J Korean Ophthalmol Soc.  2016 Mar;57(3):518-523. 10.3341/jkos.2016.57.3.518.

A Case of Steroid Glaucoma in a Child Treated with Systemic Steroid as Graft-Versus-Host Disease

• Eo DR
• Han JC
• Kee CW

• KMID: 2213256
• DOI: http://doi.org/10.3341/jkos.2016.57.3.518

Abstract

PURPOSE
To report a case of steroid-induced glaucoma in a child who was treated with systemic steroids for a long period due to graft-versus-host disease.
CASE SUMMARY
A 10-year-old male was referred to our ophthalmologic clinic for examination of papilledema due to persistent headache and nausea. He was diagnosed as aplastic anemia 8 years prior and took approximately 4,000 mg of oral prednisolone for 8 years from April 2007 to April 2015 for treatment of lung graft-versus-host disease after hematopoietic stem cell transplantation. His best corrected visual acuity was 0.8 (decimal) in the right eye, 0.5 in the left eye and intraocular pressure (IOP) measured using a Goldmann applanation tonometer was 42 mm Hg in the right eye and 43 mm Hg in the left eye. His cup-to-disc ratio was 0.8 in the right eye and 0.7 in the left eye. Additionally, superior and inferior neuroretinal rim thinning was present in both eyes. Despite using IOP-lowering agents, IOP was not controlled. However, after trabeculectomy with mitomycin C in both eyes, IOP became normalized.
CONCLUSIONS
In cases of pediatric patients treated with systemic steroids for a long period of time, regular observation is necessary to prevent IOP elevation and steroid-induced glaucoma.

Keyword

Oral prednisolone; Steroid-induced glaucoma; Systemic steroid

MeSH Terms

Anemia, Aplastic
Child*
Glaucoma*
Graft vs Host Disease*
Headache
Hematopoietic Stem Cell Transplantation
Humans
Intraocular Pressure
Lung
Male
Mitomycin
Nausea
Papilledema
Prednisolone
Steroids
Trabeculectomy
Visual Acuity
Mitomycin
Prednisolone
Steroids

Figure

• 

  Figure 1. Fundus photographs of the patient. (A, B) Normal fundus photographs with a normal cup to disc ratio 5 years ago, (C, D) glaucomatous cupping of the optic disc with a cup-to-disc ratio of 0.8 in the right eye and 0.7 in the left eye, and superior and inferior neuro-retinal rim thinning in both eyes.

• 

  Figure 2. Neuro-retinal rim thinning and decreased retinal nerve fiber layer in both eyes measured by optical coherent tomography. ONH = optic nerve head; RNFL = retinal nerve fiber layer; OU = oculus unitas; OD = oculus dexter; OS = oculus sinister; TEMP = temporal; SUP = superior; NAS = nasal; INF = inferior; S = superior; T = temporal; I = inferior; N = nasal.

• 

  Figure 3. Anterior segment photograph after treated with systemic steroid. Posterior subcapsular cataract in the right eye (A) and left eye (B).

Reference

References

1. David DS, Berkowitz JS. Ocular effects of topical and systemic corticosteroids. Lancet. 1969; 2:149–51.

2. Bernstein HN, Mills DW, Becker B. Steroid-induced elevation of intraocular pressure. Arch Ophthalmol. 1963; 70:15–8.

3. Kersey JP, Broadway DC. Corticosteroid-induced glaucoma: a review of the literature. Eye (Lond). 2006; 20:407–16.

4. Biedner BZ, David R, Grudsky A, Sachs U. Intraocular pressure response to corticosteroids in children. Br J Ophthalmol. 1980; 64:430–1.

5. de Queiroz Mendonca C, de Souza CP Jr, Martins-Filho PR, et al. Steroid-induced ocular hypertensive response in children and adolescents with acute lymphoblastic leukemia and non-Hodgkin lymphoma. Pediatr Blood Cancer. 2014; 61:2083–5.

6. Hayasaka Y, Hayasaka S, Matsukura H. Ocular findings in Japanese children with nephrotic syndrome receiving prolonged corticosteroid therapy. Ophthalmologica. 2006; 220:181–5.

7. Armaly MF. Statistical attributes of the steroid hypertensive response in the clinically normal eye. I. The demonstration of three levels of response. Invest Ophthalmol. 1965; 4:187–97.

8. Godel V, Feiler-Ofry V, Stein R. Systemic steroids and ocular fluid dynamics. I. Analysis of the sample as a whole. Influence of dosage and duration of therapy. Acta Ophthalmol (Copenh). 1972; 50:655–63.

9. Garbe E, LeLorier J, Boivin JF, Suissa S. Risk of ocular hypertension or open-angle glaucoma in elderly patients on oral glucocorticoids. Lancet. 1997; 350:979–82.

10. Mitchell P, Cumming RG, Mackey DA. Inhaled corticosteroids, family history, and risk of glaucoma. Ophthalmology. 1999; 106:2301–6.

11. Cadera W, Pachtman MA, Cantor LB, et al. Filtering surgery in childhood glaucoma. Ophthalmic Surg. 1984; 15:319–22.

12. Tham CC, Ng JS, Li RT, et al. Intraocular pressure profile of a child on a systemic corticosteroid. Am J Ophthalmol. 2004; 137:198–201.

13. Lee SW, Jin KH, Lee SC, et al. Cataract and glaucoma in Korean children with chronic glomerulonephritis receiving systemic corticosteroid treatment. Acta Ophthalmol. 2010; 88:e344–5.

14. Brito PN, Silva SE, Cotta JS, Falcão-Reis F. Severe ocular hypertension secondary to systemic corticosteroid treatment in a child with nephrotic syndrome. Clin Ophthalmol. 2012; 6:1675–9.

15. Yamashita T, Kodama Y, Tanaka M, et al. Steroid-induced glaucoma in children with acute lymphoblastic leukemia: a possible complication. J Glaucoma. 2010; 19:188–90.