Risk factors and critical thresholds for glucocorticoid-induced ocular adverse reactions in children: implications for muscle and neuromuscular disease management

Systemic Glucocorticoid (GC) therapy is integral to managing various paediatric conditions, including inflammatory muscle and neuromuscular diseases. However, prolonged GC use in children poses a significant risk for severe ocular Adverse Drug Reactions (ADRs), notably Posterior Subcapsular Cataract (PSCC) and Steroid-Induced Ocular Hypertension (SIOH). These ADRs can lead to irreversible visual impairment, creating a substantial burden, particularly for paediatric patients already managing chronic conditions. Identifying specific risk factors and precise exposure thresholds is crucial for optimizing GC treatment and guiding timely ophthalmic monitoring. This retrospective case-control study analyzed data from 305 children with kidney disease, who received oral or intravenous GCs between December 2020 and December 2022. Participants were grouped into PSCC, SIOH, or control (no ocular ADRs). Logistic regression assessed risk factors, and Receiver Operating Characteristic (ROC) analysis determined critical thresholds for cumulative dose and duration. Results indicated seven significant risk factors for PSCC: younger age, longer GC duration, hypertension, growth retardation, vitamin D deficiency, immunosuppressant use, and oral methylprednisolone. Critical thresholds for cataract onset were identified as GC treatment duration >5.6 months or a cumulative dose >5,888 mg. For SIOH, higher daily GC dosage (>0.59 mg/kg/day), oral methylprednisolone, and growth retardation were significant risk factors. These findings elucidate key risk factors and establish quantitative GC exposure thresholds for ocular ADRs in children. They provide evidence-based guidance for ophthalmic screening and intervention timing, particularly relevant for paediatric patients with muscle and neuromuscular diseases requiring long-term GC therapy. Proactive monitoring and tailored GC management are essential to mitigate vision-threatening complications and improve long-term patient outcomes.