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Abstract #15882 Published in IGR 2-3
Ocular hypertensive response to topical dexamethasone in children: a dose-dependent phenomenon
Ng JSK; Fan DSP; Young AL; Yip NKF; Tan K; Kwok AKH; Lam DSCOphthalmology 2000; 107: 2097-2100
OBJECTIVE: To investigate the ocular-hypertensive response to different dosages of topical dexamethasone eye drops in Chinese children. DESIGN: Prospective, randomized clinical trial. PARTICIPANTS: Thirty-one consecutive children undergoing bilateral strabismus surgery. INTERVENTION: Topical dexamethasone (0.1%) was administered to children undergoing bilateral strabismus surgery. They were all less than ten years of age. One eye was randomized to receive a regimen of four times daily, and the other received a twice daily regimen. Intraocular pressure (IOP) was serially measured in the postoperative period for four weeks or more. Topical steroids were discontinued if IOP was 30 mmHg or more. MAIN OUTCOME MEASURES: IOP was measured on the day before surgery, on postoperative days 1, 3, 5, 8, 12, 15, 22, 29, and two weeks thereafter until the IOP reached preoperative levels. Peak IOP, IOP net increase, and time to reach an IOP of more than 20 mmHg in the two study groups were analyzed. RESULTS: A total of 31 patients (20 male, 11 female) were examined. The mean age was 5.8 ± 2.0 years (range, 2-10 years). Preoperative IOP in groups treated twice daily and four times daily were similar. After topical dexamethasone treatment, both groups showed a significant rise in peak IOP compared with preoperative values (twice daily, 25.2 ± 6.8 versus 14.3 ± 2.4 mmHg, p < 0.01; four times daily, 28.7 ± 6.9 versus 14.3 ± 2.9 mmHg, p < 0.001). The peak IOP was significantly higher in the four times daily group (p < 0.001), as was the net increase in IOP (twice daily, 10.9 ± 5.8 mmHg versus four times daily, 14.5 ± 6.4 mmHg; p < 0.001). There was no difference in time for both groups to achieve the peak IOP, but the time to exceed its upper normal value (20 mmHg) was shorter in the four times daily group (twice daily, 12.3 ± 9.1 days versus four times daily, 10.0 ± 7.4 days, p < 0.05). CONCLUSIONS: In children treated with topical dexamethasone, ocular hypertension occurs in a dose-dependent manner. Children in the four times daily group had a quicker onset and more severe ocular hypertensive response than the twice daily group. Nevertheless, even the twice daily regimen produced significant IOP rise, suggesting that dexamethasone use in children should be avoided if possible, and that it would be desirable to monitor the IOP twice weekly when it is administered to children.
Dr. D.S.C. Lam, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong. dennislam@cuhk.edu.hk
Classification:
9.4.1 Steroid-induced glaucoma (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
