OCULAR-HYPERTENSIVE RESPONSE TO TOPICAL STEROIDS IN CHILDREN

Objective: The purpose of the study is to investigate the rate and deg ree of ocular-hypertensive response to topical steroids in Chinese chi ldren. Design: The study design was an institutional, randomized, clin ical trial. Participants: A total of 19 consecutive patients were stud ied. Intervention: Topical steroids were administered to Chinese child ren younger than 10 years of age who underwent bilateral strabismus su rgery. One eye was randomized to receive topical 0.1% dexamethasone (D MS), whereas the fellow eye received 0.1% fluorometholone (FML) six ti mes per day for up to 4 weeks. Intraocular pressure (IOP) was measured on the day before operation and at postoperative days 1, 3, 6, 10, 13 , and 27, then every 2 weeks thereafter until the IOP fell to preopera tive levels. Topical steroids would be stopped if IOP was 30.00 mmHg o r greater. Main Outcome Measures: Peak IOP and maximal change of IOP f rom baseline were measured and categorized into low, intermediate, and high levels, Time to peak IOP also was studied. Results: A total of 1 6 patients were included. The peak IOP for DMS-treated eyes was 30.66 +/- 8.35 mmHg (range, 13.00-48.00 mmHg), whereas that in FML-treated e yes was significantly lower at 20.66 +/- 6.03 mmHg (range, 11.30-36.30 mmHg) (P = 0.001). The maximal change in IOP ranged from -2.60 to +31 .00 mmHg in DMS-treated eyes (mean, 15.48 +/- 8.71 mmHg), almost doubl e that of FML-treated eyes (range, +1.00 to +17.00 mmHg; mean, 5.83 +/ - 4.96 mmHg) (P = 0.001). When the ocular-hypertensive responses of bo th DMS and FML groups were categorized into three levels of severity, significant differences were found between the two treatment groups (P 0.001). In the DMS group, nine patients (56.25%) were high responders and six patients (37.5%) were intermediate responders, In the FML gro up, only one patient (6.25%) was a high responder. Conclusions: The oc ular-hypertensive response to topical DMS in children occurs more freq uently, more severely, and more rapidly than that reported in adults, A total of 56% of the studied children, all younger than 10 years of a ge, were high responders to topical DMS. Of these, 89% attained their peak IOP within 8 days. Its use in children should best be avoided if possible. It would be desirable to monitor the IOP when it is being us ed. Conversely, FML produced a much less ocular-hypertensive effect an d therefore poses an acceptable risk of clinically significant pressur e elevation.