Steroid induced glaucoma pdf

It is urged that patients receiving steroid therapy, either systemically or locally to the eye, be examined periodically for possible elevations in intraocular pressure. Patients who have a family history or previous diagnosis of open-angle glaucoma should be observed more frequently [5] . Refractive surgeries should not be considered when IOP is poorly controlled. Provider must recognize that the interface fluid characteristic of post-refractive surgery steroid-induced glaucoma leads to inaccurately low central applanation tonometry measurements and obscures the diagnosis of steroid-induced glaucoma. Measurements of central cornea should be confirmed with those obtained from the cornea peripheral—preferably temporal rather than nasal--to the flap using Tono-Pen, pneumotonometery, or applanation tonometer [3,11,12] [7] [4] [2] .

Steroids in susceptible individuals can cause a clinical condition similar to primary open-angle glaucoma. Five percent of the population are high steroid responders and develop an intraocular pressure (IOP) elevation of more than 15 mm Hg above baseline. IOP elevation may occur as early as 1 day to as late as 12 weeks after intravitreal triamcinolone in 20–65% of patients. On average, 75% of eyes with steroid implants require IOP-lowering therapy at some point within 3 years of follow-up. The exact mechanism of steroid-induced glaucoma is not totally understood, but decreased trabecular meshwork outflow is regarded as the main cause of IOP elevation. High-risk patients who receive steroids should be monitored closely and if they develop elevated IOP, steroids with lower potency or steroid-sparing agents should be used. The IOP usually returns to normal within 2–4 weeks after stopping the steroid. About 1–5% of patients do not respond to medical therapy and need surgery. Trabeculectomy, trabeculotomy, shunt surgery, and cyclodestructive procedures are among the methods employed. Removal of residual sub-Tenon or intravitreal steroids may help hasten the resolution of the steroid response. Early results with anecortave acetate, an analog of cortisol acetate with antiangiogenic activity, in controlling IOP have been promising.

Cells of the zona fasciculata and zona reticularis lack aldosterone synthase (CYP11B2) that converts corticosterone to aldosterone, and thus these tissues produce only the weak mineralocorticoid corticosterone. However, both these zones do contain the CYP17A1 missing in zona glomerulosa and thus produce the major glucocorticoid, cortisol. Zona fasciculata and zona reticularis cells also contain CYP17A1, whose 17,20-lyase activity is responsible for producing the androgens, dehydroepiandosterone (DHEA) and androstenedione. Thus, fasciculata and reticularis cells can make corticosteroids and the adrenal androgens, but not aldosterone.

Steroid induced glaucoma pdf

steroid induced glaucoma pdf

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