Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
J Glaucoma. 2010 Mar;19(3):188-90. doi: 10.1097/IJG.0b013e3181af321d.
To evaluate the ocular hypertensive response to repetitive cycles of high-dose systemic corticosteroid in young patients with acute lymphoblastic leukemia (ALL).
Five patients up to 6 years of age with ALL who received chemotherapy between November 2003 and March 2005 were examined. As maintenance therapy, they received oral or intravenous dexamethasone 6 to 12 mg/m²/day for 2 weeks, followed by 1-week taparing and 5 weeks break were used in 1 cycle. The duration of maintenance therapy was 15 cycles for 2.5 to 3 years. Comprehensive ophthalmic check-up, including best-corrected visual acuity, intraocular pressure (IOP), and slit-lamp and fundus examinations, were performed.
All patients were followed up until final cycle. Symmetrical IOP rise >21 mm Hg was observed in all patients. Right IOP increased to a maximum of mean 39.6 ± 7.2 mm Hg. (range: 28 to 47). The range of cycle to reach a maximal IOP was 5th to 11th. All patients were maintained IOP control with antiglaucoma medications. However, 1 patient already had severe glaucomatous optic atrophy at the time of consultation.
Systemic corticosteroid in childhood-ALL treatment has a risk for IOP elevation. Periodical and careful ophthalmic check-up is necessary, especially in patients with dexamethasone.
评估大剂量全身皮质类固醇激素在急性淋巴细胞白血病（ALL）患儿中重复周期的眼压升高反应。
对 2003 年 11 月至 2005 年 3 月接受化疗的 5 例年龄在 6 岁以下的 ALL 患儿进行了检查。作为维持治疗，他们接受了 6 至 12mg/m²/天的口服或静脉内地塞米松治疗 2 周，然后进行 1 周的减量，5 周的停药，1 个周期内重复使用。维持治疗的持续时间为 15 个周期，持续 2.5 至 3 年。进行了全面的眼科检查，包括最佳矫正视力、眼压（IOP）以及裂隙灯和眼底检查。
所有患者均随访至最后一个周期。所有患者均观察到对称的 IOP 升高>21mmHg。右眼 IOP 最高升高至平均 39.6±7.2mmHg（范围：28 至 47）。达到最大 IOP 的周期范围为第 5 至第 11 个周期。所有患者均使用抗青光眼药物控制眼压。然而，1 例患者在就诊时已经出现严重的青光眼视神经萎缩。
儿童 ALL 治疗中的全身皮质类固醇激素有引起眼压升高的风险。需要定期和仔细的眼科检查，特别是在使用地塞米松的患者中。
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