Inhaled Corticosteroid and Secondary Glaucoma: A Meta-analysis of 18 Studies

Mai Ishii; Nobuyuki Horita; Masaki Takeuchi; Hiromi Matsumoto; Risa Ebina-Shibuya; Yu Hara; Nobuaki Kobayashi; Nobuhisa Mizuki; Takeshi Kaneko

doi:10.4168/aair.2021.13.3.435

Inhaled Corticosteroid and Secondary Glaucoma: A Meta-analysis of 18 Studies

Allergy Asthma Immunol Res. 2021 May;13(3):435-449. doi: 10.4168/aair.2021.13.3.435.

Authors

Affiliations

¹ Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
² Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan. horitano@yokohama-cu.ac.jp.
³ Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
⁴ Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

^# Contributed equally.

Abstract

Purpose: Guidelines and systematic reviews frequently warn of inhaled corticosteroid (ICS)-induced glaucoma. However, most of the published studies deny it.

Methods: We performed a systematic review of randomized, cohort, nested-case control, cross-sectional studies by using Meta-analyses of Observational Studies in Epidemiology statement. Four major databases, PubMed, EMBASE, Cochrane Search Manager, and the Web of Science Core Collection as well as meta-analysis were used. Studies comparing incidence, prevalence and intraocular pressure (IOP) between patients who were treated with and without ICSs were included. A random-model meta-analysis was performed using the inverse variance method.

Results: Out of 623 studies screened, 18 with 31,665 subjects were finally included. No significant difference between the 2 groups was observed for crude glaucoma incidence (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.86-1.04; P = 0.26; I² = 0%; P for heterogeneity = 0.57) as a primary endpoint, adjusted glaucoma incidence (OR, 0.90; 95% CI, 0.65-1.24; P = 0.64), crude prevalence (OR, 1.82; 95% CI, 0.23-14.19; P = 0.57), adjusted prevalence (OR, 1.22; 95% CI, 0.50-2.96; P = 0.66), IOP change during ICS treatment (mean difference [MD] +0.01 mmHg; 95% CI, -0.19-0.20; P = 0.95), and single measurement IOP (MD +0.37 mmHg; 95% CI, -0.24-0.97; P = 0.23). Time-to-event analysis for glaucoma development as one of the secondary endpoints (adjusted hazard ratio, 0.52; 95% CI, 0.28-0.96) suggested a reverse association between ICS and glaucoma.

Conclusions: The ophthalmological side effects of ICSs, such as glaucoma and intraocular hypertension, should not be exaggerated.

Trial registration: University Hospital Medical Information Network Center Clinical Trial Registry Identifier: UMIN000040351.

Keywords: Asthma; adrenal cortex hormones; chronic obstructive pulmonary disease; cohort studies; glaucoma; intraocular pressure; meta-analysis; review.