Marsh P, Pflugfelder S C
Ocular Surface and Tear Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami School of Medicine, Florida 33136, USA.
Ophthalmology. 1999 Apr;106(4):811-6. doi: 10.1016/S0161-6420(99)90171-9.
To review the efficacy and side effects of topical nonpreserved corticosteroid therapy for treatment of severe keratoconjunctivitis associated with Sjögren syndrome.
Retrospective, noncomparative case series.
Twenty-one patients with Sjögren syndrome-associated keratoconjunctivitis sicca and annoying ocular irritation.
Treatment with topical nonpreserved methylprednisolone sodium succinate.
Symptom severity, frequency of instillation of artificial tears, corneal fluorescein staining scores, resolution of filamentary keratitis, steroid-related side effects.
Before starting methylprednisolone therapy, all patients were experiencing moderate-to-severe eye irritation despite prior punctal occlusion in most cases and frequent use of nonpreserved artificial tears by all. After 2 weeks of topical application, three to four times per day, moderate (43%) or complete (57%) relief of irritation symptoms was experienced by all patients and no complications were observed. An average decrease in corneal fluorescein scores of 2.6 +/- 0.5 points (on a 12-point scale) was observed, and filamentary keratitis resolved in all ten eyes with this condition. Therapy was stopped after 2 weeks in eight patients, and six of these patients reported that their symptoms remained at a tolerable level for weeks to months. Lower dose steroid therapy was continued in the remaining patients, whose symptoms worsened after attempted weaning. Complications of corticosteroid therapy in patients receiving prolonged therapy included increased intraocular pressure in one patient at 3 months, worsening of pre-existing posterior subcapsular cataracts in one patient at 6 months, and formation of posterior subcapsular cataracts in another patient at 6 months.
These findings indicate that topical nonpreserved methylprednisolone is an effective treatment option for patients suffering from severe keratoconjunctivitis sicca who continue to experience bothersome eye irritation despite maximum aqueous enhancement therapies. They also suggest that inflammation is a key pathogenic factor in this condition. Careful monitoring is essential in dry eye patients treated with corticosteroids for more than 2 weeks because steroid-related complications (increased intraocular pressure and cataract formation) were observed after several months of therapy in this series. Because of the chronic nature of this disease and the likelihood of patients developing steroid-related complications with their long-term use, topical nonpreserved methylprednisolone therapy appears to be most appropriate for short-term "pulse" treatment of exacerbations of keratoconjunctivitis sicca.
回顾局部应用无防腐剂皮质类固醇疗法治疗与干燥综合征相关的严重角结膜炎的疗效及副作用。
回顾性、非对照病例系列研究。
21例患有干燥综合征相关的角结膜干燥症且眼部刺激症状恼人的患者。
局部应用无防腐剂的甲泼尼龙琥珀酸钠进行治疗。
症状严重程度、人工泪液滴眼频率、角膜荧光素染色评分、丝状角膜炎的消退情况、与类固醇相关的副作用。
在开始甲泼尼龙治疗前，尽管大多数患者此前已行泪小点封闭且所有人都频繁使用无防腐剂的人工泪液，但所有患者仍有中度至重度的眼部刺激症状。每天局部应用3至4次，持续2周后，所有患者的刺激症状均有中度（43%）或完全（57%）缓解，且未观察到并发症。角膜荧光素评分平均下降2.6±0.5分（满分12分），所有10例患有丝状角膜炎的患者病情均得到缓解。8例患者在2周后停止治疗，其中6例患者报告其症状在数周或数月内仍维持在可耐受水平。其余患者继续采用低剂量类固醇治疗，在尝试减药后症状加重。接受长期治疗的患者中，皮质类固醇治疗的并发症包括1例患者在3个月时眼压升高，1例患者在6个月时原有后囊下白内障病情恶化，另1例患者在6个月时出现后囊下白内障。
这些研究结果表明，对于患有严重角结膜干燥症且尽管采用了最大限度的泪液补充疗法仍持续存在烦人的眼部刺激症状的患者，局部应用无防腐剂的甲泼尼龙是一种有效的治疗选择。这些结果还提示炎症是该病的关键致病因素。对于接受皮质类固醇治疗超过2周的干眼症患者，仔细监测至关重要，因为在本系列研究中，在治疗数月后观察到了与类固醇相关的并发症（眼压升高和白内障形成）。由于该病具有慢性特点，且患者长期使用类固醇可能出现相关并发症，局部应用无防腐剂的甲泼尼龙疗法似乎最适合用于角结膜干燥症急性加重期的短期“脉冲”治疗。
