Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital, London, UK.
Br J Ophthalmol. 2011 Nov;95(11):1531-3. doi: 10.1136/bjo.2010.192773. Epub 2011 Feb 4.
BACKGROUND/AIMS: Although fluorometholone (FML) is considered a steroid of minimal ocular penetration, reports in children have shown dose-dependent intraocular pressure (IOP) rise. The authors aimed to assess whether reducing regimens of FML for paediatric ocular surface disease have sustained clinically significant ocular hypertensive effects.
Retrospective case-note review. Glaucoma was defined as an IOP of ≥ 21 mm Hg on at least two occasions or, in young children, moderate/firm digital IOP with one of the following: myopic shift, increased cup:disc ratio or corneal oedema. Exclusion criteria were other concurrent steroids or pre-existing optic nerve disease.
107 cases were included. The median age was 6 years (range 3 months to 17 years). The commonest indication for FML was blepharo-kerato-conjunctivitis. The maximal frequency prescribed was four times a day, gradually reduced to once weekly in cases of long-term treatment. The mean total number of eye-drop applications was 228 over a mean time span of 9 months. Post-FML IOP was formally documented in 51/107 casenotes (median age 6.85 years, range 4 months to 16 years) and it was <19 mm Hg in all cases. 56 cases did not allow IOP measurement (median age 5.9 years, range 3 months to 17 years), but none met the glaucoma definition.
In this cohort, reducing regimens of FML proved to be a safe anti-inflammatory treatment in terms of avoiding steroid-induced glaucoma.
背景/目的：尽管氟米龙（FML）被认为是一种眼部穿透性极小的类固醇，但在儿童中的报告显示其眼压（IOP）升高与剂量有关。作者旨在评估儿科眼表疾病的 FML 减量方案是否具有持续的临床显著的高眼压效应。
回顾性病历审查。青光眼的定义为至少两次眼压≥21mmHg，或在年幼的儿童中，中度/硬性数字眼压，伴有以下一种情况：近视漂移、杯盘比增加或角膜水肿。排除标准为其他同时使用的类固醇或先前存在的视神经疾病。
共纳入 107 例病例。中位年龄为 6 岁（范围 3 个月至 17 岁）。最常见的 FML 适应证是睑-角-结膜病变。规定的最大频率为每天四次，在长期治疗的情况下逐渐减少至每周一次。平均总滴眼次数为 228 次，平均时间跨度为 9 个月。51/107 例病历（中位年龄 6.85 岁，范围 4 个月至 16 岁）正式记录了 FML 后的眼压，所有病例的眼压均<19mmHg。56 例病例不允许进行眼压测量（中位年龄 5.9 岁，范围 3 个月至 17 岁），但均不符合青光眼的定义。
在本队列中，FML 的减量方案被证明是一种安全的抗炎治疗方法，可避免类固醇引起的青光眼。
