Risk of Cataract and Ocular Hypertension in Chronic Anterior Uveitis Patients on Stable-Dosing of Topical Corticosteroids

Abstract

PURPOSE: To assess the association of cataract progression and intraocular pressure (IOP) elevation with stable-dosing of topical corticosteroid for chronic anterior uveitis (CAU). METHODS: All patients with CAU from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort treated with topical prednisolone 1% or equipotent equivalent for at least six months were analyzed. Main outcomes were incident cataract formation and IOP elevation above predefined thresholds (≥21 mmHg and ≥30 mmHg). Additional variables with potential to influence the frequency of the main outcomes were also collected. RESULTS: = 260 and 282 for ≥21 and ≥30 mmHg, respectively). In general, the incidence of cataract formation increased with increasing daily drops of stable-dosing of topical corticosteroid; however, there was no excess risk (relative to zero drops) for eyes exposed to ≤1 drop daily of prednisolone 1% or equivalent [aHR, 0.91 (95% CI, 0.29, 2.84)]. Similarly, higher daily topical corticosteroid exposure conferred greater risk of both IOP outcomes, though plateau effects were observed. For eyes receiving ≤1 drop daily of prednisolone 1% or equivalent, there was no excess risk of either IOP outcome [aHR for ≥21 mmHg, 0.77 (95% CI, 0.19, 3.05) and aHR for ≥30 mmHg, 0.92 (95% CI, 0.11, 7.76)]. CONCLUSIONS: Stable-dosing of topical prednisolone 1% or equivalent more than once daily was associated with increased cataract formation and IOP elevation over medium-term follow-up, whereas ≤1 drop/day was not.