Ocular complications in children with nephrotic syndrome on long term oral steroids.

OBJECTIVES

To estimate the burden of ocular complications like posterior subcapsular cataract (PSCC) and raised intra ocular pressure (IOP) in children with nephrotic syndrome on long term steroid therapy and to assess the correlation of cumulative dosage and duration of consumption of steroids with these ocular complications.

METHODS

Children between 4-18 y with nephrotic syndrome, who received steroids for at least six months, were included in this cross sectional study. Demographic, clinical and treatment details were obtained from case records. Detailed ocular evaluation was performed to detect PSCC and to measure IOP.

RESULTS

One hundred and eighteen children were screened and 82 with a median (IQR=Interquartile range) follow up of 4.2 y (2.4, 6.3 y) were included in the final analysis. The median (IQR) age of children was 9.3 y (6, 12.5 y) at recruitment. The proportion of children with PSCC and raised IOP were 22/82 (26.8 %) and 9/82 (10.97 %) respectively. PSCC was associated with older age (p = 0.009). The median cumulative dose of steroids in those with and without cataract was 338.4 mg/kg and 343.2 mg/kg respectively (p = 0.58). The median duration of steroid theraphy was 58 wk and 59 wk in the two groups respectively (p = 0.73). Of children with PSCC, 9 (42.8 %) had mild diminution of vision.

CONCLUSIONS

One in 4 and 1 in 9 children with nephrotic syndrome in the present study had PSCC and raised IOP respectively. Cumulative dose and duration of steroid therapy were not significantly associated with PSCC or raised IOP. The present study emphasizes the need for regular ocular evaluation and also to explore additional factors in causation of steroid induced ocular complications.