Department of Ophthalmology, University of Washington School of Medicine, Seattle, 98104, USA.
Am J Ophthalmol. 2012 May;153(5):932-8. doi: 10.1016/j.ajo.2011.10.008. Epub 2012 Jan 20.
To evaluate the clinical effect of topical difluprednate in pediatric patients for treatment of noninfectious uveitis.
Retrospective, observational case series.
Twenty-six eyes of 14 pediatric patients with noninfectious uveitis who were treated with topical difluprednate were evaluated. Anterior and posterior cell grade, visual acuity, intraocular pressure (IOP), and cystoid macular edema (CME) were recorded at each visit. Main outcome measures were changes in anterior segment cell, CME, visual acuity, and IOP and development of a visually significant cataract.
A significant (≥ 2-grade decrease or decrease to 0 in anterior segment cell) reduction in anterior segment inflammation was observed during treatment with topical difluprednate in 88% of eyes (22/25) when used as an adjuvant to systemic immunomodulatory therapy. In addition, improvement in CME associated with uveitis was seen in response to topical therapy with difluprednate in 78% of eyes with CME (7/9). A significant IOP response (IOP increase of ≥ 10 mm Hg from baseline and IOP ≥ 24 mm Hg) was seen in 50% of eyes (13/26) and in 50% of patients (7/14); 3 eyes of 2 patients required glaucoma surgery. Cataract formation or progression was observed in 39% of eyes (10/26) and in 43% of patients (6/14); 5 eyes of 3 patients required cataract surgery.
Difluprednate is an effective agent for both control of anterior segment inflammation and reduction of CME in pediatric patients with uveitis when used as an adjuvant to systemic immunomodulatory therapy. A high rate of steroid-induced IOP elevation and cataract formation is seen in this population. Close monitoring of pediatric patients receiving difluprednate is recommended.
评估局部用二氟泼尼酯治疗儿童非感染性葡萄膜炎的临床疗效。
回顾性、观察性病例系列研究。
评估了 14 例非感染性葡萄膜炎患儿的 26 只眼，这些患儿使用局部用二氟泼尼酯进行治疗。每次就诊时记录眼前段细胞、视力、眼内压（IOP）和囊样黄斑水肿（CME）。主要观察指标是眼前段细胞、CME、视力和 IOP 的变化以及是否出现明显的白内障。
在联合全身免疫调节治疗时，88%（22/25）的眼在使用局部用二氟泼尼酯治疗时观察到眼前段炎症有明显（≥2 级下降或降至 0）减轻。此外，在有 CME 的 78%（7/9）眼中，局部用二氟泼尼酯治疗可改善与葡萄膜炎相关的 CME。50%（13/26）的眼和 50%（7/14）的患者出现显著的眼压反应（眼压较基线升高≥10mmHg，眼压≥24mmHg）；2 例 3 只眼需要行青光眼手术。39%（10/26）的眼和 43%（6/14）的患者出现白内障形成或进展；3 例 5 只眼需要行白内障手术。
当联合全身免疫调节治疗时，二氟泼尼酯是一种有效控制儿童葡萄膜炎眼前段炎症和减少 CME 的药物。在该人群中，观察到较高的类固醇诱导性眼压升高和白内障形成发生率。建议密切监测接受二氟泼尼酯治疗的儿科患者。
