|Year : 1987 | Volume
| Issue : 3 | Page : 141-145
Study of topical corticosteroid response in glaucoma suspects and family members of established glaucoma patients
FA Jilani, AM Khan, RK Kesharwani
AMU Institute of Ophthalmology, Aligarh, India
F A Jilani
AMU Institute of Ophthalmology, Aligarh
Source of Support: None, Conflict of Interest: None
The present study was conducted to study the topical steroid response in glaucoma suspects and family members of established glaucoma patients and its hereditary pattern The cases understudy were divided into three groups, namely normal (25 cases), suspected open angle glaucoma cases (20) and family members of established open angle glaucoma cases (33). After preliminary examination each patient was advised to put dexamethasone drop 1 % in one eye and a placebo in other eye. The IOP was noted after three weeks It was found that 80% of all eyes under study showed a rise in IOP after use of topical dexamethasone. The highest mean IOP was found in primary open angle glaucoma suspects, and the highest mean post-corticosteroid rise in IOP of 8.91 mm Hg was found among family members of established open angle glaucoma patients.
The lOP response to topical corticosteroids was found to be of three phenotypical types viz., poor responders (nn), moderate responders (ng) and high responders (gg). Normal subjects were generally poor responders. Suspected open angle glaucoma cases were generally high responders. However, family members of established open angle glaucoma cases showed the highest percentage of presence of responder gene.
Keywords: I.O.P. Intra Ocular Pressure
|How to cite this article:|
Jilani F A, Khan A M, Kesharwani R K. Study of topical corticosteroid response in glaucoma suspects and family members of established glaucoma patients. Indian J Ophthalmol 1987;35:141-5
|How to cite this URL:|
Jilani F A, Khan A M, Kesharwani R K. Study of topical corticosteroid response in glaucoma suspects and family members of established glaucoma patients. Indian J Ophthalmol [serial online] 1987 [cited 2015 Apr 19];35:141-5. Available from: http://www.ijo.in/text.asp?1987/35/3/141/26195
| Introduction|| |
These days topical corticosteroids have got unmatched popularity and prestige as anti-allergic and anti-inflammatory agents, but their disadvantage is that they may cause symptomless ocular hypertension and subsequent glaucoma in susceptible cases As the pressure response of the eye to topical steroids is genetically determined, it can be of great help in discovering cases having high probability of developing glaucoma in future. Moreover, steroid responsiveness can act as a provocative test and can help in determining hereditary patterns among families of known glaucoma subjects Keeping these facts in view, a study was conducted to find topical steroid response in glaucoma suspects and family members of patients with open angle glaucoma.
| Materials and Methods|| |
Group I : For the present study 25 normal volunteers with no family history of glaucoma were selected as control group.
Group 11:20 suspected open angle glaucoma cases were selected from the glaucoma clinic, in whom angle grade was from wide open to grade II according to Scheie's classification and in whom any of the following findings were present:
a) LO. P. > 21 mmHg by applanation tonometry.
b) Positive water drinking test (LO.P. rise 8 mm of Hg)
c) Suspicious cupping, cup/disc ratio more than 0.3
d) Field defects : enlargement of blind spot or baring of blind spot
Group 111: 33 cases were selected from the family members of patients with established open angle glaucoma This group included parents, siblings and offspring of those cases in whom any two of the following findings were present
a) LO.P. > 24 mmHg with applanation tonometer
b) Pathologically cupped disc
c) Typical glaucomatous field defects
d) Positive water drinking test
In all cases, a general ocular examination and slit lamp examination was done Refraction under mydriasis followed by post .mydriatic test was carried out in all patients Direct Ophthalmoscopic examination was done in each case particularly to establish cup/disc ratio. Applanation and Schiotz tonometry was done in each case The angle of the anterior chamber was assessed on slit lamp using a Goldman gonioscope. Central fields were chartered on Bjerrum's screen and peripheral fields on Lister's perimeter.
After all the preliminary investigations, each patient was instructed to instill 1% dexamethasone drops three times a day in the eye having relatively higher I.C.P. Non-steroid drops (Placebo) were instilled in the other eye. Each patient was called for a weekly checkup of LO. P. After 3 weeks the difference in I.C.P. was noted.
| Observations|| |
The mean LO.P before and after the local use of corticosteroids in experimental eyes, and before and after the use of a placebo in the control eyes in the three groups is shown in [Table - 1] The mean differences in LO.P. within each group are also shown in this table. The highest mean initial LO. P. was seen in group It i e. primary open angle glaucoma suspects The highest mean post corticosteroid rise in I.O.P. of 8.91 mm Hg was found among family members of established glaucoma cases
However, a high difference was seen in suspected open angle glaucoma cases as well The above data from [Table - 1] was further subjected to statistical analysis in order to estimate the statistical significance of the observed differences in the mean values of IOP in each group.
Thus the range, mean standard deviation, difference of mean values of IOP and Z values of each group above are shown in [Table - 3][Table - 4]. For this series it was found that the tabulated value of Z at 5% level of significance was 1.96. Therefore, any value of Z higher than 1.96 is statistically significant at the 5% level [Table - 2] (Group I) shows that the initial and post corticosteroid values were highly significant in control eyes The same pattern of significance was noted in the other two groups [Table - 2][Table - 4]. In each group the initial and post-corticosteroid values were significant in experimental eyes and, either insignificant or slightly significant in control eyes
| Intraocular pressure response to topical corticosteroids|| |
[Table - 5] shows the intraocular pressure response to topical corticosteroids according to phenotypical groups, namely:
1) nn - with rise in IOP upto 5 mm Hg.
2) ng - from 6 to 15 mm Hg rise
3) gg - above 16.0 mm Hg. rise
As shown in [Table - 5] group I (normals) had 48% poor responders, 48% moderate and 4% high responders In group II (primary open angle glaucoma suspects) 40% were poor responders, 55% moderate and 5% high responders However, in group III (family members of established open angle glaucoma), there was a very high percentage (21.21 %) of strong responders (gg). It was therefore, found that among the family members of patients with open angle glaucoma, there was a greater tendency towards a positive corticosteroid response.
| Rise in I OP in control (non tested) eyes|| |
Few cases (15.9%) showed some rise in IOP in control eyes The range of rise was from 3 to 5 mm Hg. This rise in IOP in control eyes was always associated with a rise in lOP in experimental eyes Thus in cases where no rise in lOP occurred following use of topical steroids in experimental eyes, there was never a rise in 1OP in the contralateral (non tested) eyes.
| Discussion|| |
In the present study of the 78 cases comprising all the three groups 80% cases showed a rise in IOP (more than 2 mm Hg) in steroid tested (experimental) eyes This positive response of the topical steroids in raising the UP had been observed by Franηois  (1966); Becker and Shaffer  (1965) and Amba et a1  (1973).
The average post corticosteroid rise in intra ocular pressure was most significantly high among family members of established open angle glaucoma patients However, suspicious cases of primary open angle glaucoma also showed a highly significant post corticosteroid rise in IOP.
| Intraocular pressure response in contralateral eyes|| |
It has been reported by certain workers (Das and Hitchings , 1971 and Kitazawa et aL 1972) that there is a positive IOP response to topical corticosteroids in contralateral (non steroid tested) eyes, although Palmberg ] (1975) did not observe any effect of dexamethasone in contralateral eyes
In the present study none of the 27 poor responders showed any rise in IOP in the contralateral (non steroid tested) eyes However, among moderate responders there was a comparable rise in the lOP in the contralateral eyes, (20%) whereas among the high responders there was a much greater tendency for this type of response in the contralateral eyes (47%). This rise of IOP in contralateral eyes ranged from 3-;7 mm Hg and was always associated with a rise in IOP in the steroid tested eyes The exact mechanism for this response has not been established, but it is supposed to be mediated by an adrenal suppressive mechanism or by neurogenic factors.
| Inheritance of open angle glaucoma normal subjects|| |
In this group there was a high incidence of poor responders (nn) of 48%. In the remaining cases 48% were moderate responders (ng) and 4% high responders (gg). This shows that the responder gene (g) was present in 52% of all the normal cases
| Open angle glaucoma suspects|| |
In this group 40% of the cases showed poor corticosteroid response (nn) whereas 60% of the cases carved the responder gene and gave either an intermediate (ng) or a high response (gg).
| Family members of established cases of open angle glaucoma|| |
Among these patients it was found that there was a high percentage of high responders (gg) Le. 21.2% as compared to other groups under study. Similarly the combined responder gene (ng + gg) was found to be present in 72.7% in this group. This was in accordance with the observations of Becker and Hahn  (1964), Becker and Shaffer  (1965), and Becker and Chevrette (1966) and confirmed the presence of a definite responder gene among the family members of established cases of open angle glaucoma. From the observations in the present series of cases, this hereditary trend among family members of open angle glaucoma appears to be similar in Indian subjects to the patterns observed by European and other authors.
| References|| |
Francois, J and Bree, CH. (1966). Amer, J. Ophthal, 62,844
Becker, B and Shaffer, RH. (1965). Diagnosis and therapy of Glaucomas CV. Mosby Co. St Louis, 1965, P 210, 212, 243
Amba, SK, Jain, LA and Gupta, S.D. (1973). Ind. 3, Ophthal, 21, 102
Das, S.N. and Hitchings, RA (1971). Trans OphthaL Soc. U. K 91, 749-756
Kitazawa, Y. Nose, H., and Saitoh, S. (1972). Actor Soc. OphthaL Jap. 76, 1277
Palmerg, P. F. Mandell, A Wilensky, J.T., Podos, S. M. and Becker, B (1975). Arch OphthaL 70 p 15, 482,500
Becker, B and Hahn, KA (1964). Amer. J. Ophthal, 57,543.
Becker, B and Chavrette, L (1966). AMA Arch. Ophth 76, 484.
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]