Steroid induced glaucoma prognosis

Cells of the zona fasciculata and zona reticularis lack aldosterone synthase (CYP11B2) that converts corticosterone to aldosterone, and thus these tissues produce only the weak mineralocorticoid corticosterone. However, both these zones do contain the CYP17A1 missing in zona glomerulosa and thus produce the major glucocorticoid, cortisol. Zona fasciculata and zona reticularis cells also contain CYP17A1, whose 17,20-lyase activity is responsible for producing the androgens, dehydroepiandosterone (DHEA) and androstenedione. Thus, fasciculata and reticularis cells can make corticosteroids and the adrenal androgens, but not aldosterone.

During conventional pharmacologic dose corticosteroid therapy, ACTH production is inhibited with subsequent suppression of cortisol production by the adrenal cortex. Recovery time for normal HPA activity is variable depending upon the dose and duration of treatment. During this time the patient is vulnerable to any stressful situation. Although it has been shown that there is considerably less adrenal suppression following a single morning dose of prednisolone (10 mg) as opposed to a quarter of that dose administered every six hours, there is evidence that some suppressive effect on adrenal activity may be carried over into the following day when pharmacologic doses are used. Further, it has been shown that a single dose of certain corticosteroids will produce adrenal cortical suppression for two or more days. Other corticoids, including methylprednisolone, hydrocortisone, prednisone, and prednisolone, are considered to be short acting (producing adrenal cortical suppression for 1¼ to 1½ days following a single dose) and thus are recommended for alternate day therapy.

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A number of classification schemes for the glaucomas have been proposed. They are based on the age of the person (infantile, juvenile, adult), the site of obstruction to aqueous outflow (pre-trabecular, trabecular, post-trabecular), the tissue principally involved (. glaucoma caused by diseases of the lens), and etiology. Although each of these systems has value, the classification scheme that separates angle closure from open angle glaucoma has been used most widely, because it focuses on pathophysiology and points to proper clinical management. A classification outline for open angle, angle closure, combined-mechanism and childhood glaucoma follows:

Steroid induced glaucoma prognosis

steroid induced glaucoma prognosis

A number of classification schemes for the glaucomas have been proposed. They are based on the age of the person (infantile, juvenile, adult), the site of obstruction to aqueous outflow (pre-trabecular, trabecular, post-trabecular), the tissue principally involved (. glaucoma caused by diseases of the lens), and etiology. Although each of these systems has value, the classification scheme that separates angle closure from open angle glaucoma has been used most widely, because it focuses on pathophysiology and points to proper clinical management. A classification outline for open angle, angle closure, combined-mechanism and childhood glaucoma follows:

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