Jezeela K, Deleepkumar Kozhikkot Velayudhan, Rajini Chereyath, Janaki Menon, Rini Raveendran
BACKGROUND Nephrotic syndrome occurs when the filtering units of the kidneys- the glomeruli are damaged. The annual incidence of nephrotic syndrome ranges from 2-7 per 100,000 children. Oral corticosteroids form the cornerstone for management of most children with nephrotic syndrome. Long-term steroid therapy in childhood is associated with a number of significant adverse effects- major ophthalmic adverse effects include decreased vision, recurrent hordeolum, posterior subcapsular cataract, pseudotumour cerebri, visual hallucinations. This study aims to analyse the ocular findings in children with nephrotic syndrome, and their treatment related ocular abnormalities. MATERIALS AND METHODS This is a cross sectional study, conducted at The Department of Ophthalmology, Government Medical College Thrissur of 1-year duration. Study participants include patients who attended outpatient department of Paediatrics, Govt. Medical College, Thrissur, with clinical and objective investigational evidence of nephrotic syndrome. 70 children who were included in the study were interviewed with a questionnaire; Detailed history was taken from the patients and their parents, regarding the onset of the disease, treatment details, year of starting steroids, history of hypertension, additional drugs, history of defective vision, headache, allergic diseases of eye, eyelid swellings and use of spectacles. Visual acuity was assessed with Snellen s’ chart. Best corrected visual acuity was noted. Acuity was also measured with spectacles if the child was wearing them. Anterior segment was examined under torchlight and later in slit lamp and in all cases fundus examination and retinoscopy were done after dilating pupils with homatropine. Intraocular pressure was measured with Goldman Applanation Tonometer. RESULTS Since the sample size is small, the exact sex distribution cannot be ascertained. History of headache was present in 45 children (64.3%). Visual acuity was assessed in both eyes and were divided into 5 groups. Group 5 with vision 6/6 accounted for 50% in both eyes separately. Group 4 with vision in the range of 6/9-6/12 amounted to 42.9% in right eye and 44.3% in left eye. Examination of anterior segment of the eye was normal in 47 (67.1%) children. Hordeolum, which included both varieties hordeolum internum and externum were present in 15 (21.4%) children. 8 children (11.4%) had blepharitis. 11 children (15.7%) had posterior subcapsular cataract. All of them had cataracts in both eyes, but not to the same extent. Duration of steroid therapy was found to be associated with development of cataract. With a percentage of 6.2% at a duration of 1-3 years, it increased to 17.4% within 4-6 years duration. Among the 70 children, only one child had elevated intraocular pressure and none of the children with hypertension had features of retinopathy. Myopic astigmatism was the commonest refractive error noted, followed myopia. CONCLUSION ??? The ocular abnormalities noted in the study group, were hordeolum internum and externum, blepharitis and refractive errors. ??? Myopic astigmatism was the commonest refractive error, followed by myopia. ??? Posterior sub capsular cataract was the most common treatment related abnormality detected. ??? Duration of steroid treatment was seen to be directly associated with development of cataract.
