOP screening in patients requiring long-term systemic steroids

Case Report

Findings

Discussion