Treatment Of Steroid-Induced Glaucoma: A Case Report

Tri Kartika Utomo1, Fidalia2

1
Residence at Department of Ophthalmology, Faculty of Medicine, Sriwijaya University, Indonesia.
2
Departement of Ophthalmology, Faculty of Medicine, Muhammad.Hoesin Hospital, Sriwijaya
University, Indonesia

ABSTRACT

Introduction: Optic neuropati due to progressive damage to retinal ganglion cells (RGC)
which resilts in characteristics of cupping of the optic nerve head (ONH) and corresponding
visual field defects. Corticosteroid induced secondary glaucoma is open angle
glaucomacaused by prolonged use of topical, periocular, intravitreal, inhalation, or, oral
corticosteroids. Provides an overview of primary open angle glaucoma (POAG) in its
presentation.
Case illustration: A 25-year-old woman presented with a several-month history of narrow
vision of the right eye (RE), with history of corticosteroids eye drop of the right eye that are
in the patient's own purchase due to advice from her friend of such drug patients can cure
long-sighted blurry eyes. RE: BCVA 5/60 and 6/6 with spectacles, IOP 36,0 mmHg, a AC
depth of Van Herick’s grade 3. Gonioscopy: grade 3 in 4 quadrants. C/D ratio 0.9 with
cupping, notching and nasalisation of vessels. OCT suggested RNFL thinning at the whole
quadrant. Inadequate IOP control with 2 anti glaucoma medication.
Discussion: In the examination of ocular coherence tomography (OCT) there is a depletion
of retinal nerve fiber layer (RNFL) ehich occurs mainly in both eyes, but severe in the right
eyes, depletion of RNFL in left eye may be influenced by myopia. treatment with 3
medication of anti-glaucoma has demonstrated success in achieving lower IOP. It is
accordance with the signs of damage occuring to glaucomaglaucoma. At field inspection of
humprey, there is a field of view on the right and left eye that shows the image
depressiondepression.
Conclusion: Corticosteroid-induced glaucoma can develop within weeks, months, or years of
drug use; thus, IOP should be monitored regularly in patients receiving this drug. About one-
third of the population without glaucoma shows an IOP increase of between 6 and 15 mm Hg
in response to corticosteroids, and only a small proportion (4% -6%) have a significant IOP
increase of more than 15 mm Hg. A high percentage (up to 95%) of patients with POAG
respond to topical corticosteroids. Risk factors for corticosteroid-induced glaucoma include a
history of POAG, very young age (<6 years) or older age, connective tissue disease, type 1
diabetes mellitus, and myopia. The increase in IOP is the result of increased resistance to
aquos flow in the trabecular meshwork. The prognosis of this patient was quo ad vitam
bonam and the prognosis quo ad functionam of this patient was dubia ad malam in the right
eye. The best management is trabeculectomy, but the patient is not required and is currently
using 3 types of eye pressure reducing drugs.
Keywords: Corticosteroid-induced glaucoma, Corticosteroids, Secondary Open Glaucoma.