Ocular complications of paediatric patients with nephrotic syndrome

Purpose: To investigate ocular complications arising from nephrotic syndrom e and/or its treatments in children. Methods: A cross-sectional study was conducted in a teaching hospital. A to tal of 31 paediatric patients with nephrotic syndrome were studied. Compreh ensive ophthalmic assessments on best-corrected visual acuity, intraocular pressure, slit-lamp and fundus examination were taken. Information regardin g histological diagnosis of nephrotic syndrome and its treatment regimen in each patient was reviewed and analysed. Results: Bilateral posterior subcapsular cataracts were detected in three o f 29 patients (10.3%) who received steroid therapy. Two had normal vision w hile one had visual acuity reduced to 6/15 in both eyes. The age of onset o f the nephrotic syndrome in these three patients was 2 years, which was sig nificantly younger than those without cataract (5.4 +/- 3.2 years, P < 0.00 1). Three patients (9.7%) had isolated asymptomatic fundal findings of tort uous and dilated retinal vessels. Hypertensive retinopathy was found in one patient (3.2%). No steroid-induced glaucoma, uveitis, ocular infection, or other eye complications related to the use of steroids or other immunosupp ressive agents were noted. Conclusions: Children who have nephrotic syndrome often require prolonged, intermittent high dose of systemic corticosteroid therapy. Paediatricians s hould be aware of the potential risk of developing steroid-related complica tions, especially posterior subcapsular cataract. It appears to have a high er risk when steroid therapy is used in very young patients. Early detectio n would help to prevent amblyopia development, particularly in the group of immature eyes.