-
-
prednisolone acetate conc
1% and 0.12% phenylephrine
-
prednisolone minim conc
0.5%
-
fluorometholone acetate conc
0.1%
-
fluorometholone conc
0.1%
-
hydrocortisone conc
1% - ointment
-
corticosteroid contraindication
- active ocular infection
- especially HSK or fungal keratitis
-
corticosteroid precautions
- h/p HSK
- glaucoma, OHTN, narrow angles, h/o steroid response
-
corticosteroids and children
increased susceptibility to raised IOP + cataract
-
corticosteroids and pregnancy/breastfeeding
safe
-
Types of corticosteroid base
- acetate: lipid soluble, enhanced corneal penetration
- salts: e.g. sodium phosphate. hydrophilic, limited penetration
-
corticosteroid common >1% adverse effects
- OHTN
- retarded corneal healing
- rebound inflammation
- PSC
-
OHTN as a side effect of corticosteroids is dependent on:
- dosage
- potency
- penetration
- treatment
-
PSC as a side effect of corticosteroid occurs with
- long-term use >1yr
- high dose
-
mechanism underlying PSC as a side effect of corticosteroids
- not fully understood
- glucocorticoids enter lens fibre cells --> reacts with lens crystallins --> alters protein conformations and bonds
-
corticosteroid MOA
upregulates lipocortins --> inhibits lipophosphase A2 --> inhibits inflammatory cascade, fibrocyte + keratocyte activity in stroma
-
Prostaglandins are associated with what signs of inflammation
-
Leukotrienes are associated with what signs of inflammation
- increased vascular permeability
- chemotaxis
- WBC recruitment
-
corticosteroid adverse effect infrequent 0.1-1%
opportunistic infection
-
Why do some steroids cause more IOP rise?
- not fully understood
- possible factors:
- penetration
- shorter half life
- susceptibility to metabolism (fluorometholone + hydrocrtisone metaolised > prednisolone + dexamethasone)
- site of administration
-
MOA for IOP rise with corticosteroids
- steroid inhibits beta receptor --> alpha overactivitiy --> ECM overproduction
- inhibits ECM degradation mechanism
- accumulation of ECM + debrisÂ
- actin cross-linking --> stronger blockage
- inhibits TM cell phagocytosis
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