Steroid induced glaucoma in the paediatric population

Abstract

Aims/Purpose: Steroid induced glaucoma is an iatrogenic pathology secondary to the prolonged use of corticosteroids, it is a serious pathology with a high risk of blindness. The aim of this study is to evaluate the epidemiological, clinical, therapeutic and evolutionary profile of steroid induced glaucoma in children.Methods: It is a retrospective study of cases treated between November 2007 and February 2022, including patients followed in the paediatric ophthalmology department of Casablanca for steroid induced glaucoma.Results: Our study involved́ 35 children (60 eyes), including 20 boys and 15 girls, with an average age of 12 years. The involvement was bilateral in 25 eyes. All the patients had a history of discontinuous self‐medication with local corticosteroids for a mean period of 5 years. The initial condition that led to the use of steroids was in 19 cases allergic conjunctivitis, in 10 cases it was used for recurrent meibomian cysts, 3 cases of uveitis, 2 cases of blepharitis and one episcleritis. 60% eyes had visual acuity raging between 0.1 to 0.3. Mean Intraocular pressure was 36 ± 1 2 mmHg. Mean vertical cup disc ratio was 0.68 ± 0.25. all our patients had an open angle on gonioscopy and severe perimetric deficits were noted in all our patients. 19 eyes (32%) had an associated cataract. IOP was controlled after the withdrawal of steroids in 8 eyes, associated to antiglaucoma treatment in 22 eyes. The surgical management consisted of a Trabeculectomy + IP + 5 F.U in 30 eyes. Cyclophotocoagulation was not required in any of the patients. On a follow up of 24 months, the average final visual acuity was <2/10th and the tonometric results were globally good with a stabilization of the papillary excavation and visual field in 82% of the cases.Conclusions: Steroid induced glaucoma is a condition in which the functional prognosis is at risk, especially in young patients. It shows the importance of regular monitoring of the IOP in patients undergoing corticosteroid treatment. The first line of treatment consist of the prevention: awareness of the risks of self‐medication by steroids.