Systemic corticosteroid therapy increases the incidence of high intraocular pressure (IOP) in children with B-cell precursor acute lymphoblastic leukemia (BCP-ALL) according to research published in the Japanese Journal of Ophthalmology. The study found increased IOP frequently in pediatric patients treated with prednisolone during induction therapy and with dexamethasone during reinduction therapy.
High doses of systemic corticosteroid therapies are used to treat hematologic malignancies and may cause an ocular hypertensive response as a side effect; however, guidelines are lacking for ophthalmic care of these patients. This study characterizes the incidence and severity of a steroid-induced ocular hypertensive response in pediatric patients receiving prednisolone or dexamethasone for BCP-ALL treatment.
The researchers retrospectively evaluated data from 28 patients. The incidence of high IOP was 54.5% in the prednisolone group and 75.0% in the dexamethasone group, suggesting a correlation between systemic corticosteroid therapy type and degree of IOP elevation.
Of the 23 patients that had high IOP, 6 of them reported symptoms that included severe headache and vomiting.
There was no clear correlation between total corticosteroid dosage and maximum IOP but the ocular hypertensive response was reproducible during subsequent systemic corticosteroid therapy courses. Given the high frequency, the study authors recommend that regular ophthalmic examinations should be included in the treatment guidelines for ALL.
“Many patients with high IOP are asymptomatic, and children might be less likely to have symptoms of high IOP,” the researchers report. “In addition, it is difficult to infer whether symptoms are due to high IOP or to poor physical condition from the primary disease, chemotherapy, or the difficulty infants have in complaining of symptoms. Therefore, regular check-ups are necessary when corticosteroids are used, even in the absence of symptoms.”
The study was limited by retrospective access to incomplete and variable data. For example, some patients did not have baseline IOP recorded, timing of examinations were variable, and the criteria for pharmacologic management were vague.
Sawada M, Takachi T, Watanabe K, et al. Steroid-induced ocular hypertensive response in pediatric patients with acute lymphoblastic leukemia. Jpn J Ophthalmol. 2023;67(4):396-401. doi:10.1007/s10384-023-01005-7