Ang Marcus, Ti Seng-Ei, Loh Raymond, Farzavandi Sonal, Zhang Rongli, Tan Donald, Chan Cordelia
Singapore National Eye Centre, Singapore.
Clin Ophthalmol. 2012;6:1253-8. doi: 10.2147/OPTH.S32936. Epub 2012 Aug 3.
We describe clinical characteristics and risk factors for corticosteroid response in children with severe vernal keratoconjunctivitis (VKC).
Retrospective, noncontrolled, comparative case series.
Patients from three tertiary centers in Singapore.
We reviewed patients with severe VKC (clinical grade > 2) who were on topical steroid therapy, with a minimum follow-up period of 1 year post-presentation. Logistic regression was used to determine risk factors for corticosteroid response.
Corticosteroid response was defined as intraocular pressure (IOP) >21 mmHg (three consecutive readings), or a rise of more than 16 mmHg from baseline, after commencement of steroid therapy in the absence of other possible causes of raised IOP.
Forty-one of 145 (28.3%) patients developed a corticosteroid response, of which eight (5.5%) progressed to glaucoma. The overall mean age of onset of VKC was 9.9 ± 4.4 years. Longer duration of corticosteroid use (OR, 5.06; 95% CI: 1.04-25.56; P = 0.45) and topical dexamethasone 0.01% (OR, 2.25; 95% CI: 1.99-5.08; P = 0.40) were associated with corticosteroid response. Mixed type of VKC (OR, 9.76; 95% CI: 3.55-26.77; P < 0.001), the presence of limbal neovascularization of ≥ three quadrants (OR, 6.33; 95% CI: 2.36-16.97; P < 0.001), and corneal involvement (OR, 3.51; 95% CI: 1.31-9.41; P = 0.012) were significant clinical risk factors after adjusting for potential confounders such as age, sex, ethnicity, duration, and type of corticosteroid used.
Children on long-term oral corticosteroids with severe, mixed-type VKC and corneal involvement are more likely to develop corticosteroid response, and may require early treatment to prevent progression to glaucoma.
我们描述了重度春季角结膜炎（VKC）患儿皮质类固醇反应的临床特征和危险因素。
回顾性、非对照、比较性病例系列研究。
来自新加坡三个三级医疗中心的患者。
我们回顾了接受局部类固醇治疗的重度VKC患者（临床分级>2级），就诊后至少随访1年。采用逻辑回归分析确定皮质类固醇反应的危险因素。
皮质类固醇反应定义为在开始类固醇治疗后，在没有其他可能导致眼压升高的原因的情况下，眼压（IOP）>21 mmHg（连续三次测量），或较基线升高超过16 mmHg。
145例患者中有41例（28.3%）出现皮质类固醇反应，其中8例（5.5%）进展为青光眼。VKC的总体平均发病年龄为9.9±4.4岁。使用皮质类固醇的时间更长（比值比[OR]，5.06；95%置信区间[CI]：1.04 - 25.56；P = 0.45）和使用0.01%的局部地塞米松（OR，2.25；95% CI：1.99 - 5.08；P = 0.40）与皮质类固醇反应相关。在调整了年龄、性别、种族、使用皮质类固醇的时间和类型等潜在混杂因素后，混合型VKC（OR，9.76；95% CI：3.55 - 26.77；P < 0.001）、三个及以上象限存在角膜缘新生血管（OR，6.33；95% CI：2.36 - 16.97；P < 0.001）以及角膜受累（OR，3.51；95% CI：1.31 - 9.41；P = 0.012）是显著的临床危险因素。
患有重度、混合型VKC且角膜受累的长期口服皮质类固醇的儿童更有可能出现皮质类固醇反应，可能需要早期治疗以防止进展为青光眼。
