Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York, U.S.A.
Ophthalmic Plast Reconstr Surg. 2019 Sep/Oct;35(5):465-468. doi: 10.1097/IOP.0000000000001320.
To study the effect of periocular steroid use on intraocular pressure (IOP).
Charts of adult patients with atopic dermatitis or eczema treated with topical periocular steroid creams and ointments from January 1st, 2007 to October 1st, 2017 were reviewed. Patients with the following were excluded: glaucoma, ocular hypertension, known systemic/topical/injectable steroid history, and lack of documented IOP prior to or during treatment with periocular steroid ointment. Patient data were collected regarding gender, treatment regimen, as well as IOP prior to and during treatment. Steroid responders were identified. Statistical analysis was performed using linear mixed effects models adjusting for follow-up time to test the relationship between pre and posttreatment IOP change adjusting for intereye correlations.
Thirty-one patients were identified. Twenty-one were treated bilaterally and 10 unilaterally. Five patients were glaucoma suspects. The mean treatment period was 14.2 weeks with a range of 0.1-83.9 weeks. Patients were treated with fluorometholone (42%), loteprednol etabonate (23%), dexamethasone-neomycin-polymyxin B (13%), hydrocortisone 1% or 2.5% (3%), and tobramycin-dexamethasone (19%). In the combined sample, there was no significant IOP change even after adjusting for follow-up time (mean change: +0.44 mm Hg, p = 0.126). However, eyes with baseline IOP ≥ 14 mm Hg had a significant increase (+0.73 mm Hg/year, p = 0.032). Individual steroid responses included the following: 1 intermediate and 30 low responders, of which 19 patients had an IOP change of <1 mm Hg. One patient had a clinically significant intermediate steroid response of 7 mm Hg.
Periocular steroid treatment causes a statistically significant rise in IOP in eyes with higher baseline IOP measurements, the risk of which increases with follow up. While this change is not always correlated with a clinically significant rise in IOP, clinicians should monitor more closely patients at greatest risk of steroid response.
研究眼周皮质类固醇使用对眼内压（IOP）的影响。
回顾了 2007 年 1 月 1 日至 2017 年 10 月 1 日期间接受局部眼周皮质类固醇乳膏和软膏治疗的特应性皮炎或湿疹成人患者的图表。排除以下患者：青光眼、高眼压、已知全身/局部/注射皮质类固醇史以及在接受眼周皮质类固醇软膏治疗之前或期间未记录 IOP。收集患者的性别、治疗方案以及治疗前后的 IOP 数据。确定皮质类固醇应答者。使用线性混合效应模型进行统计分析，调整随访时间以测试治疗前后 IOP 变化与双眼相关性之间的关系。
共确定了 31 名患者。21 名患者接受双侧治疗，10 名患者接受单侧治疗。5 名患者为青光眼疑似患者。平均治疗时间为 14.2 周，范围为 0.1-83.9 周。患者接受氟米龙（42%）、洛美他松依托泊苷（23%）、地塞米松-新霉素-多粘菌素 B（13%）、1%或 2.5%氢化可的松（3%）和妥布霉素-地塞米松（19%）治疗。在综合样本中，即使在调整随访时间后，IOP 也没有明显变化（平均变化：+0.44mmHg，p=0.126）。然而，基线 IOP≥14mmHg 的眼睛有显著增加（+0.73mmHg/年，p=0.032）。个体皮质类固醇反应包括以下内容：1 名中度和 30 名低度反应者，其中 19 名患者的 IOP 变化<1mmHg。1 名患者出现 7mmHg 的中度类固醇反应。
眼周皮质类固醇治疗会导致基线 IOP 较高的眼睛的 IOP 出现统计学上的显著升高，这种风险随着随访时间的增加而增加。虽然这种变化并不总是与 IOP 的临床显著升高相关，但临床医生应更密切地监测处于皮质类固醇反应风险最大的患者。
