Departments of Pediatric Gastroenterology.
Ophthalmology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
J Glaucoma. 2019 Oct;28(10):929-933. doi: 10.1097/IJG.0000000000001352.
Topical corticosteroids are known to cause raised intraocular pressure (IOP). However, there is a scarcity of literature regarding systemic steroids-induced raised IOP in children. The authors aimed to evaluate the IOP in children with autoimmune hepatitis (AIH) receiving oral prednisone.
In this prospective study, children (1 to 18 y) with newly diagnosed AIH who received oral prednisone (July 2016 to December 2017) were included. Comprehensive ophthalmic check-up, including visual acuity, IOP, slit-lamp, and fundus examinations were done before and at 1, 3, and 6 months of follow-up. IOP ≥20 mm Hg was considered raised IOP. Symptomatic raised IOP patients were managed with antiglaucoma medication with a tapering dose of prednisone.
A total of 33 children (19 boys) with a median age of 11 (3 to 18) years were analyzed. Raised IOP was observed in 20 (61%) children (19 were moderate and 1 was high responder) at 1 month, 8 (24%) at 3 months, and 1 (3%) at 6 months of treatment. Patients who developed raised IOP had a more severe liver disease in terms of decompensation and low albumin and high pediatric end-stage liver disease scores at presentation. There was no correlation between IOP and starting and cumulative dose of steroids. On multivariate analysis, decompensation at presentation was significantly associated with raised IOP (P<0.001; odds ratio, 30; 95% confidence interval, 4.2-210.6). Raised IOP returned to normal with antiglaucoma medication along with prednisone tapering in all except one.
Systemic corticosteroids in children with AIH carry a risk for IOP elevation, especially in decompensated liver disease. A periodic ophthalmic check-up is necessary for early recognition and intervention before irreversible vision loss.
已知局部皮质类固醇会引起眼内压升高（IOP）。然而，关于儿童系统性类固醇引起的IOP 升高的文献却很少。作者旨在评估接受口服泼尼松治疗的自身免疫性肝炎（AIH）儿童的 IOP。
在这项前瞻性研究中，纳入了 2016 年 7 月至 2017 年 12 月期间接受口服泼尼松治疗的新诊断为 AIH 的儿童（1 至 18 岁）。在随访的 1、3 和 6 个月进行全面眼科检查，包括视力、IOP、裂隙灯和眼底检查。IOP≥20mmHg 被认为是升高的 IOP。对有症状的升高的 IOP 患者进行抗青光眼药物治疗，并逐渐减少泼尼松的剂量。
共分析了 33 名儿童（19 名男孩），中位年龄为 11（3 至 18）岁。在治疗 1 个月时，20 名（61%）儿童出现升高的 IOP（19 名是中度，1 名是高度反应者），8 名（24%）在 3 个月时，1 名（3%）在 6 个月时。出现升高的 IOP 的患者在发病时存在更严重的肝病，表现为肝功能失代偿、低白蛋白血症和高儿童终末期肝病评分。IOP 与激素的起始剂量和累积剂量之间没有相关性。多变量分析显示，发病时的肝功能失代偿与升高的 IOP 显著相关（P<0.001；比值比，30；95%置信区间，4.2-210.6）。除 1 例外，所有患者在停用泼尼松的同时使用抗青光眼药物治疗后，IOP 恢复正常。
AIH 儿童全身使用皮质类固醇会增加 IOP 升高的风险，尤其是在肝功能失代偿的情况下。为了避免视力不可逆转的丧失，有必要定期进行眼科检查以早期发现和干预。
