Posterior subcapsular cataracts are most commonly associated with which treatment?

• A. Prednisone
• B. Dexamethasone eyedrops
• C. Topical steroids
• D. Hydrocortisone

Answer: (C)

Corticosteroid exposure is the major factor behind posterior subcapsular cataracts. These cataracts form in the posterior subcapsular zone because steroids disrupt the function and differentiation of lens epithelial cells and fiber cells, leading to the accumulation of abnormal material right beneath the posterior capsule. The effect is most pronounced when the lens is exposed to high levels of steroid in the aqueous, which happens with topical ocular steroids used for long periods. Among the options, the broad category of topical steroids represents the strongest and most consistent association with PSC because it delivers sustained, high concentrations directly to the lens. Systemic steroids like prednisone can contribute as well, but the link is less predictable, and a weaker or less potent steroid (such as hydrocortisone) carries a lower risk. Hence, topical steroids are the best answer.