Ng J S, Fan D S, Young A L, Yip N K, Tam K, Kwok A K, Lam D S
Department of Ophthalmology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, New Territories, Hong Kong.
Ophthalmology. 2000 Nov;107(11):2097-100. doi: 10.1016/s0161-6420(00)00357-2.
To investigate the ocular-hypertensive response to different dosages of topical dexamethasone eye drops in Chinese children.
Prospective, randomized clinical trial.
Thirty-one consecutive children undergoing bilateral strabismus surgery.
Topical dexamethasone (0.1%) was administered to children undergoing bilateral strabismus surgery. They were all less than 10 years of age. One eye was randomized to receive a regimen of four times daily, and another received a twice daily regimen. Intraocular pressure (IOP) was serially measured in the postoperative period for 4 weeks or more. Topical steroids were discontinued if IOP was 30 mmHg or more.
Intraocular pressure was measured on the day before the surgery, on postoperative days 1, 3, 5, 8, 12, 15, 22, 29, and 2 weeks thereafter until the IOP reached preoperative levels. Peak IOP, IOP net increase, and time to reach an IOP more than 20 mmHg in the two study groups were analyzed.
A total of 31 patients (20 male, 11 female) were examined. The mean age was 5.8 +/- 2.0 years (range, 2-10 years). Preoperative IOP in groups treated twice daily and four times daily were similar. After topical dexamethasone treatment, both groups showed a significant rise in peak IOP compared with preoperative values (twice daily, 25.2 +/- 6.8 mmHg vs. 14.3 +/- 2.4 mmHg, P < 0.001; four times daily, 28.7 +/- 6.9 mmHg vs. 14.3 +/- 2.9 mmHg, P < 0.001). The peak IOP was significantly higher in the four times daily group (P < 0.001), as was the net increase in IOP (twice daily, 10.9 +/- 5.8 mmHg vs. four times daily, 14.5 +/- 6.4 mmHg; P < 0.001). There was no difference in time for both groups to achieve the peak IOP, but the time to exceed its upper normal value (20 mmHg) was shorter in the four times daily group (twice daily, 12.3 +/- 9.1 days vs. four times daily, 10.0 +/- 7.4 days; P < 0.05).
In children treated with topical dexamethasone, ocular hypertension occurs in a dose-dependent manner. Children in the four times daily group had a quicker onset and more severe ocular hypertensive response than the twice daily group. Nevertheless, even the twice daily regimen produced significant IOP rise, suggesting that dexamethasone use in children should be avoided if possible, and it would be desirable to monitor the IOP twice weekly when it is administered to children.
研究中国儿童局部应用不同剂量地塞米松滴眼液后的眼压升高反应。
前瞻性随机临床试验。
31例连续接受双眼斜视手术的儿童。
对接受双眼斜视手术的儿童局部应用0.1%地塞米松。他们均不满10岁。一只眼随机接受每日4次的用药方案，另一只眼接受每日2次的用药方案。术后连续4周或更长时间测量眼压。如果眼压达到或超过30 mmHg，则停用局部类固醇药物。
在手术前一天、术后第1、3、5、8、12、15、22、29天以及术后2周直至眼压恢复到术前水平，测量眼压。分析两个研究组的眼压峰值、眼压净增加值以及眼压超过20 mmHg的时间。
共检查了31例患者（20例男性，11例女性）。平均年龄为5.8±2.0岁（范围2 - 10岁）。每日2次和每日4次治疗组的术前眼压相似。局部应用地塞米松治疗后，与术前值相比，两组的眼压峰值均显著升高（每日2次，25.2±6.8 mmHg对14.3±2.4 mmHg，P < 0.001；每日4次，28.7±6.9 mmHg对14.3±2.9 mmHg，P < 0.001）。每日4次治疗组的眼压峰值显著更高（P < 0.001），眼压净增加值也是如此（每日2次，10.9±5.8 mmHg对每日4次，14.5±6.4 mmHg；P < 0.001）。两组达到眼压峰值的时间没有差异，但每日4次治疗组超过正常上限值（20 mmHg）的时间更短（每日2次，12.3±9.1天对每日4次，10.0±7.4天；P < 0.05）。
在局部应用地塞米松治疗的儿童中，眼压升高呈剂量依赖性。每日4次治疗组的儿童眼压升高反应比每日2次治疗组更快且更严重。然而，即使是每日2次的用药方案也会导致眼压显著升高，这表明应尽可能避免在儿童中使用地塞米松，并且在给儿童使用时，每周监测两次眼压是可取的。
