Ivey Eye Institute, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
Can J Ophthalmol. 2010 Feb;45(1):41-5. doi: 10.3129/i09-198.
Oral acetazolamide is a potent medical treatment for pediatric glaucoma, but ophthalmologists may have concerns that it retards weight gain in children and may choose surgical management instead.
Retrospective chart review.
Twenty-two well children with glaucoma taking acetazolamide orally for >or=3 months.
Abnormal weight gain was determined using downward crossing of 2 percentile lines on growth charts and change in z score for weight using a hierarchical linear model.
One patient with Sturge-Weber syndrome and growth failure was excluded when growth hormone deficiency was diagnosed. Two patients crossed 2 lines downward; both showed metabolic acidosis. The trend for the 2 reversed after medication was discontinued. The other 20 tracked steadily on growth curves. Eleven patients (11/22, 50%) showed a decline in z score for weight over the follow-up period, and the remainder showed an increase, for an overall estimate of slope in this sample of 0.01, which was not significant (p = 0.8).
Oral acetazolamide may cause poor weight gain in a small subset of children on treatment. Metabolic acidosis may be a mediating factor for growth failure. Our data suggest that acetazolamide does not cause significant weight changes in cases of pediatric glaucoma. Growth parameters should be followed. Growth hormone deficiency should be considered in Sturge-Weber syndrome. Prospective study is needed.
口服乙酰唑胺是治疗小儿青光眼的有效药物，但眼科医生可能担心它会减缓儿童的体重增长，并选择手术治疗。
回顾性图表分析。
22 名患有青光眼并口服乙酰唑胺>3 个月的健康儿童。
使用生长图表上的 2 条百分位线下行交叉和使用分层线性模型的体重 z 分数变化来确定体重异常增长。
1 名患有 Sturge-Weber 综合征和生长发育迟缓的患者被诊断为生长激素缺乏症后被排除在外。2 名患者体重向下交叉 2 条线；均显示代谢性酸中毒。停药后，这种趋势逆转。其他 20 名患者在生长曲线上稳定跟踪。11 名患者（11/22，50%）在随访期间体重 z 分数下降，其余患者体重增加，总体估计斜率为 0.01，无显著差异（p=0.8）。
口服乙酰唑胺可能会导致一小部分接受治疗的儿童体重增长不良。代谢性酸中毒可能是生长发育迟缓的中介因素。我们的数据表明，乙酰唑胺不会导致小儿青光眼病例的体重显著变化。应监测生长参数。Sturge-Weber 综合征应考虑生长激素缺乏症。需要进行前瞻性研究。
