A Case of Steroid Glaucoma in a Child Treated with Systemic Steroid as Graft-Versus-Host Disease

Doo Ri Eo; Jong Chul Han; Chang Won Kee

doi:10.3341/jkos.2016.57.3.518

Journal List > J Korean Ophthalmol Soc > v.57(3) > 1010543

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Eo, Han, and Kee: A Case of Steroid Glaucoma in a Child Treated with Systemic Steroid as Graft-Versus-Host Disease

Case Report

J Korean Ophthalmol Soc 2016;57(3):518-523.

Published online: 3 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.3.518

A Case of Steroid Glaucoma in a Child Treated with Systemic Steroid as Graft-Versus-Host Disease

Doo Ri Eo, MD, Jong Chul Han, MD, Chang Won Kee, MD, PhD

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Address reprint requests to Chang Won Kee, MD, PhD, Department of Ophthalmology, Samsung Medical Center, #81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea, Tel: 82-2-3410-3548, Fax: 82-2-3410-0074, E-mail: ckee@skku.edu

Received 30 July 2015 Revised 16 September 2015 Accepted 20 November 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of steroid-induced glaucoma in a child who was treated with systemic steroids for a long period due to graft-versus-host disease.

Case summary

A 10-year-old male was referred to our ophthalmologic clinic for examination of papilledema due to persistent headache and nausea. He was diagnosed as aplastic anemia 8 years prior and took approximately 4,000 mg of oral prednisolone for 8 years from April 2007 to April 2015 for treatment of lung graft-versus-host disease after hematopoietic stem cell transplantation. His best corrected visual acuity was 0.8 (decimal) in the right eye, 0.5 in the left eye and intraocular pressure (IOP) measured using a Goldmann applanation tonometer was 42 mm Hg in the right eye and 43 mm Hg in the left eye. His cup-to-disc ratio was 0.8 in the right eye and 0.7 in the left eye. Additionally, superior and inferior neuroretinal rim thinning was present in both eyes. Despite using IOP-lowering agents, IOP was not controlled. However, after trabeculectomy with mitomycin C in both eyes, IOP became normalized.

Conclusions

In cases of pediatric patients treated with systemic steroids for a long period of time, regular observation is necessary to prevent IOP elevation and steroid-induced glaucoma.

Keywords: Oral prednisolone, Steroid-induced glaucoma, Systemic steroid

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Figure 1.

Fundus photographs of the patient. (A, B) Normal fundus photographs with a normal cup to disc ratio 5 years ago, (C, D) glaucomatous cupping of the optic disc with a cup-to-disc ratio of 0.8 in the right eye and 0.7 in the left eye, and superior and inferior neuro-retinal rim thinning in both eyes.

Figure 2.

Neuro-retinal rim thinning and decreased retinal nerve fiber layer in both eyes measured by optical coherent tomography. ONH = optic nerve head; RNFL = retinal nerve fiber layer; OU = oculus unitas; OD = oculus dexter; OS = oculus sinister; TEMP = temporal; SUP = superior; NAS = nasal; INF = inferior; S = superior; T = temporal; I = inferior; N = nasal.

Figure 3.

Anterior segment photograph after treated with systemic steroid. Posterior subcapsular cataract in the right eye (A) and left eye (B).

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