Comparing glaucoma risk in children receiving low-dose and high-dose glucocorticoid treatment after cataract surgery.
Schmidt Diana Chabané, Martinussen Torben, Solebo Ameenat Lola, Larsen Dorte Ancher, Bach-Holm Daniella, Kessel Line
AI Summary
This study found low-dose glucocorticoids after pediatric cataract surgery reduced glaucoma risk in children with longer eyes (≥18mm), suggesting high-dose use should be limited.
Abstract
Purpose
Treatment with glucocorticoids following paediatric cataract surgery is crucial to prevent inflammation, but may lead to secondary glaucoma, and hypothalamic-pituitary-adrenal axis suppression. We wish to compare glaucoma outcomes following high-dose and low-dose glucocorticoid treatment after paediatric cataract surgery.
Methods
This cohort study included Danish children undergoing cataract surgery before 10 years of age, receiving either a low-dose or high-dose postoperative glucocorticoid treatment. Case identification and collection of a standardized dataset were retrospective, from 1 January 2010 to 31 December 2016, and prospective thereafter, until 31 December 2021. High-dose treatment included 0.5-1.0 mg subconjunctival depot dexamethasone or methylprednisolone, followed by 6-8 drops of dexamethasone for 1 week, tapered by one drop weekly. Low-dose treatment included 6 drops for 3 days, followed by 3 drops for 18 days. Sustained (>3 months) ocular hypertension or glaucoma was compared between the two groups.
Results
Overall, 267 children (388 eyes) were included in the study. Ninety-five children (133 eyes) had received high-dose treatment and had a median follow-up time of 89 months (IQR: 57.2-107.4), while 173 children (255 eyes) had received the low-dose treatment and had a median follow-up time of 40.5 months (IQR: 22.9-60.4). Survival curves showed a lower risk of glaucoma in the low-dose group for children with axial lengths ≥18 mm.
Conclusion
Low-dose glucocorticoid treatment was associated with a lower risk of glaucoma in children with axial lengths ≥18 mm. The same effect was not observed in children with shorter eyes. High-dose glucocorticoid should be limited in children undergoing cataract surgery.
MeSH Terms
Shields Classification
Key Concepts6
Low-dose glucocorticoid treatment was associated with a lower risk of glaucoma in children with axial lengths ≥18 mm after paediatric cataract surgery, compared to high-dose treatment.
The lower risk of glaucoma with low-dose glucocorticoid treatment was not observed in children with shorter eyes (axial lengths <18 mm) after paediatric cataract surgery.
High-dose glucocorticoid treatment should be limited in children undergoing cataract surgery due to the increased risk of glaucoma, particularly in those with axial lengths ≥18 mm.
A cohort study of 267 Danish children (388 eyes) undergoing cataract surgery before 10 years of age, receiving either a low-dose or high-dose postoperative glucocorticoid treatment, was conducted to compare glaucoma outcomes.
High-dose glucocorticoid treatment after paediatric cataract surgery included 0.5-1.0 mg subconjunctival depot dexamethasone or methylprednisolone, followed by 6-8 drops of dexamethasone for 1 week, tapered by one drop weekly.
Low-dose glucocorticoid treatment after paediatric cataract surgery included 6 drops for 3 days, followed by 3 drops for 18 days.
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