Topical prednisolone acetate usage risk for developing steroid-induced ocular hypertension

Ocular hypertension though isn't a serious disease by itself but might be the cause to develop glaucoma. As of 2022, an estimated 3 million people in the United States had glaucoma and more than 120,000 are legally blind because of this disease. These statistics emphasize the need to identify and closely monitor people who are at risk of developing glaucoma, particularly those with ocular hypertension.

Topical corticosteroids are the most preferred way to treat short-term control of postoperative ocular inflammation, however with long-term use, they are known to cause cataract formation and steroid-induced ocular hypertension with the potential for steroid-induced glaucoma, which can cause irreversible vision loss.

A recent review in the journal Cornea aimed to assess the long-term risk of steroid-induced ocular hypertension and the need for glaucoma treatment with long-term use of topical prednisolone acetate 1% in patients without preexisting glaucoma.

This retrospective analysis of patients who underwent Descemet stripping endothelial keratoplasty and were on long-term therapy with topical prednisolone acetate 1% to prevent graft rejection showed a cumulative risk of developing steroid-induced ocular hypertension of 29% at 1 year, 41% at 5 years, and 49% at 10 years.

Researchers reviewed the charts of 211 patients without previous glaucoma, who underwent Descemet stripping endothelial keratoplasty (DSEK) and used topical prednisolone acetate long-term to prevent graft rejection. Dosing was 4 times daily for 4 months and tapered to once daily. The main outcomes were ocular hypertension (defined as intraocular pressure ≥24 mm Hg, or increase of ≥10 mm Hg over baseline) and initiation of glaucoma treatment.

The review found that

• The median patient age was 70 years (range: 34–94 years). The indications for DSEK were Fuchs dystrophy (88%), pseudophakic corneal edema (7%), failed DSEK (3%), and failed penetrating keratoplasty (2%).

• The median follow-up period was 7 years (range, 1–17 years). At 1, 5, and 10 years, the cumulative risks of steroid-induced ocular hypertension were 29%, 41%, and 49%, respectively, and the risks of requiring glaucoma treatment were 11%, 17%, and 25%, respectively.

• Among 35 eyes treated for glaucoma, 28 (80%) were managed medically and 7 (20%) had filtration surgery.

Researchers noted that Patients can develop steroid-induced increased intraocular pressure even after years of incident-free use of prednisolone acetate 1%. Continued long-term follow-up and consideration of medication changes, when indicated, are required, With corneal transplantation, the risk can be mitigated by using techniques with a low inherent risk of rejection, such as Descemet membrane endothelial keratoplasty, whenever possible, to allow earlier reduction of steroid potency they ended.

Reference: Price, Marianne O. PhD*; Price, David A. MD*; Price, Francis W. Jr MD†. Long-Term Risk of Steroid-Induced Ocular Hypertension/Glaucoma With Topical Prednisolone Acetate 1% After Descemet Stripping Endothelial Keratoplasty. Cornea ():10.1097/ICO.0000000000003312, June 7, 2023.