Risk factors of pediatric steroid-induced ocular hypertension

Purpose

Steroid-induced ocular hypertension (SIOH) is a significant ocular complication of pediatric steroid administration. In this study, we analyzed the risk factors associated with pediatric SIOH.

Methods

We retrospectively collected data from 78 children under 20 years of age who received systemic steroids during hospitalization. The data included age, gender, primary disease, intraocular pressure (IOP) before and one month after administration, total monthly steroid dose adjusted for body weight (BW), and one-month changes in red blood cell, white blood cell, and platelet counts. A multivariate analysis was used to identify risk factors related to steroid responsiveness.

Results

Thirty patients (38.5%) were classified as steroid responders, and 48 as non-responders. The median IOP during the first month of steroid treatment was 24.0 mmHg (IQR; 23.0–28.3) for responders and 15.0 mmHg (IQR; 12.3–18.0) for non-responders. The Generalized Estimating Equations analysis revealed that younger age, male sex, primary disease, increase the amount of white blood cell (WBC) and total steroid dose per BW in one month were independently associated variables. The receiver operating characteristic analysis also revealed that the cutoff values for age, total monthly steroid dose, the increase amount of WBC were 11.0 years, 40.7 mg/kg and 3.40 × 10²/µl respectively.

Conclusion

High-dose steroid administration, especially in male, younger patients, necessitates careful monitoring for IOP changes during treatment. WBC count also needs to be monitored during IOP follow-ups.

Key messages

What is known

Steroid-induced ocular hypertension (SIOH) is one of the essential complications during steroid administration, but only limited analyses have been performed in children.

What is new

A comprehensive analysis of multiple factors was performed that are predicted to be associated with pediatric SIOH from previous literature.

Younger age, male sex, primary disease, increase the amount of WBC, and higher total monthly steroid dose were extracted as risk factors of SIOH.

This study can contribute to the prediction of cases in which ophthalmologic examinations are particularly important during systemic steroid administration in children.