Great Disappointment Today

[jayuk]

The thing that concenrs me regarding cataracts is the length of time graftees are on the steroid drops compared to 20 years ago.

Totally agree! Think weve had this conv before where you only had the drops for a small amount of time didnt you?...yet now they can do on for like 12 months.....what would have been interesting was to see the outcome\rejection rates during the period you had yours and now?.....but I doubt they can do that now..

[GarethB]

Jayuk,

You are correct, I think I had the drops for 3 months, certainly no more than six.

I know I had drops again when all the stiches were out, but those were anti biotic drops because your eye is sore afterwards.

As so many people 5 plus years post graft seem to drop out of the hospital system it would probably be hard, if not impossible to compare rejection rates. There is also the extra variable in that some of the medication used has changed, the techniques have improved and so on.

Medicine is like fashion and has a habit of going in phases and we might just be going through one where medication is prescribed for a year or so and ina couple more years they might decide less medication is the order of the day.

[Andrew MacLean]

There is strong scientific evidence linking prolonged steroid use, post graft, to cataract growth.

However, the prolonged use of steroids on a "maintainance dose" (one drop every other day) does have a theraputic value.

So there is a trade-off. Do they end steroid use early, and risk other consequences, or continue it and risk cataracts?

Actually cataracts (in my recent experience) are fairly easily sorted.

Andrew

[John Smith]

Hmmm...

I've been on steroids almost continually for my right PK eye since my graft in Jan 2002. This is because of the excessive number of rejection episodes I experienced.

I know that there is a higher risk of glaucoma, which is why I'm also on Xalatan drops to reduce the pressure, but have never been told about a cataract risk at all!

[GarethB]

John,

It is possible that the second medicaton to reduce eye pressure also counteratcts the risk of the steroids on the cataracts risk.

No disrespect to those who have undergone catarct or goung to have cataract operations but you are younger then them

I have been surprised how little many doctors know about the medication they are prescribing.

An exmple is the most commonly used asthema treatments, most contain Salbutamol Sulphate which is quite safe when used as a releiver periodically through the day. Use too much and you can get tremours and racing heart which can lead to sever heart problems and death! Yet doctors still tell patients to use the medication as and when necessary, unaware of the risks.

[Andrew MacLean]

John

I found this

Steroids
The association between steroid use and development of cataract is well established. There seems to be consensus that higher the dose of steroid and longer the duration of use, the higher will be the risk for PSC cataracts. However, despite all the published data, we still do not know what is a safe daily dose of corticosteroid, and how long can this dose be maintained? It is difficult to determine a safe steroid dose even by pooling all published data because of the differing cataract diagnosis criteria of the studies as well as the differing potency of steroids used.
Steroids differ in their potency as well as in the side effect potential. Pred Forte (prednisone acetate) eye drops are perhaps the most widely prescribed steroid eye drop for eye inflammation treatment. There are now several steroid eye drops that have less tendency to cause eye pressure rise or cataract than Pred Forte (FML, Vexol, Lotemax or Alrex, HMS), in part because they are metabolized in the cornea to some extent. Steroids like Inflamase (prednisone phosphate) penetrate the cornea less.
FML, Lotemax or Vexol are good alternatives to Pred-Forte if avoidance of steroid induced cataract or eye pressure rise is a consideration. Using Alrex, Inflamase or a much lesser steroid dose (0.12% prednisone instead of 1%) as is available in Pred Mild is a good idea if only ocular surface inflammation is being treated. (Lotemax & Alrex have the same steroid but in different concentrations, Alrex being milder)
We will present data from 3 widely quoted studies. These data are generally viewed as good guidelines for assessing the risk of cataract development with steroid treatment.

Oral Steroids
Patients treated with Prednisone in amounts less than 10 mg/day for one year stand a negligible chance of developing a PSC cataract. However 75% of patients receiving more than 15 mg/day Prednisone for more than one year were found to have cataracts (JAMA 1960;174:166-71). Other studies have shown that children develop cataracts much earlier than adults, often as early as within 6 months with similar steroid doses.

Topical Steroids
The total dose of steroids that produced a PSC cataract in half of the cataract patients was 765 drops of 0.1% dexamethasone over 10.5 months. 765 drops represent slightly less than 8 bottles of 5 ml each. By reducing the dose to 360 drops (less than 4 bottles of 5 ml each) the chances of developing a cataract are significantly reduced. Prednisone acetate 1% (Pred Forte) is expected to behave similar to 0.1% dexamethasone eye drops (Ann Ophthalmol 1981;13:29-32).

at http://www.agingeye.net/cataract/catara ... mation.php

Andrew