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Do reducing regimens of fluorometholone for paediatric ocular surface disease cause glaucoma?
  1. Asimina Mataftsi1,2,
  2. Aman Narang1,
  3. Will Moore1,
  4. Ken K Nischal1,3
  1. 1Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital, London, UK
  2. 2II Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
  3. 3Developmental Biology Unit, Institute of Child Health, University College London, London, UK
  1. Correspondence to Dr K K Nischal, Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital, London, UK; kkn{at}btinternet.com

Abstract

Background/aims Although fluorometholone (FML) is considered a steroid of minimal ocular penetration, reports in children have shown dose-dependent intraocular pressure (IOP) rise. The authors aimed to assess whether reducing regimens of FML for paediatric ocular surface disease have sustained clinically significant ocular hypertensive effects.

Methods Retrospective case-note review. Glaucoma was defined as an IOP of ≥21 mm Hg on at least two occasions or, in young children, moderate/firm digital IOP with one of the following: myopic shift, increased cup:disc ratio or corneal oedema. Exclusion criteria were other concurrent steroids or pre-existing optic nerve disease.

Results 107 cases were included. The median age was 6 years (range 3 months to 17 years). The commonest indication for FML was blepharo-kerato-conjunctivitis. The maximal frequency prescribed was four times a day, gradually reduced to once weekly in cases of long-term treatment. The mean total number of eye-drop applications was 228 over a mean time span of 9 months. Post-FML IOP was formally documented in 51/107 casenotes (median age 6.85 years, range 4 months to 16 years) and it was <19 mm Hg in all cases. 56 cases did not allow IOP measurement (median age 5.9 years, range 3 months to 17 years), but none met the glaucoma definition.

Conclusions In this cohort, reducing regimens of FML proved to be a safe anti-inflammatory treatment in terms of avoiding steroid-induced glaucoma.

  • Fluorometholone
  • intraocular pressure
  • glaucoma
  • children
  • ocular surface
  • treatment medical
  • ocular surface
  • intraocular pressure
  • treatment medical

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Footnotes

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Great Ormond Street Hospital—audit approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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