Methylprednisolone
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Elevated intraocular pressure: 2 case reports Two patients developed elevated intraocular pressure (IOP) immediately after receiving IV methylprednisolone for severe uveitis. Patient 1, a 53-year-old man with bilateral, intermediate and anterior uveitis, had refused systemic immunosuppressants and was treated primarily with topical prednisolone. He developed secondary glaucoma and an ischaemic optic neuropathy in the right eye. He subsequently received methotrexate, infliximab and mycophenolate mofetil. His IOPs were 29 and 20mm Hg in the left and right eye, respectively, at the time of a flare-up of his uveitis. He was receiving acetazolamide, dorzolamide/timolol and brimonidine. He decided to discontinue mycophenolate mofetil. He then received IV methylprednisolone 1 g/day for 3 days. The following day he experienced increased visual haziness. His IOPs were 54 and 56mm Hg in the left and right eyes, respectively, and his visual acuity was 20/400 bilaterally. Emergency surgery was required to reduce the IOP. Two months later, his vision in the left eye had improved to 20/25-1, but remained unchanged in the right eye. The IOP was 13mm Hg in both eyes. Patient 2, a 50-year-old woman, had a history of Beh¸cet disease as well as primary open-angle glaucoma and was receiving timolol. Preoperatively, her IOPs were 22 and 21mm Hg in the left and right eyes, respectively. During surgery for a cataract of the left eye, she received IV methylprednisolone 60mg and betamethasone. She presented the day after her operation with a florid hypopyon uveitis with fibrin affecting the left eye that was suggestive of a sterile inflammatory response to trauma. The IOP in the left eye was 17mm Hg. She received IV methylprednisolone 1 g/day for 3 days and topical prednisolone acetate. Her IOPs were 38 and 42mm Hg in the left and right eyes, respectively, a day after completion of the methylprednisolone infusions. She received brimonidine. Her vision was 20/20 and 20/25 in the left and right eyes, respectively, 3 months later. She was receiving timolol and her IOPs were normal and the inflammation was well controlled. Author comment: "We do not believe that the uveitis was a predisposing factor independently of the glaucoma because the second patient had a marked rise in pressure in an uninflammed eye." Gupta SR, et al. Intravenous methylprednisolone can cause an acute, visionthreatening rise in intraocular pressure. JCR: Journal of Clinical Rheumatology 16: 397-398, No. 8, Dec 2010. Available from: URL: http://dx.doi.org/10.1097/ 803048518 rhu.0b013e3181ffdd4f - USA
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Reactions 29 Jan 2011 No. 1336
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