Mehmet Tahir ESKİ, İlhan ÜNLÜ

The effect of nasal steroids on retinal nerve fiber layer in patients with a family history of glaucoma

Objectives: We aimed at analyzing the effect of nasal steroids on intraocular pressure (IOP) and retinal nerve fiber layer thickness (RNFL) in patients with a family history of glaucoma who also use fluticasone propionate (FP group) and mometasone furoate (MF group). Methods: Patients with a family history of glaucoma and suitable for using nasal steroids were included in the study population. IOP, anterior chamber depth (ACD), axial length (AL) and central corneal thickness (CCT) and RNFL thickness measurements of the patients were carried out. Measurements were done on 3 levels, namely, one before starting the medication, the other 1 month after starting the medication and the last one 3 months after the medication. 3 groups were established in our study: patients who are using MF group and FP group and also C group (control group; healthy individuals who have a family history of glaucoma but not using any medication). Results: The average age of patients in our study who were under medication was 33.2 ± 8.9 years. The study consisted of a total of 46 patients, 32 of whom were using nasal steroids and 14 belonging to the C group. It was found that global value in MF group decreased from 100.9 ± 7.7 to 99.6 ± 7.6 in the 3rd month and ACD in MF group decreased from 3.2 ± 0.4 mm to 2.9 ± 0.4 mm in the 1st month, both to be found statistically significant (p = 0.037 and p = 0.001 respectively). During the RNFL thickness measurements of patients, it was found that Temporal (T) segment in FP group decreased from 82.1 ± 13.8 to 81.7 ± 13.3 in the first month and T segment in MF group decreased from 72.8 ± 12.0 to 71.3 ± 10.2 in 3 months, both decreases to be found statistically significant (p = 0.047 and p=0.003 respectively). It was found that IOP in FP group increased from 15.3 ± 3.6 mm Hg to 17.7 ± 4.1 mm Hg in the 3rd month hence found to be statistically significant (p = 0.006). CCT in FP patients was found to be significantly higher in the 3rd month (p = 0.025). Conclusions: As a result of our study, it was found that nasal steroid usage in patients with a family history of glaucoma may cause an increase in IOP and thinning of the RNFL.

Keywords:

Mometasone furoate, fluticasone propionate intraocular pressure, retinal nerve fiber layer thickness,

PDF

___

1. Baroody FM. Allergic rhinitis: broader disease effects and implications for management. Otolaryngol Head Neck Surg 2003;128:616-31.
2. Naclerio RM, Baroody FM, Bidani N, De Tineo M, Penney BC. A comparison of nasal clearance after treatment of perennial allergic rhinitis with budesonide and mometasone. Otolaryngol Head Neck Surg 2003;128:220-7.
3. Salib RJ, Drake-Lee A, Howarth PH. Allergic rhinitis: past, present and the future. Clin Otolaryngol Allied Sci 2003;28:291-303.
4. Mygind N, Lund V. Intranasal corticosteroids for nasal polyposis : biological rationale, efficacy, and safety. Treat Respir Med 2006;5:93-102.
5. Man LX, Farhood Z, Luong A, Fakhri S, Feldman RM, Orlander PR, et al. The effect of intranasal fluticasone propionate irrigations on salivary cortisol, intraocular pressure, and posterior subcapsular cataracts in postsurgical chronic rhinosinusitis patients. Int Forum Allergy Rhinol 2013;3:953-7.
6. Bross Soriano D, Arrieta Gómez JR, Schimelmitz Idi J, Guzmán Urrutia R, Hanenberg Milver C. [Changes in intraocular pressure with the use of topical nasal mometasone furoate]. Rev Alerg Mex 2000;47:12-6. [Article in Spanish]
7. Alsaadi MM, Osuagwu UL, Almubrad TM. Effects of inhaled fluticasone on intraocular pressure and central corneal thickness in asthmatic children without a family history of glaucoma. Middle East Afr J Ophthalmol 2012;19:314-9.
8. Desnoeck M, Casteels I, Casteels K. Intraocular pressure elevation in a child due to the use of inhalation steroids--a case report. Bull Soc Belge Ophtalmol 2001;280:97-100.
9. Nuyen B, Weinreb RN, Robbins SL. Steroid-induced glaucoma in the pediatric population. J AAPOS 2017;21:1-6.
10. Kersey JP, Broadway DC. Corticosteroid-induced glaucoma: a review of the literature. Eye (Lond) 2006;20:407-416.
11. Halpern DL, Grosskreutz CL. Glaucomatous optic neuropathy: mechanisms of disease. Ophthalmol Clin North Am 2002;15:61-68.
12. Mitchell P, Cumming RG, Mackey DA. Inhaled corticosteroids, family history, and risk of glaucoma. Ophthalmology 1999;106:2301-6.
13. Rolle T, Dallorto L, Briamonte C, Penna RR. Retinal nerve fibre layer and macular thickness analysis with Fourier domain optical coherence tomography in subjects with a positive family history for primary open angle glaucoma. Br J Ophthalmol 2014;98:1240-4.
14. Zhang HG, Ying GS. Statistical approaches in published ophthalmic clinical science papers: a comparison to statistical practice two decades ago. Br J Ophthalmol 2018;102:1188-91.
15. Sullivan GM, Feinn R. Using effect size-or why the P value is not enough. J Grad Med Educ 2012;4:279-82.
16. Taner P, Bayar N, Akarsu C, Koç C. [Effect of topical nasal corticosteroids used for the treatment of allergic rhinitis to the intraocular pressure]. KBB ve BBC Dergisi 2001;9:21-4. [Article in Turkish]
17. Şimşek A, Bayraktar C, Doğan S, Karataş M, Sarıkaya Y. The effect of long-term use of intranasal steroids on intraocular pressure. Clin Ophthalmol 2016;10:1079-82.
18. Oztürk F, Yücetürk AV, Kurt E, Unlü HH, Ilker SS. Evaluation of intraocular pressure and cataract formation following the long-term use of nasal corticosteroids. Ear Nose Throat J 1998;77:846-848.
19. Martino BJ, Church CA, Seiberling KA. Effect of intranasal dexamethasone on endogenous cortisol level and intraocular pressure. Int Forum Allergy Rhinol 2015;5:605-9.
20. Yuen D, Buys YM, Jin YP, Alasbali T, Trope GE. Effect of beclomethasone nasal spray on intraocular pressure in ocular hypertension or controlled glaucoma. J Glaucoma 2013;22:84-7.
21. Opatowsky I, Feldman RM, Gross R, Feldman ST. Intraocular pressure elevation associated with inhalation and nasal corticosteroids. Ophthalmology 1995;102:177-9.
22. Seiberling KA, Chang DF, Nyirady J, Park F, Church CA. Effect of intranasal budesonide irrigations on intraocular pressure. Int Forum Allergy Rhinol 2013;3:704-7.
23. Mohd Zain A, Md Noh UK, Hussein S, Che Hamzah J, Mohd Khialdin S, Md Din N. The relationship between long-term use of intranasal corticosteroid and intraocular pressure. J Glaucoma 2019;28:321-4.
24. Bross-Soriano D, Hanenberg-Milver C, Schimelmitz-Idi J, Arrieta-Gomez JR, Astorga del Toro R, Bravo-Escobar G. Effects of three nasal topical steroids in the intraocular pressure compartment. Otolaryngol Head Neck Surg 2004;130:187-91.
25. Maeng MM, De Moraes CG, Winn BJ, Glass LRD. Effect of topical periocular steroid use on intraocular pressure: a retrospective analysis. Ophthalmic Plast Reconstr Surg 2019;35:465-468.
26. Marzouki HZ, AlThomali RK, Hefni L, Almarzouki N, Alhejailli F, Merdad M, et al. Effect of intranasal corticosteroids on intraocular pressure and nerve fiber layer thickness: a cross-sectional study at a tertiary care hospital in Western Saudi Arabia. Cureus 2021;13:e13146.
27. Ozkaya E, Mete F, Ozsutcü M, samanci N, Cekiç O. Evaluation impact of long-term usage of inhaled fluticasone propionate on ocular functions in children with asthma. Steroids 2011;76:548-52.