Steroid glaucoma

Glucocorticosteroids are widely used in clinical and ophthalmic practice, but their unjustifi ed and uncontrollable use is unacceptable. Prescription of steroids has to be controlled strictly and the level of intraocular pressure must be diagnosed, because one of the signifi cant side eff ect of steroids is increased intraocular pressure level and, as a result, the development of glaucomatous optic neuropathy. This review deals with the pathogenesis of an increase in the level of intraocular pressure against various forms of glucocorticosteroids intake, describes the time and duration of their ocular-hypertensive eff ect. The available data on the features of the clinical picture of steroid glaucoma, depending on the routes of their entry, have been studied in detail. The tactics of treating patients with ocular hypertension or a proven case of steroid glaucoma are described.

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Ocular Hypertension: A Review And Evidence-Based Roadmap

Canadian Journal of Optometry ◽

10.15353/cjo.79.442 ◽

2017 ◽

Vol 79 (1) ◽

pp. 17

Author(s):

Andrew John Rixon

Keyword(s):

Risk Factor ◽

Intraocular Pressure ◽

Ocular Hypertension ◽

Optic Neuropathy ◽

Daily Practice ◽

Modifiable Risk Factor ◽

Glaucomatous Optic Neuropathy ◽

Study Group ◽

Evidence Based ◽

Management Decisions

Increased intraocular pressure is arguably the most important, and currently the only modifiable, risk factor for glaucomatous optic neuropathy. Ocular hypertension is often encountered by clinicians in daily practice and is expected to be seen with increasing frequency as the population ages. Awareness and understanding of the extensive research performed on this subject, with particular focus on the work of the Ocular Hypertension Study Group, are critical for comprehensively assessing the risk of conversion to glaucoma. Although management decisions can be complex, they can be aptly handled by the well-informed optometrist in consultation with their patients.

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Bilateral Glaucomatous Optic Neuropathy Caused by Eye Rubbing

Case Reports in Ophthalmology ◽

10.1159/000439163 ◽

2015 ◽

Vol 6 (3) ◽

pp. 279-283 ◽

Cited By ~ 1

Author(s):

Alfonso Savastano ◽

Maria Cristina Savastano ◽

Laura Carlomusto ◽

Silvio Savastano

Keyword(s):

Intraocular Pressure ◽

Visual Field ◽

Optic Disc ◽

Optic Neuropathy ◽

Correct Diagnosis ◽

Visual Fields ◽

Pattern Electroretinogram ◽

Glaucomatous Optic Neuropathy ◽

Fiber Layer ◽

The Right

In this report, we describe a particular condition of a 52-year-old man who showed advanced bilateral glaucomatous-like optic disc damage, even though the intraocular pressure resulted normal during all examinations performed. Visual field test, steady-state pattern electroretinogram, retinal nerve fiber layer and retinal tomographic evaluations were performed to evaluate the optic disc damage. Over a 4-year observational period, his visual acuity decreased to 12/20 in the right eye and counting fingers in the left eye. Visual fields were severely compromised, and intraocular pressure values were not superior to 14 mm Hg during routine examinations. An accurate anamnesis and the suspicion of this disease represent a crucial aspect to establish the correct diagnosis. In fact, our patient strongly rubbed his eyes for more than 10 h per day. Recurrent and continuous eye rubbing can induce progressive optic neuropathy, causing severe visual field damage similar to the pathology of advanced glaucoma.

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Intraocular Pressure and Glaucomatous Optic Neuropathy in High Myopia

Investigative Opthalmology & Visual Science ◽

10.1167/iovs.17-21942 ◽

2017 ◽

Vol 58 (13) ◽

pp. 5897 ◽

Cited By ~ 18

Author(s):

Jost B. Jonas ◽

Natsuko Nagaoka ◽

Yu Xin Fang ◽

Pascal Weber ◽

Kyoko Ohno-Matsui

Keyword(s):

Intraocular Pressure ◽

Optic Neuropathy ◽

High Myopia ◽

Glaucomatous Optic Neuropathy

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Experimental reproduction of the glaucomatous process

Ophthalmology journal ◽

10.17816/ov2013343-50 ◽

2013 ◽

Vol 6 (3) ◽

pp. 43-50 ◽

Cited By ~ 1

Author(s):

Ilmira Rifovna Gazizova ◽

Vladimir Nikolayevich Alekseyev ◽

Dmitriy Nikolayevich Nikitin

Keyword(s):

Intraocular Pressure ◽

Ocular Hypertension ◽

Experimental Studies ◽

Pressure Level ◽

Trophic Factors ◽

Experimental Reproduction ◽

Experimental Animals ◽

New Knowledge ◽

The Brain

The glaucomatous process is one of the important challenges in ophthalmology. And this is due primarily to the fact that, so far, the main causes for the onset and progression of glaucoma are not been fully determined. Numerous experimental studies concentrate on the role of ocular hypertension. However, there are forms of glaucoma, which are independent of the intraocular pressure level. A better experimental model for the study of glaucoma would also take into consideration the development of the characteristic complex of signs, in which a key sign would be a slowly progressing optic disc excavation. Therefore, taking into account the new knowledge in the pathogenesis of neurodegenerative changes in glaucoma, the ability to investigate the brain, vascular factors of progression, the level of neurotransmitters, trophic factors, etc. should be added to this model. Therefore we tried to make an analysis of glaucoma models in various experimental animals to find most appropriate models to study the aspects of glaucoma pathogenesis.

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Reduction of Intraocular Pressure and Glaucoma Progression

50 Studies Every Ophthalmologist Should Know ◽

10.1093/med/9780190050726.003.0014 ◽

2020 ◽

pp. 79-84

Author(s):

Alan D. Penman ◽

Kimberly W. Crowder ◽

William M. Watkins

Keyword(s):

Intraocular Pressure ◽

Optic Neuropathy ◽

Open Angle Glaucoma ◽

Controlled Clinical Trial ◽

Glaucomatous Optic Neuropathy ◽

Delayed Treatment ◽

Lowering Therapy ◽

Risk Of Progression ◽

Modest Reduction

The Early Manifest Glaucoma Trial (EMGT) was a randomized, placebo-controlled clinical trial in patients with newly detected, previously untreated, primary open-angle glaucoma (POAG) to determine whether immediate institution of intraocular pressure (IOP)–lowering therapy reduces the risk of progression compared to delayed treatment or observation. The study showed that IOP-lowering therapy offered a definitive benefit in patients with early glaucoma by delaying progression of glaucomatous optic neuropathy, especially in eyes with higher IOPs (>21 mm Hg) at baseline. Even modest reduction in IOP decreased the risk of progression. However, a large percentage of treated eyes still showed progression during follow-up. The progression of glaucomatous optic neuropathy was highly variable and difficult to predict for an individual patient.

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Association of peripheral anterior synechia, intraocular pressure, and glaucomatous optic neuropathy in primary angle-closure diseases

International Journal of Ophthalmology ◽

10.18240/ijo.2021.10.09 ◽

2021 ◽

Vol 14 (10) ◽

pp. 1533-1538

Author(s):

Ming Zhang ◽

◽

Cong Ye ◽

Su-Jie Fan ◽

Yuan-Bo Liang ◽

...

Keyword(s):

Intraocular Pressure ◽

Optic Neuropathy ◽

Estimating Equation ◽

Angle Closure ◽

Independent Effect ◽

Generalized Estimating Equation ◽

Glaucomatous Optic Neuropathy ◽

Spherical Equivalent ◽

Primary Angle Closure ◽

Primary Angle Closure Glaucoma

AIM: To investigate the association of peripheral anterior synechiae (PAS) with intraocular pressure (IOP) and glaucomatous optic neuropathy (GON) in primary angle closure (PAC) and primary angle-closure glaucoma (PACG). METHODS: Totally 355 eyes (238 PAC and 117 PACG) of 181 patients were included in this retrospective analysis of baseline data from a randomized clinical trial. All patients had undergone a comprehensive ophthalmic examination. The extent of PAS in clock hours as determined on gonioscopy was documented. The independent effect of the extent of PAS on IOP and the prevalence of GON were determined using multivariable generalized estimating equation (GEE) models. RESULTS: The frequency of GON increased with the extent of PAS and a higher IOP. PAS were more extensive (8 vs 1 clock hour, P<0.001) and IOP higher (28.01 vs 18.00 mm Hg, P<0.001) in PACG compared to PAC. The prevalence of GON among the PAS quartiles were 10.2% (PAS<0.5 clock hours), 16.9% (PAS≥0.5 and PAS<3 clock hours), 29.6% (PAS≥3 and PAS<7 clock hours), and 74.4% (PAS≥7 clock hours), respectively. After adjusting for IOP, age, gender, spherical equivalent, average Shaffer score and number of medications, the odds ratio (OR) for GON was 4.4 (95%CI: 1.5-13.0; P=0.007) with PAS≥3 clock hours and 13.8 (95%CI: 4.3-43.6; P<0.001) with PAS≥7 clock hours as compared to eyes with PAS<0.5 clock hours. The frequency of GON increased linearly with the extent of PAS. Extent of PAS was also associated with higher IOP. Eyes with both PAS≥6 clock hours and IOP≥21 mm Hg had the highest risk of GON compared to eyes with both PAS<6 clock hours and IOP<21 mm Hg (OR=18.0, 95%CI: 7.5-43.4; P<0.001). CONCLUSION: The extent of PAS in PAC and PACG is an important predictor of higher IOP and is linearly associated with GON independent of IOP, suggesting other factors related to PAS formation may be involved in the development of GON in PACG.

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