Risk of cataract among users of intranasal corticosteroids

Background: Oral corticosteroid users are at increased risk of cataract, but the risk among intranasal corticosteroids users is unknown. Objective: Our purpose was to describe the risk of cataract among users of intranasal steroids. Methods: A retrospective observational cohort study of cataract incidence was conducted among users of oral and intranasal steroids identified from the United Kingdom-based General Practice Research Database with a nested case-control analysis to control for confounding factors, The study population included 286,078 subjects aged less than 70 years old drawn from 350 general practices in England and Wales. Patients were classified as users of only intranasal corticosteroids, users of only oral corticosteroids, and nonusers of either medication. Computerized medical records were used to identify cases of cataract. Two hundred twenty-five cases were randomly selected for validation against general practitioners' held referral and hospitalization letters. Results: The incidence rate of cataract (1.0/1000 person-years) among users of intranasal corticosteroids was similar to the incidence rate among nonusers. However, oral corticosteroid users were at higher risk of cataract (2.2/1000 person-years). Approximately 70% of intranasal corticosteroid exposure mas to beclomethasone dipropionate only; the event rate in this group was similar to that in the unexposed group. Cataract risk did not increase with the number of prior prescriptions for intranasal corticosteroids. Conclusion: The use of intranasal corticosteroids was not associated with an increased risk of cataracts in this study population.