Ocular hypertensive response to topical dexamethasone in children - A dose-dependent phenomenon

Objective: To investigate the ocular-hypertensive response to different dos ages of topical dexamethasone eye drops in Chinese children. Design: Prospective, randomized clinical trial. Participants: Thirty-one consecutive children undergoing bilateral strabism us surgery. Interventions: Topical dexamethasone (0.1%) was administered to children un dergoing bilateral strabismus surgery. They were all less than 10 years of age. One eye was randomized to receive a regimen of four times daily, and a nother received a twice daily regimen. Intraocular pressure (IOP) was seria lly measured in the postoperative period for 4 weeks or more. Topical stero ids were discontinued if IOP was 30 mmHg or more. Main Outcome Measures: Intraocular pressure was measured on the day before the surgery, on postoperative days 1,3, 5, 8, 12, 15, 22, 29, and 2 weeks t hereafter until the IOP reached preoperative levels. Peak IOP, IOP net incr ease, and time to reach an IOP more than 20 mmHg in the two study groups we re analyzed. Results: A total of 31 patients (20 male, 11 female) were examined. The mea n age was 5.8 +/- 2.0 years (range, 2-10 years). Preoperative IOP in groups treated twice daily and four times daily were similar. After topical dexam ethasone treatment, both groups showed a significant vise in peak IOP compa red with preoperative values (twice daily, 25.2 +/- 6.8 mmHg vs. 14.3 +/- 2 .4 mmHg, P < 0.001; four times daily, 28.7 +/- 6.9 mmHg vs. 14.3 +/- 2.9 mm Hg, P < 0.001). The peak IOP was significantly higher in the four times dai ly group (P < 0.001), as was the net increase in IOP (twice daily, 10.9 +/- 5.8 mmHg vs, four times daily, 14.5 +/- 6.4 mmHg; P < 0.001). There was no difference in time for both groups to achieve the peak IOP, but the time t o exceed its upper normal value (20 mmHg) was shorter in the four times dai ly group (twice daily, 12.3 +/- 9.1 days vs. four times daily, 10.0 +/- 7.4 days; P<0.05). Conclusions: in children treated with topical dexamethasone, ocular hyperte nsion occurs in a dose-dependent manner. Children in the four times daily g roup had a quicker onset and more severe ocular hypertensive response than the twice daily group. Nevertheless, even the twice daily regimen produced significant IOP rise, suggesting that dexamethasone use in children should be avoided if possible, and it would be desirable to monitor the IOP twice weekly when it is administered to children. Ophthalmology 2000;107: 2097-21 00 (C) 2000 by the American Academy of Ophthalmology.