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Serum cortisol and adrenocorticotrophic hormone (ACTH) in infants receiving topical and subconjunctival corticosteroids following cataract surgery



Cushingoid features are occasionally encountered in infants after pediatric cataract surgery. The aim of this study is to evaluate whether the use of topical glucocorticoids (GCs) following congenital cataract surgery can result in endogenous adrenal suppression and/or systemic side effects similar to those seen with systemic steroids.


A prospective study was performed on 20 infants with bilateral congenital cataract. All infants received a single subconjunctival betamethasone injection of 1 mg at the end of surgery in addition to topical dexamethasone eye drops 1 mg/ml for 6 weeks. All infants had anthropometric measurements and blood pressure measurements, serum cortisol, and ACTH level measurements before surgery and 2 months after. In addition, the total administered glucocorticoid adjusted per weight was calculated.


The mean age of the infants was 4.93 ± 2.58 months. Thirteen were males (65%). The total administered glucocorticoid dose was 18.7 mg and the mean cumulative dexamethasone equivalent dose administered was 2.75 ± 1.31 mg/kg. There was a statistically significant increase in the adjusted weight percentile for age (P = 0.009). Both the systolic and diastolic blood pressure were significantly elevated (P = 0.005 and P = 0.025 respectively). There was a statistically significant reduction in both the morning and afternoon serum ACTH levels (P = 0.023 and P = 0.014). The reduction in serum cortisol levels was statistically non-significant.


Topical steroids following pediatric cataract surgery can result in both subclinical and clinical changes in the hypothalamic–pituitary–adrenal axis that can be easily overlooked and need careful attention and follow-up.

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Full data are available from the corresponding author upon request.

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Authors and Affiliations



Abeer Aly performed the literature review, tabulated the data, and drafted the manuscript. Jylan Gouda collected the clinical data, drafted, and revised the manuscript. Ahmed Awadein contributed to the study design, cleaned, and analyzed the data; did the statistical analysis; and revised the paper. He is the guarantor. Hend M. Soliman contributed to the study design, analyzed the clinical and serological data, and revised the manuscript. Dina El-Fayoumi performed the surgeries, wrote, and revised the manuscript.

Corresponding author

Correspondence to Ahmed Awadein.

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All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee (Cairo University Research Ethics Committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from the guardians of all individual participants included in the study.

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Additional informed consent was obtained from the guardians of all individual participants for whom identifying information is included in this article.

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The authors declare no competing interests.

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Aly, A., Gouda, J., Awadein, A. et al. Serum cortisol and adrenocorticotrophic hormone (ACTH) in infants receiving topical and subconjunctival corticosteroids following cataract surgery. Graefes Arch Clin Exp Ophthalmol 259, 3159–3165 (2021).

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  • Cushing
  • Cortisol
  • ACTH
  • Congenital cataract
  • Pediatric cataract
  • Topical steroids
  • Exogenous Cushing
  • Ocular steroids