A clinical case of steroid cataract in a patient after a new coronavirus infection

Posterocapsular cataract due to the use of glucocorticoids is a clinically significant adverse reaction that is accompanied by a decrease in the patients’ ability to work and their quality of life. The use of these drugs as a preventive anti-inflammatory therapy during the new coronavirus infection pandemic, the increase in the overall incidence of cataracts in the Chuvash Republic in recent years, and the lack of scientific literature describing such adverse reactions make it relevant to demonstrate a clinical case of steroid cataract in a patient after a new coronavirus infection.

The purpose of the study was to draw the attention of practitioners to the problem of the safety of dexamethasone pharmacotherapy using the example of a case of posterior capsular cataract in both eyes after a new coronavirus infection.

Materials and research methods. On the basis of the Budgetary institution “Republican Clinical Ophthalmological Hospital” of the Ministry of Health of the Chuvash Republic (Cheboksary), a retrospective analysis of the case of posterocapsular cataract of both eyes in a patient was performed after 1.5 years of hospital treatment for a new coronavirus infection using therapeutic doses of dexamethasone.

Research results. Patient E., 68 years old with posterior capsular cataract of both eyes, applied to the Budgetary institution “Republican Clinical Ophthalmological Hospital” of the Ministry of Health of the Chuvash Republic for surgical treatment. It became known from her medical history that 1.5 years ago she received hospital treatment for a new coronavirus infection complicated by pneumonia using dexamethasone. After that, she began to notice a gradual decrease in vision in both eyes, about which she contacted the Republican Clinical Ophthalmological Hospital. Upon examination by an ophthalmologist, posterocapsular cataract of both eyes was diagnosed, and therefore the patient was hospitalized for surgical treatment.

Conclusions. This clinical case demonstrates that the use of therapeutic doses of dexamethasone against the background of a new coronavirus infection may precede the development of posterocapsular cataract as a clinically significant adverse reaction that necessitates hospitalization and surgical treatment.

1. Jobling D. W., Augusteyn R. C., What causes steroid cataracts? A review of steroid-induced posterior subcapsular cataracts. Clinical and Experimental Optometry. 2002; 85(2): 61–75.

2. Temporary guidelines for the prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Version 7 (06.03.2020). URL: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/075/182/original/ВМР_COVID-19_V19.pdf (In Russ.).

3. Federal Law No. 152-FZ of 27.07.2006 “On Personal Data”. https://www.consultant.ru/document/cons_doc_LAW_61801/ (In Russ.).

4. Prescription drug information URL: www.drugs.com (In Russ.).

5. State Register of Medicines. URL: https://grls.minzdrav.gov.ru/ (In Russ.).

6. The Register of OHLP and LV of the EAEU. URL: https://lk.regmed.ru/Register/EAEU_SmPC (In Russ.).

7. Order of the Ministry of Health of the Russian Federation, Federal Service for Healthcare Supervision Order No. 3518 dated June 17, 2024 “On Approval of the Procedure for Pharmacovigilance of Medicinal Products for Medical Use”. URL: https://normativ.kontur.ru/document?moduleId=1&documentId=477890 (In Russ.).

8. Methodological recommendations Determination of the degree of reliability of the causal relationship “Adverse side effect-drug” (classification and methods) 02.10.2008. URL: https://docs.cntd.ru/document/499043554 (In Russ.).

9. Rice M. L., Wong B., Horn P. S., Yang M. B. Cataract development associated with long-term glucocorticoid therapy in Duchenne muscular dystrophy patients. Journal of the American Association for Pediatric Ophthalmology and Strabismus 2018, 22 (3) P. 192–196.

10. Wong B. L., Rybalsky I., Shellenbarger K. C., Tian C., McMahon M. A., Rutter M. M., Sawnani H., Jefferies L. Long-Term Outcome of Interdisciplinary Management of Patients with Duchenne Muscular Dystrophy Receiving Daily Glucocorticoid Treatment. Journal of Pediatrics. 2017; 182: 296–303.

11. Nath T., Roy S. S., Kumar H., Agrawal R., Kumar S., Satsangi S. K. Prevalence of Steroid-Induced Cataract and Glaucoma in Chronic Obstructive Pulmonary Disease Patients Attending a Tertiary Care Center in India. Asia-Pacific journal of ophthalmology (Phila.). 2017; 6(1): 28–32.

12. Dickerson Jr J. E., Dotzel E., Clark A. F. Steroid-induced cataract: new perspective from in vitro and lens culture studies. Experimental Eye Research. 1997; 65 (4): 507–516.

13. Kamilov Kh. M., Kasimova M. S., Rizayeva M. A., Khamraeva G. H. Cataracts in middle-aged people in the post-ovarian period. Journal of Oral Medicine and Maxillofacial Research. 2023; 3(4): 65–67 (In Russ.).

14. Eldred J. A., Dawes L. J., Wormstone I. M. The lens as a model for fibrotic disease // Philosophical Transactions of the Royal Society of London B: Biological Sciences. 2011; 366 (1568): 1301–1319.

15. James E. R., The etiology of steroid cataract. Journal of Ocular Pharmacology and Therapeutics. 2007; 23 (5): 403–420.

16. Teng M., Wang J., Su X., Tian Y., Ye X., Zhang Y. Causal associations between circulating inflammatory cytokines and blinding eye diseases: a bidirectional Mendelian randomization analysis. Front Aging Neurosci. 2024. doi: 10.3389/fnagi.2024.1324651. eCollection 2024.

17. Chen W., Lin H., Zhong X., Liu Z., Geng Y., Xie C., Chen W. Discrepant expression of cytokines in inflammation- and age-related cataract patients. PLoS One. 2014; 9 (10): e109647.

18. Temporary guidelines for the prevention, diagnosis and treatment of new coronavirus infection (COVID19). Version 12 (21.09.2021). URL: https://normativ.kontur.ru/document?moduleId=1&documentId=401856 (In Russ.).

19. Agrawal V., Devpura K., Mishra L., Agarwal S. Study on Steroid Induced Ocular Findings in Children with Nephrotic Syndrome. Journal of Clinical and Diagnostic Research. 2017; 11 (3): SC05–SC06.

20. State Register of Medicines. URL: https://grls.minzdrav.gov.ru/Grls_View_v2.aspx?routingGuid=7fbf7aa4-dfc2-4b41-870c-56ad9933dc17 6е (In Russ.).