|Year : 1969 | Volume
| Issue : 3 | Page : 95-98
Effect of topical steroids on Intraocular pressure in young diabetics
IS Jain, M.M.S Gill
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
|Date of Web Publication||10-Jan-2008|
I S Jain
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jain I S, Gill M. Effect of topical steroids on Intraocular pressure in young diabetics. Indian J Ophthalmol 1969;17:95-8
Diabetics both in adult and juvenile age groups have been found to have a rather high mean intraocular pressure Christiansson  , Jain and Luthra  and Safir, Paulson, Klayman and Crestenfeld. 
Furthermore some authors, Mooney  Jain and Luthra  , have reported higher intraocular pressures in diabetics without retinopathy than in those with retinopathy i.e. low intraocular pressure rather facilitates the development of diabetic retinopathy. Still other authors, Christiansson  have been able to demonstrate lower intraocular pressure in diabetics having proliferative retinopathy than in those having non-proliferative retinopathy.
The topical use of steroids in the eye, is now known to cause ocular hypertension. This observation has been found to have hereditary implication and appears to be genetically determined. Becker and Hahn  suggested a recessive mode of inheritance of primary open-angle glaucoma and a close correlation between glaucoma and steroid response. He has also shown that the response in patients with diabetes mellitus, another genetically determined entity, differs from the non-diabetic population, Becker. 
Since no such study has been reported from India, the authors undertook the present study to explore possible relationship between young diabetics with and without retinopathy, and intraocular pressure before and after topical corticosteroids.
| Material and Methods|| |
Fifty selected young diabetics were studied which included juvenile diabetics and patients developing diabetes before the age of 35 years, and those who required insulin for their control.
The intraocular pressure was recorded with a Schiotz tonometer using 5.5 and 10 gin weights and the corrected P0 value was noted from the tables based on Friedenwald's nomogram of 1955. A repeat check up of intraocular pressure was done on . the following day and the mean of the two recordings were taken. Pupils were then dilated and refraction was done in each case, followed by fundus examination.
Subsequently, every patient was given Betamethasone 0.1% (Betnesol), eye drops to be put in both the eyes, three times a day for four weeks. Intraocular pressure was recorded again after 2 and 4 weeks. Intraocular pressure in 60 eyes of non-diabetics of comparable ages were recorded before and after steroids, and served as controls.
| Observations and Comments|| |
In the present study of 60 eyes (normal) the mean intraocular pressure before steroids and after steroids is as follows:
Before steroids 14.93 S.D. 2.23
After steroids 16.47 S.D. 3.2
This shows an average increase of 1.54 mm of Hg after topical steroids, which is statistically significant (p < 0.05).
The mechanism of this rise of pressure after topical steroids is still obscure and a matter of speculation. But Goldman,  Becker,  Armaly  suggested that there was some mechanical obstruction in the trabecular mesh-work to the outflow of aqueous, the nature of which was not clear. Armaly  proposed that increased mechanical resistance after topical steroids was due to increased thickness of the layer lining the intra-trabecular spaces, of the mesh-work in the eye by the deposition of mucopolysaccharides, the source of which is the mast cells.
Recently, Becker  considered open-angle glaucoma as a heritable trait representing the homozygous recessive state (gg) and non-glaucomatous eyes represent the heterozygous (ng) and (nn) the normal dominant state. The genetic postulation was tied to the steroid therapy in the following manner. The presence of recessive gene as in (ng) or (gg) produce a greater magnitude of hypertension. So normal eyes can be separable into two groups (ng) and (nn), the former cannot be distinguished from glaucoma (gg). The author further speculated the prevalence of the presumed responsive gene in the population.
The response of intraocular pressure in diabetics [Table - 2] also showed quite comparable results to those of Levieffs  , Becker  and Becker et al  The rise in. pressure in our series of patients is highly significant (p < 0.01).
Levieff  studied 34 patients before and after steriods and found pressure of over 20 mm of Hg in 21 per cent and 65 per cent respectively, while Becker et. al.  reported 21 per cent and 60 per cent respectively from his study of 52 juvenile diabetics. Our figures are 15.55 per cent and 37.78 per cent respectively.
| Relationship of Corticosteroids Response to Retinopathy|| |
28.57 per cent of the eyes having retinopathy developed intraocular pressure more than 21 mm of Hg after the use of topical steroids, while 40.58 per cent of the eyes having no retinopathy developed intraocular pressure more than 21 mm of Hg after steroids. This observation further strengthens the view that there is greater prevalence of retinopathy in eyes having lower intraocular pressure and vice versa.
None of the three eyes having proliferative retinopathy showed rise of intraocular pressure greater than 21 mm of Hg. Becker Bresnick, Cheorette, Kolker, Oaks and Andrea  noted that the presence of proliferative retinopathy was clearly associated with lower degree of response to topical steroids as compared to non-proliferative retinopathy cases and then the response resembled more closely the non-diabetic population.
In the present study, since the number of eyes having proliferative retinopathy were very small, it is difficult to draw any firm conclusion, but certainly is suggestive.
The above observations of Becker  and the results of the present study indicate that the gene for glaucoma and steroid responsiveness: protect the diabetic from proliferative retinopathy.
| Summary|| |
Diabetic eyes have been found to have high mean intraocular pressure as compared to non-diabetic eyes.
The response of intraocular pressure in the diabetic eyes after the use of topical steroids is highly significant as compared to that observed in non-diabetic eyes. The response was found to be significant in eyes having no retinopathy than in eyes with retinopathy.
These observations in the present study tend to indicate that the steroid responsiveness may be a useful tool in predicting the development or progress of diabetic retinopathy.
| References|| |
Armaly, M. F.: Effect of corticosteroids on intraocular pressure and fluid dynamics: 1. The effect of Dexamethasone in the normal. Arch. Oph. (Chicago), 70, 782, 1963.
Armaly, AI. F.: Statistical attributes of the steroid Ii ypertensivc response in the clinically normal eve. Invest. Ophth., 4, 187, 1965.
Becker, B.: Intraocular pressure response to topical corticosteroids. Invest. Ophth., 4, 198, 1965.
Becker, B, and IIahn, K. A.: Topical corticosteroids and heredity in primary open angle glaucoma. Amcr. ,J. Ophth., 57, 543, 196-1.
Becker, B.; Bresniek, G.; Chevrette, L.; Kolker, A. E.; Oaks, A1. C.; Cibis Andea: Intraocular pressure and its response to topical corticosteroids in diabetes. A.M.A. Arch. Oph., 76, 479, 1966.
Christiansson. J.: Intraocular pressure in diabetes mellitus. Acta Ophtli., 39, 1.55, 1961.
Goldman, IL: Cortisone glaucoma. A. M.A. Arch. Ops. (Chicago), 68,
Jain, I. S. and Luthra, C. L. Diabetes Mellitus, its relationship with intraocular pressure. Arch. Oph. (Chicago), 97, 179, 1967.
Levieff et al.
Personal communications. Quoted by Becker, B, et al. in 5.
Mooney, A.: Diabetic retinopathy-A challenge. Brit. J. Oph. 47, 513, 1963.
Safir, A.; Paulson, E. P.; Klayman, J. and Cre.stenfeld, J.: Ocular abnormalities in juvenile diabetics. Arch. Oph., 76, 1966.
[Table - 1], [Table - 2]