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SYSTEMIC STEROIDS AND OCULAR FLUID DYNAMICS. II
Author(s) -
GODEL V.,
FEILEROFRY V.,
STEIN R.
Publication year - 1972
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.1972.tb06607.x
Subject(s) - steroid , dexamethasone , medicine , intraocular pressure , population , anesthesia , surgery , hormone , environmental health
In 59 patients treated with long‐term systemic steroids, 3 distinct groups with different levels of sensitivity to the steroid effect on intraocular pressure and fluid dynamics could be distinguished by a topical dexame‐thasone test. The percental distribution of the 3 pressure‐rise‐level groups and the mean pressure change within each group were equal to those found in a normal population not pre‐treated with systemic steroids. Whereas only 16% of the patients with steroid pressures lower than 18 mmHg were sensitive to topically applied dexamethasone, 70% of the patients responding with intermediate and high pressure rise to topical dexamethasone had systemic steroid pressures in the range of 18 mmHg or more. The effect of systemic steroids on ocular pressure apparently does not affect the magnitude of pressure elevation induced in the positive responders by topical dexamethasone. Intergroup analysis of the steroid group classified according to dosage and duration of treatment proved that differences in mean values of applanation pressure between the subgroups depend solely on the proportion of positive and negative steroid responders within the subgroups. The mean systemic steroid C value in the group of patients responding to topical steroid with pressure elevation of 6 mmHg or more was only 10% lower than the same value in patients regarded as non‐responders by the topical dexamethasone test. While pressures of 20 mmHg or more in systemic steroid patients are strongly suspected to be due to the steroid effect, systemic steroid C values lack such predictive value. In accordance with Armaly it was found that the magnitude of the reduction in outflow facility after topically applied dexamethasone was directly related to the initial C and irrespective of this value was greater by a constant and equal amount in steroid responders than in non‐responders. It was similarly found that while in non‐responders the per cent reduction in C values after topical dexamethasone increased with the initial C value, in responders the reduction remained fairly constant and independent of the original C value. It amounted in our steroid patients to almost the same value (50%) as in Armaly's group of normal volunteers. The rate of formation of aqueous humor effected by systemic steroids was higher in patients classified as responders according to the effect of topical steroids on the pressure or the outflow facility. This fact is evidence that systemic steroids exert their influence on ocular pressure in sensitive individuals mainly by an increased inflow.