Pei M H, Zhao C, Gao F, Zhang M F
Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Zhonghua Yan Ke Za Zhi. 2018 Nov 11;54(11):839-842. doi: 10.3760/cma.j.issn.0412-4081.2018.11.008.
To investigate the clinical features of glucocorticoid eye drops induced ocular hypertension in pediatric and adult uveitic eyes. Retrospective survey of consecutive uveitic patients attending referral service at Peking Union Medical College Hospital from March 2013 to August 2017. Incidences of glucocorticoid eye drops induced ocular hypertension were compared between the pediatric and adult uveitic groups. The clinical patterns of 1% prednisolone acetate eye drops induced ocular hypertension in pediatric and adult uveitic eyes were also investigated. Data were analyzed using the Mann-Whitney test and the χ(2) test. The clinical data of 1 138 uveitic eyes [677 patients; 331 males and 346 females; mean age (31±16) years]receiving corticosteroid eye drops were reviewed, among which 246 eyes (143 patients) had pediatric uveitis and 892 eyes (534 patients) had adult uveitis. The incidence of glucocorticoid eye drops induced ocular hypertension was higher in pediatric eyes (39.8%, 98/246) as compared to adults (29.1%, 260/892) (χ(2)=9.880, 0.002). One hundred and thirty eyes (75 patients) with 1% prednisolone acetate induced ocular hypertension were included in the clinical pattern analysis, including 49 [28 patients; 15 males and 13 females; mean age (11±3) years] pediatric and 81 [47 patients; 22 males and 25 females;mean age (34±12) years] adult uveitic eyes. No differences were found in daily doses of 1% prednisolone acetate between the pediatric group [4.60 (3.46, 5.36) drops/day] and the adult group [4.00 (3.30, 4.88) drops/day; -1.675, 0.094]. But the duration of medication in pediatric eyes [4.71 (2.79, 6.36) weeks] was significantly shorter as compared to the adults [6.00 (4.86, 9.00) weeks; -3.446, 0.001]. The intraocular pressure (IOP) was 26.00 (24.00, 31.00) mmHg (1 mmHg=0.133 kPa) in pediatric uveitic eyes and 26.00 (23.30, 31.15) mmHg in the adults, which showed no statistical significance (-0.231,0.818). To achieve effective IOP control, 79.6% (39/49) of pediatric and 54.3% (44/81) of adult eyes received IOP-lowering drug therapy (χ(2)=8.447,0.004). And during the follow-up, the withdrawal rate of IOP-lowering drugs was much lower in pediatric eyes (48.7%, 19/39) as compared to the adult group (72.7%, 32/44) (χ(2)=5.031, 0.025). Compared with adult patients with uveitis, children with uveitis are more prone to IOP elevation, which is more difficult to control after the use of glucocorticoid eye drops. .
探讨糖皮质激素滴眼液诱发小儿及成人葡萄膜炎性眼病性高眼压的临床特征。回顾性调查2013年3月至2017年8月在北京协和医院接受转诊服务的连续性葡萄膜炎患者。比较小儿和成人葡萄膜炎组中糖皮质激素滴眼液诱发高眼压的发生率。还研究了1%醋酸泼尼松龙滴眼液诱发小儿及成人葡萄膜炎性眼病性高眼压的临床模式。采用Mann-Whitney检验和χ²检验进行数据分析。回顾了1138只接受皮质类固醇滴眼液治疗的葡萄膜炎性眼病的临床资料[677例患者；男性331例，女性346例；平均年龄(31±16)岁]，其中246只眼(143例患者)为小儿葡萄膜炎，892只眼(534例患者)为成人葡萄膜炎。小儿葡萄膜炎性眼病中糖皮质激素滴眼液诱发高眼压的发生率(39.8%，98/246)高于成人(29.1%，260/892)(χ²=9.880，P=0.002)。130只眼(75例患者)发生1%醋酸泼尼松龙诱发的高眼压被纳入临床模式分析，其中小儿葡萄膜炎性眼病49只[28例患者；男性15例，女性13例；平均年龄(11±3)岁]，成人葡萄膜炎性眼病81只[47例患者；男性22例，女性25例；平均年龄(34±12)岁]。小儿组[4.60(3.46，5.36)滴/天]和成人组[4.00(3.30，4.88)滴/天；Z=-1.675，P=0.094]之间1%醋酸泼尼松龙的每日剂量无差异。但小儿葡萄膜炎性眼病的用药时间[4.71(2.79，6.36)周]明显短于成人[6.00(4.86，9.00)周；Z=-3.446，P=0.001]。小儿葡萄膜炎性眼病的眼压(IOP)为26.00(24.00，31.00)mmHg(1mmHg=0.133kPa)，成人为26.00(23.30，31.15)mmHg，差异无统计学意义(Z=-0.231，P=0.818)。为有效控制眼压，小儿葡萄膜炎性眼病中79.6%(39/49)和成人葡萄膜炎性眼病中54.3%(44/81)接受了降眼压药物治疗(χ²=8.447，P=0.004)。在随访期间，小儿葡萄膜炎性眼病中降眼压药物的停用率(48.7%，19/39)明显低于成人组(72.7%，32/44)(χ²=5.031，P=0.025)。与成人葡萄膜炎患者相比，小儿葡萄膜炎患者更容易出现眼压升高，使用糖皮质激素滴眼液后眼压更难控制。
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