Visual loss caused by corticosteroid-induced glaucoma: how to avoid it.

摘要

The initial report of elevation of intraocular pressure (IOP) in response to corticosteroids was that by McLean, who, in 1950, noted that adrenocortico-tropic hormone (ACTH) could have such an effect. The report by Francois on pressure elevation caused by topical steroids appeared in 1954, and much is now known about its pathogenesis. Nevertheless, visual loss caused by steroid-induced glaucoma continues to occur. Concerns about this entity have increased after the institution of intravitreal corticosteroid treatment, primarily for retinal diseases. This commentary does not deal with the benefits of intravitreal, topical, or systemic corticosteroid treatment for ocular disease. Although the appropriate role of corticosteroids in comparison with other treatments is controversial, there is evidence that such treatments can be effective in preventing visual loss from uveitis, can improve the success of glaucoma-filtering surgery, and can have temporary or long-term benefits in some patients with some types of retinal disease. Clearly, no treatment of any kind is indicated unless there is a reasonable likelihood of a clinical benefit from that treatment. Herein, we do not concern ourselves with the important "benefit" side of the risk/benefit ratio, but rather examine in detail one of the many risks associated with the use of corticosteroids, specifically visual loss from glaucoma.