Abstract
Objective: To study the Ocular side effect by chronic use of steroid in Chronic obstructive pulmonary disease (COPD) attending tertiary care center in north India
Method: 500 COPD patients of age group 50 -90 years with minimum steroid exposure of 4 months and on inhaled corticosteroids were selected from TBCD and Ophthalmology department, S.N. Medical College and Hospital, Agra during the period of one year August 2017 to August 2018, a detailed clinical history, physical and ocular examination was done. Various investigations and diagnostic criteria were used during study. Average daily dose of inhaled corticosteroids was defined as low (1–250 μg), medium (251–500 μg), and high (501–1000 μg) using fluticasone propionate equivalents
Result: Out of 500 COPD patients, of which 58 were dropouts. We identified 78 cataract and 24 glaucoma patients with a prevalence of 17.64 % and 5.42% respectively. We also observed a dose-response relationship with the highest prevalence of cataract (39.74%) and glaucoma (41.6%) at daily doses of 501–1000 μg fluticasone propionate equivalents.
Conclusion: Both cataract and glaucoma are associated with Chronic use of high dose inhaled corticosteroid in COPD patients, cataract being the more commoner one, judicious use of such medication can prevent these manifestations.
Keywords: chronic obstructive pulmonary disease, steroid-induced cataract, steroid-induced glaucoma,
References
- American lung Association Epidemiology and Statistics unit .trends in COPD: morbidity and mortality. 2013. http://www.lung.org/assets/documents /research/COPD- trend –report.pdf (accessed 12august2016).
- Kim V, Crapo j, Zhao H, et al. Comparasion between an alternative and classic definition of Chronic bronchitis in COPD gene .Annals of the American thoracic society 2015 : 12 (3) :332-9.
- World Health Organization. Prevention of blindness and visual impairment. Priority eye diseases: cataract. Available at: http://www.who.int/blindness/ causes/priority/en/index1.html
- Jobling AI, Augusteyn RC. What causes steroid cataracts? A review of steroid-induced posterior subcapsular cataracts. Clin Exp Optom. 2002; 85:61–75.
- McLean JM. Use of ACTH and cortisone. Trans Am Ophthalmol Soc. 1950;48:293–296. Discussion
- Dada T, Konkal V, Tandon R, et al. Corneal topographic response to IOP reduction in steroid induced glaucoma with VKC. Eye. 2005;5:122–129
- Garbe E, Suissa S, LeLorier J Association of inhaled corticosteroid use with cataract extraction in elderly patients. 1998 Aug 12;280(6):539-43.
- Smeeth L, Boulis M, Hubbard R, et al. Apopulation based case-control study of cataract and inhaled corticosteroids. Br J Ophthalmol. 2003;87: 1247–1251.
- Miller DP, Watkins SE, Sampson T, et al. Long-term use of fluticasone propionate/ salmeterol fixed-dose combination and incidence of cataracts and glaucoma among chronic obstructive pulmonary disease patients in the UK General Practice Research Database. Int J Chron Obstruct Pulmon Dis. 2011;6:467–476.
- Tinkelman DG, Reed CE, Nelson HS, et al. Aerosol beclomethasone dipropionate compared with theophylline as primary treatment of chronic, mild to moderately severe asthma in children. 1993;92:64–77.
- Nassif E, Weinberger M, Sherman B, et al. Extrapulmonary effects of maintenance corticosteroid therapy with alternate-day prednisone and inhaled beclomethasone in children with chronic asthma. J Allergy Clin Immunol. 1987;80:518–529
- Mitchell P, Cumming RG, Mackey DA. Inhaled corticosteroids, family history, and risk of glaucoma. 1999; 106:2301–2306.
Corresponding Author
Dr Anupriya Mehrotra
Senior Resident, P.G. Department of Ophthalmology, Sarojini Naidu Medical College, Agra-282002 Uttar Pradesh, India
Mobile: +9411684812 Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i9.79
