High-dose steroid treatment is used in the majority of juvenile acute lymphoblastic leukemia (ALL) regimens. However, the recognized propensity of high-dose steroids to considerably raise intraocular pressure (IOP) and cause glaucomatous optic neuropathy in children with ALL has not been well explored. Furthermore, because children with ALL were not frequently measured for IOP, the need for IOP monitoring and treatment was unclear. For a study, researchers assessed IOP in 90 children with newly diagnosed ALL who were seen at a tertiary pediatric hematology/oncology center at diagnosis, as well as in the middle and end of induction treatment. Ocular hypertension (IOP > 21 mm Hg) was seen in 64 children (71%) at any time point, with the frequency increasing throughout induction.  

About 36 children (40%) had increased IOP prior to treatment commencement at the time of ALL diagnosis, and categorization to non-standard ALL was a risk factor. Nearly 13 children (14%) had IOP lowering treatment; none required surgery. In all situations, the values had been normalized. Dexamethasone medication was found to be a significant risk factor for ocular hypertension in a multivariate logistic regression study. In children with increased IOP upon ALL diagnosis, a high BMI was an additional risk factor. Routine IOP monitoring during steroid medication was critical in ALL children to guarantee early intervention, which might avoid lasting eye damage.

Reference:onlinelibrary.wiley.com/doi/10.1111/bjh.17987