Clinical Ophthalmology (May 2022)
Impact of Inhaled and Intranasal Corticosteroids Exposure on the Risk of Ocular Hypertension and Glaucoma: A Systematic Review and Meta-Analysis
Abstract
Anastasiya Vinokurtseva,1 Matthew Fung,1 Erica Ai Li,2 Richard Zhang,1 James J Armstrong,1,2 Cindy ML Hutnik1– 3 1Department of Ophthalmology, Schulich School of Medicine and Dentistry, London, Ontario, Canada; 2Department of Pathology, Schulich School of Medicine and Dentistry, London, Ontario, Canada; 3Ivey Eye Institute, St Joseph’s Healthcare, London, Ontario, CanadaCorrespondence: Anastasiya Vinokurtseva, Department of Ophthalmology, Schulich School of Medicine and Dentistry, 268 Grosvenor St., London, ON, N6A 4V2, Canada, Tel +1 519.646.6100 x.66272, Fax +1 519.646.6410, Email [email protected]: Starting in 2019, the Global Initiative for Asthma recommended the use of inhaled corticosteroids (ICS) as part of reliever combination therapy in patients 12 years of age and older, thus dramatically increasing the population exposure to ICS. ICS and intranasal corticosteroids (INS) are commonly used for a variety of respiratory diseases. Chronic steroid use is a well-known risk factor for elevated intraocular pressure (IOP) and glaucoma regardless of route of administration. This study aimed to determine the reported risk of glaucoma, ocular hypertension (OHT) and IOP elevation associated with ICS and INS use.Materials and Methods: Systematic literature search in MEDLINE, EMBASE, Cochrane, CINAHL, BIOSIS, and Web of Science databases from the date of inception identified studies that assess ocular outcomes related to glaucoma in ICS and INS users. Study selection, risk of bias assessment and data extraction were done independently in duplicate. Meta-analysis assessed glaucoma incidence, OHT incidence and IOP changes in patients using ICS and INS. Study adhered to PRISMA guidelines. Study protocol was registered with PROSPERO: CRD42020190241.Results: Qualitative and quantitative analyses included 65 and 41 studies, respectively. Incidence of glaucoma was not significantly different in either ICS or INS users compared to control over 45,457 person-years of follow-up. Similarly, no significant difference in OHT incidence over 4431 person-years was detected. In studies reporting IOP, a significantly higher IOP was observed (0.69 mmHg) in 857 ICS or INS users compared to 615 controls. However, no significant increase in IOP was observed within ICS or INS users when compared to pre-treatment baseline.Conclusion: Overall, use of ICS or INS does not significantly increase the incidence of glaucoma or OHT. However, ICS and INS patients had significantly higher IOPs compared to untreated patients. Awareness of these findings is significant in care of patients with additional risk factors for glaucoma.Keywords: corticosteroids, asthma, glaucoma, intranasal, inhalation
