Tolérance glycémique des bolus intraveineux de méthylprednisolone en milieu ophtalmologique

Introduction: Short-term, high-dose intravenous methylprednisolone therapy, also called pulse methylprednisolone, is widely used in a variety of inflammatory eye diseases. Monitoring blood glucose during this therapy is recommended. We evaluated the clinical implications of glycemia monitoring during repeated pulse methylprednisolone for eye disease. Patients and methods: During the year 2000, 224 patients received 120-1 000 mg daily intravenous methylprednisolone for 3 consecutive days for acute optic neuritis (n=91), severe uveitis (n=35), ocular infectious diseases (n=22), corneal graft rejection (n=17) and miscellaneous disorders (n=59). Serial morning fasting blood glucose, i.e., before the first pulse and the day after each pulse, and specific hypoglycemic drug interventions were recorded. Results: All patients showed a median 50% increase in fasting glucose after the first pulse with no significant difference between diabetic and nondiabetic patients. Thereafter, the 196 nondiabetic patients showed a spontaneous decrease in their fasting glucose towards baseline values despite the following infusions. However, none of them required hypoglycemic intervention. In contrast, the 28 diabetic patients demonstrated further increases in blood glucose levels and seven received rapid-release treatment. Conclusion: Glucose tolerance of pulse methylprednisolone was excellent in nondiabetic patients; close glycemia monitoring seems necessary only for patients with diabetes.