Subcapsular cataract

Posterior subcapsular cataracts, increased intraocular pressure, glaucoma, exophthalmos... 

Long-term use of oral corticosteroids may result in side-effects, such as peptic ulceration, adrenal suppression and subcapsular cataracts. 

Ocular effects Prolonged use may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may enhance the establishment of secondary ocular infections caused by fungi or viruses. 

Ophthalmic-, stinging or burning, posterior subcapsular cataracts Serious Reactions... 

Adverse effects include peptic ulceration, myopathy, steroid psychosis. On prolonged use posterior subcapsular cataract, glaucoma, osteoporosis, hyperglycemia. 

Oral glucocorticoid treatment is a risk factor for the development of posterior subcapsular cataract. A review of nine studies including 343 asthmatics treated with oral glucocorticoids showed a prevalence of posterior subcapsular cataracts of 0-54% with a mean value of 9% (55). In a 1993 study in children taking low-dose prednisone there were cataracts in seven of 23 cases (56). Some studies... 

An 11-year-old boy with iridocyclitis developed Cushing s syndrome, a posterior subcapsular cataract, and increased intraocular pressure in both eyes after the topical administration of prednisolone acetate 1% eye-drops bilaterally for 6 months. The Cushing s syndrome was aggravated when periocular methylpredni-solone acetate was started while bilateral posterior subtenon injections of 80 mg of suspension were continued every 6 weeks for 6 months. He had not used systemic glucocorticoids before. 

Nasal budesonide or beclomethasone 100 micrograms bd for 3-9 months had no effect on the eyes in 26 patients who had undergone endoscopic sinus surgery (440). Ophthalmologic examination, tonometry, visual field testing, and biomicroscopic studies showed no evidence of ocular hypertension or posterior subcapsular cataract. 

Bilateral posterior subcapsular cataracts have been reported after treatment with epidural methylpredniso-lone for low back pain secondary to degenerative joint disease and disk protrusion (453). 

A 42-year-old man had received 15 epidural injections of methylprednisolone 80 mg over 10 years. About 6 weeks after his last injection, he developed progressively worsening cloudy vision. He had bilateral posterior subcapsular cataracts and subsequently underwent bilateral cataract removal. 

In a population-based cross-sectional study of vision and common eye diseases in 3654 people, 49-97 years of age, inhaled glucocorticoid use was reported by 370 subjects, of whom 164 reported current use and 206 previous use. Subjects who reported using inhaled glucocorticoids had a higher prevalence of nuclear cataracts (OR = 1.5 Cl = 1.2, 1.9) and posterior subcapsular cataracts (OR = 1.9 Cl = 1.3, 2.8). The highest prevalence (27%) was in patients whose lifetime dose was more than 2000 mg (relative prevalence 5.5) (SEDA-22,187). 

In another study, treatment for 2 years with fluticasone propionate (500 micrograms bd) had no significant effect on ophthalmic parameters (glaucoma and posterior subcapsular cataracts) (31). Slit lamp examinations were carried out in 157 asthmatic children treated with inhaled budesonide at a mean daily dose of 504 (range 189-1322) micrograms for 3-6 years (mean 4.4 years). Posterior subcapsular cataract due to budesonide was not detected (32). 

Agertoft L, Larsen FE, Pedersen S. Posterior subcapsular cataracts, bruises and hoarseness in children with asthma receiving long-term treatment with inhaled budesonide. 

Bilateral subcapsular cataracts and glaucoma have been reported as possible risks (13), but they presumably reflect glucocorticoid effects. 

Williamson J, Dalakos TG. Posterior subcapsular cataracts and macular lesions after long-term corticotrophin therapy. Br J Ophthalmol 1967 51(12) 839 12. 

Abuse of topically administered drugs by practitioners or patients can cause significant ocular toxicity. Infiltrative keratitis has occurred from long-term use of anesthetic eyedrops for relief of pain associated with corneal abrasions. Bilateral posterior subcapsular cataracts have developed after the topical administration of prednisolone acetate 0.12% twice daily over long durations. Practitioners should closely monitor patients treated with drugs known to have potentially significant ocular or systemic side effects. 

Pilocarpine therapy should be avoided in certain patients (Box 10-10).This drug is contraindicated in patients with cataract, especially nuclear sclerotic and posterior subcapsular cataract, because the drug can affect vision and may accelerate the formation of lens opacities. Pilocarpine is generally contraindicated in patients younger than 40 years of age because of the intolerable accommodative spasm and refractive changes. Because breakdown of the blood-aqueous barrier occurs with the use of pilocarpine and other miotics, particularly in the presence of neovascular and uveitic glaucoma, pilocarpine should be avoided in these patients. 

Posterior subcapsular cataracts (PSCs) can occur with all routes of administration (Figure 12-2), including systemic, topical, cutaneous, nasal aerosols, and inhalation corticosteroids. In a study of 44 rheumatoid arthritis patients treated with various steroids, including prednisone and dexamethasone, 17 (39%) developed bilateral PSCs. Dosage and duration of therapy appeared to be correlated with the incidence of cataract development. Patients who received prednisone therapy for 1 to 4 years showed an 11% incidence if the dose range was less than 10 mg/day a 30% incidence if the dose was... 

Figure 12-2 Posterior subcapsular cataract (arrows ) in a 48-year-old man who had taken oral prednisone, 7.5 mg/day, for 13 years for the treatment of rheumatoid arthritis. Visual acuity was 20/30 (6/9)-...

Cataracts of some degree occur in approximately 10% of AKC patients and, in one series, in 25% of patients with severe recurrent disease. Posterior subcapsular cataracts... 

Lens Pigment and cellular debris, similar to KPs, are often detected on the anterior lens surfece. Faint fibrin membranes at the pupillary margin may precede areas of posterior synechiae. Cataracts are an important consideration in chronic recalcitrant uveitis and for those on long-term corticosteroid therapy, because the latter is also linked with the development of posterior subcapsular cataracts. 

Complications associated with anterior uveitis may include cataracts, glaucoma, band keratopathy, and CME. Posterior subcapsular cataracts are the most commonly encountered lenticular change associated with chronic uveitis. Additionally, it is well known that long-term topical steroid use can induce or accelerate posterior subcapsular cataract development. 

Increases in intraocular pressure and development of posterior subcapsular cataracts are femiliar sequelae to corticosteroid therapy. Increased intraocular pressure after IVTA is considerably more common than endophthalmitis and has been established in different studies. Results are not readily comparable, because different amounts of triamcinolone were administered. However, it should be noted that approximately 30% or more of patients had an increase in intraocular pressure, regardless of the dose given, which is consistent with the finding that a significant number of patients are steroid... 

Figure 35-4 Stellate pattern of anterior subcapsular cataract associated with chlorpromazine administration. (Courtesy Jerome Thaler, O.D.)...

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