Comparing glaucoma risk in children receiving low-dose and high-dose glucocorticoid treatment after cataract surgery

Abstract

Purpose: Treatment with glucocorticoids following paediatric cataract surgery is crucial to prevent inflammation, but may lead to secondary glaucoma, and hypothalamic-pituitary-adrenal axis suppression. We wish to compare glaucoma outcomes following high-dose and low-dose glucocorticoid treatment after paediatric cataract surgery.

Methods: This cohort study included Danish children undergoing cataract surgery before 10 years of age, receiving either a low-dose or high-dose postoperative glucocorticoid treatment. Case identification and collection of a standardized dataset were retrospective, from 1 January 2010 to 31 December 2016, and prospective thereafter, until 31 December 2021. High-dose treatment included 0.5-1.0 mg subconjunctival depot dexamethasone or methylprednisolone, followed by 6-8 drops of dexamethasone for 1 week, tapered by one drop weekly. Low-dose treatment included 6 drops for 3 days, followed by 3 drops for 18 days. Sustained (>3 months) ocular hypertension or glaucoma was compared between the two groups.

Results: Overall, 267 children (388 eyes) were included in the study. Ninety-five children (133 eyes) had received high-dose treatment and had a median follow-up time of 89 months (IQR: 57.2-107.4), while 173 children (255 eyes) had received the low-dose treatment and had a median follow-up time of 40.5 months (IQR: 22.9-60.4). Survival curves showed a lower risk of glaucoma in the low-dose group for children with axial lengths ≥18 mm.

Conclusion: Low-dose glucocorticoid treatment was associated with a lower risk of glaucoma in children with axial lengths ≥18 mm. The same effect was not observed in children with shorter eyes. High-dose glucocorticoid should be limited in children undergoing cataract surgery.

Keywords: congenital cataract; glaucoma; glucocorticoid; ocular hypertension; paediatric cataract; secondary glaucoma; steroid.

FIGURE 1

Scatter plot illustrating the axial length at the time of surgery compared to the age at cataract surgery in years. The orange dots are eyes diagnosed with glaucoma or ocular hypertension and the black eye are eyes not diagnosed with glaucoma or ocular hypertension at the latest follow‐up.

FIGURE 2

Average treatment effect survival curves concerning time to glaucoma or ocular hypertension after cataract surgery depending on the type of glucocorticoid treatment using axial length (< or ≥18 mm) and intraocular lens implantation (yes/no) as confounding factors. The timeline is years after cataract surgery and the dashed curves are 95%‐confidence curves. The number of children included in the analysis at a given time in both groups is illustrated at the bottom, red script is used for the number of children in the low‐dose group and black script for children in the high‐dose group.

FIGURE 3

Kaplan–Meier curves depicting the risk of treatment (Nd:YAG laser membranectomy or vitrectomy) for visual axis opacification depending on the type of glucocorticoid treatment. The timeline is years after cataract surgery and the dashed curves are 95%‐confidence curves. The number of children included in the analysis at a given time in both groups is illustrated at the bottom.

FIGURE 4

Average treatment effect survival curves concerning time to glaucoma or ocular hypertension after cataract surgery depending on the type of glucocorticoid treatment in children with axial lengths ≥18 and <18 mm using intraocular lens implantation (yes/no) as a confounding factor. The timeline is years after cataract surgery and the dashed curves are 95%‐confidence curves. The number of children included in the analysis at a given time in both groups is illustrated at the bottom.