VST Glaucoma Center, L V Prasad Eye Institute, Hyderabad, India
VST Glaucoma Center, L V Prasad Eye Institute, Hyderabad, India.
Br J Ophthalmol. 2020 Feb;104(2):265-269. doi: 10.1136/bjophthalmol-2019-313988. Epub 2019 May 4.
To report the clinical features, treatment outcomes and blindness associated with steroid-induced glaucoma in vernal keratoconjunctivitis (VKC).
Records of patients with VKC, who visited our tertiary centre from 1992 and 2009, were reviewed and those with steroid-induced glaucoma were included in the study. Glaucoma was diagnosed based on intraocular pressure (IOP) ≥22 mm Hg on two consecutive visits (ocular hypertension) and/or glaucomatous optic disc damage. Blindness was defined as best corrected visual acuity of ≤20/400 or visual field <10°.
Of the 4062 VKC subjects, 91 (157 eyes) had steroid-induced glaucoma (SIG), showing a prevalence of 2.24%. Of these 87% were men. The median (IQR) age at onset of VKC was 12 years (7-17). At presentation, the median duration of VKC was 48 months (24-72) and the median duration of steroid usage was 24 months (12-36). The median cup-to-disc ratio (CDR) was 0.9 (0.7-0.9) and median mean deviation was -21.9 dB (-30.0 to -10.2). IOP was medically controlled in 66% eyes (104/157) and 34% eyes (53/157) needed glaucoma surgery. High presenting IOP (OR: 1.04; p=0.05) and increased duration of steroid usage (OR: 1.07; p=0.02) were significantly associated with need for glaucoma surgery. At presentation, 29/91 subjects (31.8%) were bilaterally blind due to SIG. Higher CDR at presentation was significantly associated with blindness in this cohort (p=0.02).
In this cohort of VKC with SIG, the disease predominantly affected adolescent males. Glaucoma was severe with one-third needing surgery and one-third blind due to SIG.
报告春季角结膜炎（VKC）继发类固醇性青光眼的临床特征、治疗结果和相关盲率。
对 1992 年至 2009 年期间在我院就诊的 VKC 患者的病历进行了回顾性分析，纳入研究的患者均患有类固醇性青光眼。青光眼的诊断基于两次连续就诊时眼压（IOP）≥22mmHg（眼压升高）和/或青光眼性视盘损害。盲的定义为最佳矫正视力≤20/400 或视野＜10°。
在 4062 例 VKC 患者中，91 例（157 只眼）患有类固醇性青光眼（SIG），患病率为 2.24%。其中 87%为男性。VKC 的发病年龄中位数（IQR）为 12 岁（7-17 岁）。就诊时，VKC 的中位病程为 48 个月（24-72 个月），类固醇使用的中位病程为 24 个月（12-36 个月）。杯盘比（CDR）中位数为 0.9（0.7-0.9），平均偏差中位数为-21.9dB（-30.0 至-10.2）。66%（104/157）的眼通过药物控制了眼压，34%（53/157）的眼需要进行青光眼手术。较高的初始眼压（OR：1.04；p=0.05）和较长的类固醇使用时间（OR：1.07；p=0.02）与需要手术治疗显著相关。就诊时，91 例患者中有 29 例（31.8%）因 SIG 导致双眼盲。在该队列中，较高的初始 CDR 与失明显著相关（p=0.02）。
在这组 VKC 继发 SIG 的患者中，疾病主要影响青少年男性。青光眼较为严重，三分之一的患者需要手术治疗，三分之一的患者因 SIG 导致失明。
