Too many steroids?

[John Smith]

Some of you will remember the problems that I was suffering earlier in the year regarding my graft being cloudy at various times of the day.

Well, after a period of almost no cloudyness apart from a little while on waking, it's back.

Now I'm wondering whether this has anything to do with the steriods I'm on. I'm on FML drops twice per day - and have been for about 4 years now (also on one drop of Xalatan a day). But as-of last Saturday, I'm also on 40mg (8 tablets) of Prednisolone for a chest complaint.

I first noticed the cloudyness on Sunday afternoon (admittedly whilst under the benefit of beer at the KC social), but it's still ongoing from time to time, and my best corrected vision with specs is now faltering around the 6/24 line rather than 6/12 I got before.

Does anyone think that this is because of the steriod tablets, or could this be an unrelated problem?

[jayuk]

John

Sorry to hear this!

There could be a number of reasons for this to be honest

a) longer term tissue reaction due to excessive steroid use

b) cell change within the Corneal Layers

c) Change in something in your body

d) excessive steroid retention within the tissue thsu causing a reaction

It could be any of the above......what does your consultant say?.....Sadly it could also be that the tissue is simply rejecting and is getting to the end of its "supportable" cell count...what I mean by this is that the regeneration rate of the tissue is slower than the rejection of the tissue.......(very rare....but can happen)

HTH

Jay

[John Smith]

Hmmm... well last time I saw my eye consultant she was at a total loss as to why I wasn't like that all the time, as she had previously suggested that the graft was failing.

Apparently, after 8 rejection episodes, my surviving endothelial cell count is rather low, and when they're not on fine form, they can't pump water out of my cornea as fast as it arrives naturally. It's the water which is making the cornea odematous, and hence cloudy.

When they are on fine form, everything's ok.

I was wondering if anyone knew whether the steroid tablets on top of the steroid drops could cause any damage to the endothelial cells.

[Prue B]

On of the side effects of cortisone is fluid retention, theoretically if you are retaining fluid you many have more in your cornea than at other times, because you have more fluid in your body.
How long are you on the cortisone for, I know it is prescribed here for asthma and sometimes is the only thing stopping a potentially fatal attack so I definitley would not suggest stopping the cortisone. However now you have realised there is a link between cotisone intact and an affect on another condition I think you should see whoever is looking after your chest complaint and see if there is another drug preferably non steroidal that will do the same job.

[John Smith]

That's an interesting theory, Prue; thanks.

I don't know if prednisolone has the same effects as cortisone, but it sounds plausible. I know that steroids can cause fluid retention... and why not in the eye?

I'm seeing my chest consultant tomorrow, and will be sure to talk to him about the problem. He's already hinted that he may be reducing the pred. anyway, but that it will take at least a week to wean me off them!

[Andrew MacLean]

John

I was having a little bit of trouble with my steroids, so they changed me to Prednisolone once a day (now once every other day).

I had been hoping that they would discontinue them altogether but not yet. I have had no full flown rejection episodes but occasional 'threatened\ rejections and my ophthalmologist thinks it better to continue steroids to ward off danger than to try to retrieve a situation that had already begun to deteriorate.

Andrew

[GarethB]

John,

It is interesting that it coincided with beer consumption at the social and periodically since then.

Alcohol is a diaretic which as you know causes dehydration, that combined with the aldehydes and ketones the body makes as it breaks down alcohol is what causes a hangover as these are toxic to the body!

The weather has also been a lot warmer and do not know where you work, but where I am the aircon has gone into overdrive. I have found I am drinking more and I am deliberatly drinking more than normal and that has helped lens tolerance and prevented eye drying.

This with the complication of fluid retention as Pru mentions may mean that the steroids are fighting each other and your body is confused with the alcohol mildy induced dehration and the warmer weather.

Steroid interaction on the body can appear simple, but when you add others, the intereactions are far less well understood.

Drugs are always tested in isolation and never in conjunction with another.

[Sweet]

I know that we have talked about this online so you know that i agree that this could be too many steroids all at once. Hopefully though you will be seen today and your consultant can help you out!

Do KEEP on drinking loads though, but i'm talking water NOT alcohol!! LOL!! And let us know how you get on, take care Sweet X x X

[John Smith]

Well, thanks for all the advice. I saw my chest consultant today, and he's well pleased with the improvement. He is also concerned about the vision changes, and has asked me to stop the oral steroids immediately.

I'm to get a peak flow meter and graph my results twice a day for the next fortnight. Let's hope that the vision stabilises too!

[Sweet]

And of course i DIDN'T tell you about peak flows? Gee patients need advice on asthma as well!

Sweet X x X