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KMID : 0360219690100030033
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Journal of the Korean Ophthalmological Society
1969 Volume.10 No. 3 p.33 ~ p.39
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STEROID-INDUCED GLAUCOMA
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Kim, Jae Ho/金在浩
Kim, Sang Min/Park, Yung Soon/金尙敏/朴英順
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Abstract
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Since the corticosteroids were synthetically isolated in the year of 1935, its uses were applied to many ophthalmic patients with dramatic effects.
In 1961, Francois reported a case of simple secondary glaucoma induced by topical corticosteroid therapy, and in 1962, Goldmann2´ used the term "Cortisone Glaucoma" in his report, but recently such a glaucoma or ocular hypertension could be reproduced in prolonged corticosteroid
therapy. The "Steroid Glaucoma" or "Steroidinduced Glaucoma" is more a logical term.
Elevations of the intra-ocular pressure following the administration of topical and/or systemic steroid
preparations have now been well documented. 3-11)
This report is concerned with ten patients who developed steroid-induced glaucoma by prolonged use of topical steroid drops for various eye troubles.
CASE REPORTS
Among the ten patients, most patients are male except of one female, and most cases fell in the age group of 20- 39(Table 1). And five out of ten patients exhibited only monocular hypertension in spite of biocular use of topical steroids (Table 2). Glaucomatous signs such as contraction of peripheral visual fields and glaucomatous disc cupping were observed in the one year or more
treated cases (Table 3). CASE 1
S. Y. Choi, male, aged 30 years, was examined at The Department of Ophthalmology, St. Mary´s Hospital because of visual disturbance, redress, nyctalopia, ocular pain and headache which were aggravated for the last 9 months. He had been treated for 9 years for vernal catarrh by dexamethasone (Decadron) drops, 0. 05%, 2-5 times a day, without doctor´s order.
On the first visit, positive ocular findings were as follows; Visual acuity was 20/200 in right eye and 20170 in left eye, ocular tension was 37 mm Hg. (Schotz) in both eyes, visual field contracted severely within 5 degrees in both eyes (Fig. 1). And by ophthalmoscopy, the optic nerve heads revealed severe pathological cuppings of 5 diopters OD and 6 diopters OS. Anterior chamber angles
F
showed the wide angle (Grade 4) in OU. Also there were typical vernal conjunctivitis, mixed form of bulbar and tarsal types. This case also wasted with associasteroid cataracts of posterior subcapsular types in both eyes.
He was treated with 2% pilocarpine drops and Diamox 750 mg/ day on the first day (October 23, 1968) and this led to a return to normal of the pressure in both eyes, but one week later the ocular hypertension recurred. He was not hospitalized during our follow up period of three weeks.
cortisone test that is rise in intraocular pressure in outflow facility of aqueous humor. was genetically determined. This hypothesis assumes that dominant monogenic transmission, characterizing the heterozygous or carrier state of simple glaucoma and the latter represented the homozygous responsive state and is transmitted as a recessive trait.
But the Becker´s theory of recessive heredity of simple glaucoma is in conflict with Francois material (1966)23´ because 84% of the parents, 66% of the children and 78% of the grandchildren of glaucoma patients showed negative reactions.
Corticosteroids vary in potency as anti-inflammatory agent. In general the side effects and, in particular, the elevation of intraocular pressure induced by the topical corticosteroids roughly parallel the potency of the preparation.
Various topical corticosteroids demonstrated marked differences in their ability to penetrate into the anterior chamber. A new steroid, hydroxymesterone, has little tendency to cause; glaucoma but a powerful steroid such as dexamethasone (Decadron) has strong tendency to cause glaucoma.
We found here, from the excellent study of Armaly24) in man, that a dilution of dexamethasone of only one tenth greatly reduces its tendency to cause glaucoma.
In spite of their side effects, it remains clear that steroids are very useful and necessary therapy in a large array of inflammatory ocular condition.
SUMMARY
1. Ten cases of the rise of intraocular pressure followed by the prolonged use of steroid drops, mainly 0.05% dexamethasone drops, are presented.
2. In Case 1, elevated intraocular pressure failed to return to normal limits following cessation of steroid therapy and this patient had received topical steroids for a period of nine years for vernal catarrhs of both eyes. This patient also developed steroid cataracts.
3. Visual field disorders and glaucomatous cup pings of the optic nerve heads are presented only in cases of steroid drops for one year or more.
4. Subjective symptoms of glaucomatous patients are usually absent, except in late stages of far advanced cases.
5. We observed five cases of uniocular rise of intraocular pressure with binocular steroid therapeutic exposure.
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