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Do topical ophthalmic corticosteroids suppress the hypothalmic-pituitary-adrenal axis in post-penetrating keratoplasty patients?

Lookup NU author(s): Professor Francisco FigueiredoORCiD


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Purpose To establish whether hypothalmic-pituitary-adrenal axis suppression is possible secondary to long-term topical ophthalmic corticosteroid use in patients who have undergone penetrating keratoplasty (PKP).Methods Patients who had undergone a PKP and had been using corticosteroid-based eye drops continuously for more than 6 months, with no history of concomitant steroid (oral, inhaled, or cutaneous) use, were included within the study. A low-dose short Synacthen (LDSST) test was performed in each patient followed later by a short Synacthen test (SST). The mean SST and LDSST after 30 min were calculated along with their corresponding 95% confidence intervals (CIs). Correlation between both baseline SST and baseline LDSST with duration of treatment was determined using Spearman's correlation.Results In all, 20 patients were included within the study. The mean duration treatment was 28.2 months (range 11-96 months). All patients had normal baseline cortisol levels in both SST and LDSST tests. The mean 30 min SST was 753.8 nmol/l (95% CI: 696.6 nmol/l, 811.0 nmol/l) and no patients displayed inadequate adrenal response. The mean 30 min LDSST was 709.8 nmol/l (95% CI: 665.1 nmol/l, 754.5 nmol/l) and only one patient had an inadequate adrenal response. There was no correlation between baseline SST or LDSST and duration of treatment.Conclusions This study found no evidence that patients using continuous long-term corticosteroid eye drops after PKP experienced inadequate adrenal response. We did not find any evidence of a negative correlation between length of treatment and SST or LDSST measurements at baseline. Eye (2012) 26, 699-702; doi: 10.1038/eye.2012.12; published online 17 February 2012

Publication metadata

Author(s): Sandhu SS, Smith JM, Doherty M, James A, Figueiredo FC

Publication type: Article

Publication status: Published

Journal: Eye

Year: 2012

Volume: 26

Issue: 5

Pages: 699-702

Print publication date: 17/02/2012

ISSN (print): 0950-222X

ISSN (electronic): 1476-5454

Publisher: Nature Publishing Group


DOI: 10.1038/eye.2012.12


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