Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Drugs Aging. 2012 Dec;29(12):963-70. doi: 10.1007/s40266-012-0029-9.
It is largely unknown if corticosteroid-induced open-angle glaucoma (OAG) is an entity that is limited to a few susceptible individuals or whether it contributes significantly to the overall population burden of OAG.
The aim of this study was to determine whether there is an association between corticosteroid use and the incidence of OAG in the general elderly population.
A prospective population-based cohort study was conducted in a general community setting. 3,939 participants of the Rotterdam Study aged 55 years and older for whom data from ophthalmic examinations at baseline and follow-up were available and who did not have glaucoma at baseline were included (baseline examination from 1991 to 1993; follow-up examinations from 1997 to 1999 and from 2002 to 2006). Ophthalmic examinations, including measurement of the intraocular pressure, assessment of the optic nerve head and perimetry, were performed at baseline and follow-up. The use of corticosteroids was monitored continuously during follow-up. Corticosteroids were stratified into five groups: ophthalmic steroids, inhaled steroids, nasal steroids, oral steroids and steroid ointments. Associations between the use of corticosteroids and incident OAG were assessed using logistic regression models. The study outcome measures were the odds ratios (ORs) of associations between the use of corticosteroids and incident OAG.
During a mean follow-up of 9.8 years, 108 participants (2.8%) developed OAG. The median number of steroid prescriptions during follow-up was 2 for ophthalmic, 7 for inhaled, 2 for nasal and 2 for oral steroids, and 3 for steroid ointments. The OR of the use of ophthalmic steroids was 1.04 [95% confidence interval (CI) 0.66, 1.65; p = 0.86], inhaled steroids 0.79 (95% CI 0.42, 1.48; p = 0.46), nasal steroids 1.26 (95% CI 0.74, 2.13; p = 0.40), oral steroids 1.03 (95% CI 0.65, 1.64; p = 0.89) and steroid ointments 0.70 (95% CI 0.47, 1.05; p = 0.086). These analyses were adjusted for age, sex, high myopia and family history of glaucoma. The small median numbers of prescriptions made it difficult to evaluate dose-response relationships.
None of the classes of steroids were associated with the incidence of OAG in this elderly population.
皮质类固醇诱导的开角型青光眼（OAG）是否仅限于少数易感个体，或者它是否对 OAG 的总体人群负担有显著贡献，目前还知之甚少。
本研究旨在确定皮质类固醇的使用与普通老年人群中 OAG 的发生率之间是否存在关联。
在一个普通社区环境中进行了一项前瞻性的基于人群的队列研究。纳入了 3939 名年龄在 55 岁及以上的鹿特丹研究参与者，他们在基线和随访时都有眼科检查的数据，并且在基线时没有青光眼（基线检查时间为 1991 年至 1993 年；随访检查时间为 1997 年至 1999 年和 2002 年至 2006 年）。在基线和随访时进行了眼科检查，包括眼压测量、视神经头评估和视野检查。在随访期间持续监测皮质类固醇的使用情况。皮质类固醇分为五类：眼部类固醇、吸入性类固醇、鼻内类固醇、口服类固醇和类固醇软膏。使用逻辑回归模型评估皮质类固醇使用与新发 OAG 之间的关联。研究结果测量是皮质类固醇使用与新发 OAG 之间关联的优势比（OR）。
在平均 9.8 年的随访期间，108 名参与者（2.8%）患上了 OAG。在随访期间，中位数的皮质类固醇处方数量为眼部类固醇 2 张，吸入性类固醇 7 张，鼻内类固醇 2 张，口服类固醇 2 张，类固醇软膏 3 张。眼部类固醇的使用 OR 为 1.04（95%置信区间（CI）0.66，1.65；p=0.86），吸入性类固醇为 0.79（95%CI 0.42，1.48；p=0.46），鼻内类固醇为 1.26（95%CI 0.74，2.13；p=0.40），口服类固醇为 1.03（95%CI 0.65，1.64；p=0.89），而类固醇软膏为 0.70（95%CI 0.47，1.05；p=0.086）。这些分析调整了年龄、性别、高度近视和青光眼家族史。中位数数量较小的处方使得评估剂量-反应关系变得困难。
在这个老年人群中，皮质类固醇的任何一类都与 OAG 的发病率无关。
