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Purpose: To evaluate the effect of 0.125% verapamil and 0.5% diltiazem eye drops on intraocular pressure (IOP) in steroid-induced glaucoma in rabbit eyes. Methods: A total of 18 rabbits with steroid-induced glaucoma were divided into three groups (A, B and C; n = 6 each). Right eyes in groups A, B and C received 0.5% diltiazem, 0.125% verapamil and 0.5% timolol eye drops twice daily for 12 days, respectively; whereas, left eyes received distilled water. IOP was measured with Tono-pen XL at baseline, day 4, day 8, and day 12 of treatment. Results: Both 0.5% diltiazem and 0.125% verapamil eye drops significantly reduced IOP compared to control eyes (p < 0.05). Reduction of IOP by 0.5% diltiazem, 0.125% verapamil eye drops were comparable to 0.5% timolol. No surface toxicity or systemic side effects were noted during the study period. Conclusion: Calcium channel blockers, verapamil, and diltia-zem significantly reduced IOP in rabbiteyes. This group of drugs may have a potential role in treatment of glaucoma How to cite this article: Ganekal S, Dorairaj S, Jhanji V, Kudlu K. Effect of Topical Calcium Channel Blockers on Intraocular Pressure in Steroid-induced Glaucoma. J Current Glau Prac 2014;8(1):15-19.

Increased intraocular pressure and glaucoma following corticosteroid therapy are well known issues for the ophthalmologist for more than 50 years. Corticosteroids use has gained popularity in ophthalmology as anti-inflammatory and anti-allergic agents but can have important consequences and should be used only with judicious monitoring. The therapeutic use of corticosteroids can lead to the development of ocular hypertension and iatrogenic open-angle glaucoma in susceptible individuals. It can occur in any age group, either gender and from steroid therapy for any ocular or systemic disease and by any route of administration: topical, systemic or inhaled.

Objective: To assess the efficacy of surgical excision of sub-Tenon triamcinolone acetonide (TA) deposits in the control of steroid-induced glaucoma. Design: Prospective, nonrandomized, interventional case series. Participants: Eighteen eyes of 14 subjects with increased IOP within 6 months of sub-Tenon TA injection who did not respond to medical antiglaucomatous treatment were included in the study. Methods: Under topical anaesthesia, steroid deposits were completely excised and placed in ethyl alcohol for the determination of the TA amount using high-performance liquid chromatography. The patients were followed up for 6 months and a paired-sample t test was used to compare mean IOP before and after excision of sub-Tenon TA deposits. Results: The mean IOP levels before and after the sub-Tenon steroid injections were 15.9 (SD 2.9) mm Hg and 36.4 (SD 8.4) mm Hg, respectively (p < 0.001). IOP levels decreased significantly after the removal of the deposits (mean 15.3 [SD 2.1] mm Hg) (p < 0.001). Within 6 months of follow-up, all glaucoma medications were stopped in 9 subjects without further IOP increase, whereas IOP control in 5 subjects necessitated using glaucoma medications. The median TA amount was found to be 7.35 mg (range 3.3–29.68 mg). IOP decrease after the excision showed no correlation with the amount of TA (p = 0.8). Conclusions: Surgical excision of the sub-Tenon steroid deposit should be considered as the primary treatment for steroid-induced glaucoma refractory to medical treatment.

1981年当初より1990年末までの間,自験例125人の膠原病患者に対して20mg/日以上のプレドニゾロンを使用した.その中で,眼圧上昇と眼症状をきたした12例と紹介例2例の計14例に認められた15エピソードを対象とし,ステロイド投与と眼症状との関連性を検討した. SLEは12例, 13エピソードを占めた.緑内障にとって最も特徴的な症状は目のかすみであり,患者は“霧の中にいるようだ”と訴えた.視力の異常は多くが訴えたが,この症状は緑内障に特異的な症状とは考えられなかった.眼痛や吐き気は長期にわたる眼圧の上昇の後に観察されており,これらはより重篤な症状と考えるべきであると思われた.眼圧の上昇は, 11エピソードではステロイド投与開始より2ヵ月以内に観察されたが,その他の4エピソードでは100日を経過して寛解中に生じた. Acetazolamide (Diamox)あるいはその他の眼科的処方に対する反応は, 10エピソードでは良好であったが, 5症例では減圧術を要した.結論として,今回の検討では,ステロイド投与による眼圧の上昇はSLEに最も多く認められたが, SLEに特異的な副作用ではなかった.また,重篤な眼障害は注意深い眼圧の測定とステロイドを服用中の膠原病患者に対してその危険性を教育しておくことで予防できると思われた.

To evaluate the ocular hypertensive response to repetitive cycles of high-dose systemic corticosteroid in young patients with acute lymphoblastic leukemia (ALL).Five patients up to 6 years of age with ALL who received chemotherapy between November 2003 and March 2005 were examined. As maintenance therapy, they received oral or intravenous dexamethasone 6 to 12 mg/m²/day for 2 weeks, followed by 1-week taparing and 5 weeks break were used in 1 cycle. The duration of maintenance therapy was 15 cycles for 2.5 to 3 years. Comprehensive ophthalmic check-up, including best-corrected visual acuity, intraocular pressure (IOP), and slit-lamp and fundus examinations, were performed.All patients were followed up until final cycle. Symmetrical IOP rise21 mm Hg was observed in all patients. Right IOP increased to a maximum of mean 39.6 ± 7.2 mm Hg. (range: 28 to 47). The range of cycle to reach a maximal IOP was 5th to 11th. All patients were maintained IOP control with antiglaucoma medications. However, 1 patient already had severe glaucomatous optic atrophy at the time of consultation.Systemic corticosteroid in childhood-ALL treatment has a risk for IOP elevation. Periodical and careful ophthalmic check-up is necessary, especially in patients with dexamethasone.

An eight-week general practice based prospective study was carried out to determine the incidence and prevalence of various eye conditions and the frequency of prescription of different topical eye preparations. The most frequently diagnosed eye conditions were infectious conjunctivitis (35%), glaucoma (16%), allergic conjunctivitis (11%), and keratoconjunctivitis sicca (9%). Betamethasone was the fourth most commonly prescribed preparation (9%). Eye preparations containing steroids accounted for 14% of prescriptions. Two cases of steroid induced glaucoma are presented as an illustration of the potential hazards of these preparations. The pathogenesis of steroid induced glaucoma is discussed.

A 3-week-old infant developed buphthalmos and glaucoma after a 1-week course of topical steroid drops. The glaucoma resolved after cessation of the medication. This report underscores the sensitivity of infants and very young children to steroid-related intraocular pressure rises.

Purpose To report a case of severe corticosteroid-induced glaucoma after intravitreal injection of triamcinolone acetate in a 34-year-old man without a history of glaucoma. Design Observational case report. Methods Retrospective review of a clinical case. Results A 34-year-old man acquired visual field defects and severe vision loss in both eyes after intravitreal injection of triamcinolone for diabetic macular edema. Conclusions Intravitreal injection of triamcinolone is a commonly performed treatment for many retinal conditions. This treatment has the potential to cause severe vision loss as a result of intractable corticosteroid-induced glaucoma.

Purpose: To present a case of a unilateral diffuse retinal hemorrhage in a 15-year-old girl, who underwent bilateral trabeculectomy for steroid induced glaucoma. Methods: Despite the maximally tolerable medical treatment, IOP in the right eye remained above 50 mmHg for four months, and was simultaneously elevated in the left eye. So we performed bilateral trabeculectomy. Results: On the first postoperative day, diffuse retinal hemorrhages were observed in the right eye; however, no retinal hemorrhage was found in the left eye. The hemorrhages resolved completely without consequences two months later. Conclusions: In the case of high IOP for a long period, sudden lowering of IOP may acutely increase the blood flow and consequently rupture multiple retinal capillaries because of altered autoregulatory function. Special care is therefore needed to prevent an abrupt fall in IOP before, during, and after surgery, especially when IOP has been highly elevated for an extended period.

Results: Anti-glaucoma eye drops were used in 312 eyes (38%). The anti-glaucoma eye drops were started before 4 weeks postoperatively in 105 eyes (13%) and postoperatively at 5-8 weeks in 86 eyes (10%), at 9-12 weeks in 83 eyes (10%), at 13-16 weeks in 25 eyes (3%) and after 17 weeks in 13 eyes (2%). Conclusions: The overall incidence of increased IOP when treated with 0.1% fluorometholone for 3-6 months after PRK was approximately 38%. The incidence of increased IOP in each month for the first 3 months was almost identical implying that the longer 0.1 fluorometholone was used, the higher incidence of increased IOP occurred. These results can be helpful in educating patients regarding the risk of increased IOP and determining the follow-up period after PRK. J Korean Ophthalmol Soc 2015;56(7):985-991

Purpose To investigate the effect of external trabeculotomy on eyes with steroid-induced glaucoma. Methods We retrospectively analyzed the surgical results of 14 eyes of seven patients that underwent trabeculotomy for the first surgical procedure. All patients had the history of receiving topical or systemic corticosteroids before the rise of intraocular pressure had been noted. Results After an average follow-up of 60.6 +/- 33.5 months, in all of the 14 eyes, intraocular pressure was well controlled below or equal to 21 mm Hg at the final examinations. Conclusions Surgical results of external trabeculotomy remain effective for a long time. It has been shown that the trabeculotomy can be a useful and effective surgical treatment of patients with steroid-induced glaucoma.

Purpose This case report illustrates the efficacy of the Glaukos trabecular bypass (Glaukos i-stent, Glaukos Corporation, Laguna Hills, California, USA) used for intraocular pressure (IOP) control in a patient with glaucoma induced by the steroid treatment of post–laser-assisted in situ keratomileusis (LASIK) bilateral anterior uveitis. Methods A 35-year-old woman who had undergone LASIK 5 months previously presented with blurred vision in both eyes. Examination revealed bilateral anterior uveitis and diffuse lamellar keratitis (DLK) requiring steroid treatment. In response to treatment, inflammation improved but the patient had increased IOP that was difficult to control. The course of pressure elevation was more aggressive in the left eye despite the gradual discontinuation of steroids. We therefore decided to place 2 trabecular i-stents in the left eye. Results This solution achieved good pressure control with no associated complications after 1 year follow-up. Conclusions This trabecular bypass seems a safe and effective therapeutic option for IOP control when there is a poor response to conventional treatment in this type of secondary glaucoma.

Corticosteroids use can cause raised intraocular pressure (IOP), leading to glaucoma. We present a case report of steroid induced glaucoma in a young male with keratoconjunctivitis (VKC). Our patient was uncompliant with instructions to stop steroid use, initially started for VKC treatment, and required aggressive medical and surgical intervention for IOP control. He eventually progressed to severe glaucomatous optic neuropathy and eventual tunnel vision. Steroid induced glaucoma is an important and frequently encountered condition in ophthalmology clinics. This report serves to remind all physicians of the dangers of steroid eye drop usage.