Journal Article

Pattern of steroid misuse in vernal keratoconjunctivitis resulting in steroid induced glaucoma and visual disability in Indian rural population: An important public health problem in pediatric age group

Sen, Pradhnya, Jain, Swapnil, Mohan, Amit, Sen, Alok, Jain, Elesh, Shah, Chintan

2019

Overview

Purpose: To know the pattern of presentations and management outcome of steroid induced glaucoma in vernal keratoconjunctivitis (VKC). Methods: Children of VKC using steroid with two of the following criteria were enrolled: Intraocular pressure (IOP) >21 mm Hg, glaucomatous optic disc and visual field defects. Misused topical steroids were classified in 4 groups; A- Highly potent drugs (dexamethasone, betamethasone), B- Moderate (prednisolone), C- Weak (loteprednol, fluorometholone), D- Unknown drugs. Active/conservative interventions were done to control IOP. Corrected distance visual acuity (CDVA), IOP, anterior segment and fundus examinations were noted. One-way ANOVA test and post hoc Tukey HSD test were used to compare the groups. Results: Out of 1423 VKC patients, 240 were using topical steroid without prescriptions. 92 eyes of 47 patients had steroid induced glaucoma. Hence prevalence of this complication was 3.30% in this study population. Mean age was 14.1 ± 3.8 years. Mean IOP was 38 ± 12 mm of Hg and mean vertical cup disc ratio was 0.67 ± 0.25. IOP was controlled by withdrawal of steroids (9 eyes), with antiglaucoma medications (27), trabeculectomy (57) and glaucoma drainage device (1). Mean CDVA at presentation was better in group C (0.23 log MAR). Mean IOP was highest in group A (43.1 mm Hg) followed by group D (40.5 mm Hg). At presentation 17 were blind (CDVA <3/60). Post treatment marginal improvement in CDVA was found (P = 0.46). However, statistically significantly improvement was noticed in IOP (P < 0.00001). Conclusion: Injudicious use of steroids leads to vision threatening complications like ocular hypertension and glaucoma in children of VKC. Weak steroids like loteprednol or fluorometholone should be used instead of higher potency drugs. Vision and IOP should be monitored fortnightly in children using topical steroids to detect steroid responders at the earliest.

• Publisher: Wolters Kluwer India Pvt. Ltd,Medknow Publications and Media Pvt. Ltd,Medknow Publications & Media Pvt. Ltd,Wolters Kluwer - Medknow,Wolters Kluwer Medknow Publications
• Subject: Acuity / Adolescent / Automation / Cataracts / Child / Child, Preschool / Children / Complications and side effects / Conjunctivitis / Conjunctivitis, Allergic - drug therapy / Conjunctivitis, Allergic - epidemiology / Conjunctivitis, Allergic - rehabilitation / Development and progression / Dexamethasone / Disability Evaluation / Distribution / Drug abuse / Drug Misuse - adverse effects / Drug therapy / Drugs / Female / Glaucoma / Glaucoma - chemically induced / Glaucoma - epidemiology / Glaucoma - physiopathology / Glucocorticoids / Glucocorticoids - adverse effects / Glucocorticoids - therapeutic use / Humans / Hypertension / Incidence / India - epidemiology / Intraocular Pressure - physiology / Keratoconjunctivitis / Loteprednol / Male / Original / Patients / Pediatric research / Pediatrics / Population studies / Prednisolone / Public Health / Retrospective Studies / Risk factors / Rural health / Rural Population / Statistical analysis / Steroid hormones / Steroid induced glaucoma / steroid misuse / Steroids / Steroids (Drugs) / Steroids (Organic compounds) / Topical drugs / vernal keratoconjunctivitis / Vision / Vision disorders / Visual Acuity / Visual field / Visual impairment