Cortisone Cataract

PATHOLOGY

The Cataract is an ocular pathology characterized by the clouding of the eye’s natural lens; it is usually a condition linked to aging, however, it can occur at any age following an extended use of corticosteroids and, should this be the case, the pathology is referred to as cortisone cataract.

Corticosteroids belong to the large group of chemical compounds referred to as steroid compounds, or simply steroids, present both in animals and plants, where they are vested with biological functions of paramount importance. The most common corticosteroid in nature is the cortisol (or hydrocortisone) from which cortisone and corticosteroid derive. Corticosteroids are powerful anti-inflammatory and immunosuppressive agents; they are the choice drugs for fighting serious inflammations (e.g. in the case of rheumatoid arthritis) and for preventing the repeal reactions in patients who underwent an organ transplant.

Moreover, they represent true real lifesavers in several situations, such as in the case of anaphylactic shock or bronchial asthma.

With regard to the eyes, the most common known side effect given by the use of corticosteroids – in particular cortisone, desametasone and prednisone – is the development of the posterior subcapsular cataract (PSC). The relation between the extended use of corticosteroids and the PSC formation is already known since the ’60s and is valid not only for the steroids administered by systemic way, but also for those taken topically (eye drops and creams) and inhaled (nose sprays, aerosols).

A “dose-time effect” exists between the use of corticosteroids and the onset of the cataract: the higher the dosage and longer the treatment, the more the probability increases of developing the cataract. The induction effect of PSC in children is faster, also with smaller dosages. According to many researchers, in addition to the dose effect, also individual predisposition, probably due to genetic factors must be considered. In any event, the dose effect of corticosteroids gives rise to a problem to which the physicians must pay great attention when they prescribe corticosteroid based therapies to their patients, above all if a long time of treatment is envisaged. Given the existence of individual susceptibility to the same drug and a different susceptibility of the same individual to different drugs, it is not possible to predict whether and when the administration of corticosteroids gives origin to a cataract, therefore, it is always appropriate that a patient being treated with steroids be submitted to regular eye examinations in order to monitor the health condition of the lens.

TREATMENT

Thanks to the continuous advancement of technologies, the loss of vision caused by the cataract is easily reversible today thanks to a surgery executed with laser (femtolaser) or the ultrasound scanners (phacoemulsification), which provides for the removal of the clouded lens and its replacement with a perfectly transparent artificial lens (IOL). It is appropriate to avoid that the cataract evolves to such a point as to determine blindness; it must be removed as soon as it starts interfering with the normal performance of the daily and work activities. It is always advisable not to wait that the cataract reaches the more evolved stage also because, as the clouding increases, the lens becomes harder and this can prevent the use of last generation techniques and favour the arising of complications during the surgery.

The cataract surgery can take place in a day hospital facility, lasts a few minutes (usually 10-15 minutes) and its execution is minimally invasive and absolutely painless. Various types of anesthesia exist: we suggest a “blended anesthesia”, which consists in the administration of local anesthetic eye drops and a mild intravenous sedation that is regulated from time to time in function of the status of anxiety of the patient. The after surgery time is without particular inconveniences and is rather short (few days). The cataract surgery gives excellent results, restoring in the vast majority of cases a perfectly clear vision. Moreover, there is the possibility during the check up before surgery, after performing all the necessary instrumental tests before the cataract surgery, to correct also great refractive defects (such as shortsightedness, hypemethropy, astigmatism or  presbyopia), implanting different  types of artificial lenses  (IOL) depending on the needs pointed out by the patient (yellow, toric or multifocal lenses).

The contraindications are really very rare, but it is appropriate to keep in mind that the risk of complications or less satisfactory results is possible, in particular in patients suffering from severe corneal, retina or optic nerve pathologies.  For this reason, before submitting to a cataract surgery, it is very important to ask for an in-depth eye examination and evaluate together with one’s own ophthalmologist how to obtain the maximum benefit and minimize the risks of side effects.

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