Alternate-day steroid regimen in the treatment of ocular disease.

THE systemic use of cortisol and its derivatives has proved invaluable in the management of certain ocular diseases. However, the prolonged use of steroids, so often necessary in the treatment of such conditions as chronic uveitis, frequently leads to serious complications. The incidence of side-effects and their undesirable sequelae varies from case to case, but they are mainly related to the dosage and duration of therapy. The hazards range from signs of Cushing facies to major life-threatening catastrophes, such as overwhelming infections, gastrointestinal ulceration, and acute adrenal insufficiency. As the ophthalmologist is not usually in a position to control his patient's overall medical status, measures to increase the safety of long-term steroid administration are extremely advantageous. Harter, Reddy, and Thorn (1963) published the results of studies using a new approach to prolonged oral administration of steroids. Reasoning that the therapeutic (anti-inflammatory) effects of steroids appeared to persist longer than their metabolic effects, it seemed plausible that the use of an intermittent large dosage schedule might avoid the cumulative undesirable metabolic effects of the hormones, and yet be sufficient to maintain the antiinflammatory properties. The authors selected 58 medical patients with systemic diseases of various types, all of whom required prolonged steroid therapy. Each patient was given the total quantity of steroid required for a 2-day period as a single dose every 48 hours. For example, a patient requiring 10 mg. prednisone four times a day was given 80 mg. before breakfast on alternate mornings. This type of alternate-day dosage proved to be approximately equal in effectiveness, in the opinion of the authors, to the conventional four-times-a-day therapy, and there was a markedly reduced incidence of side effects. Furthermore, it was shown that, using the Thorn test and 17-ketosteroid determinations, there was little of the adrenal suppression that is usually produced by long-term use of steroids.