Clinical Analysis of Steroid Induced Glaucoma

Abstract

INTRODUCTION: Today glaucoma is the second most common cause of blindness. Glaucoma is the most common cause of irreversible blindness in the world. The world health organisation estimates (2002) that number of people who have become blind because of glaucoma were 4.4 million (12.3% of the blind world wide) population based studies have estimated that the prevalence of glaucoma in India to be about 11.9 million and 60.5 million in the world in 2010. Glaucoma is defined as a disturbance of the structural or functional integrity of the optic nerve that can usually be arrested or diminished by adequate lowering of Intraocular pressure (IOP). Traditionally glaucoma has been classified as primary and secondary forms. Within this large group of glaucoma, primary open angle glaucoma is the most common form. AIMS OF THE STUDY: 1. To analyse the clinical presentation and etiological risk factors in steroid induced glaucoma and duration and type of steroid used. 2. To establish the diagnosis and analyse about the management options in steroid induced glaucoma. 3. To know the response of selective laser trabeculoplasty in treatment of steroid induced glaucoma patients. Inclusion Criteria 1. Patients with the history of steroid use either topically or systemically. 2. Persistent elevation of IOP more than 21mm of Hg or disc suspicious of glaucomatous damage. 3. Gonioscopically open angles. Exclusion Criteria 1. Normotensive glaucoma 2. Narrow angle glaucoma 3. All other secondary glaucomas 4. Developmental glaucoma MATERIALS AND METHODS: The study was a prospective study conducted at glaucoma services at Regional Institute of Ophthalmology from the period between June 2009 – October 2011. The study was done in 43 patients of established steroid induced glaucoma after complete evaluation. A detailed history regarding the type of steroid used, mode of use, reason for use, and duration of use was recorded. The risk factors of family history of glaucoma, primary open angle glaucoma, Diabetes mellitus, hypertension, high myopia and connective tissue disorders were also asked in detail from the patients. Patients were enquired about defective vision, defective field of vision and frequent change of glasses. Visual acuity was recorded and refraction was done in all cases to correct refractive errors. Ocular examination of both eyes with slit lamp was done to rule out other causes of glaucoma and to know about the lens changes. Gonioscopy was done using single mirror Goldmann gonioprism and angles were graded by using shaffers grading method. OBSERVATION AND ANALYSIS: 68 eyes of 43 patients were taken into study. Two patients were one eyed. one had leucomatous corneal opacity and other patient had evisceration done in one eye. Rest of the 16 eyes were not involved. Steroid induced glaucoma resolved in 17 eyes of 13 patients with their stoppage of steroids and with initiation of medical treatment. SUMMARY: Steroid induced glaucoma resolved in 17 eyes of 13 patients with their stoppage of steroids and with initiation of medical treatment. The average age of presentation in the study was 51-60 yrs. There was no sex preponderance, males and females were equally affected. DISCUSSION: Steroid-induced glaucoma is an iatrogenic secondary open angle glaucoma, with decreased trabecular outflow causing a rise of intraocular pressure. CONCLUSION: In susceptible individuals and persons with risk factors, steroids should be avoided or if required should be administered in smaller doses. FUTURE SCOPE: Selective laser trabeculoplasty can be used in short term control of IOP. It is useful in very old patients who are not amenable to surgery and for those who are not willing for surgery. Plasma cortisol levels can be measured more frequently once in four hours to find out the association between plasma cortisol levels and steroid induced glaucoma. It can also be carried out in larger number of patients. Steroid provocative test will help in identifying the high steroid responders in the general population. It can also be performed in patients for whom intravitreal triamcinolone has to be given. Genetic studies may throw more light on the etiopathogenesis of steroid induced glaucoma.