Children Eye Care Center, Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Chitrakoot, Madhya Pradesh, India.
Indian J Ophthalmol. 2019 Oct;67(10):1650-1655. doi: 10.4103/ijo.IJO_2143_18.
To know the pattern of presentations and management outcome of steroid induced glaucoma in vernal keratoconjunctivitis (VKC).
Children of VKC using steroid with two of the following criteria were enrolled: Intraocular pressure (IOP) >21 mm Hg, glaucomatous optic disc and visual field defects. Misused topical steroids were classified in 4 groups; A- Highly potent drugs (dexamethasone, betamethasone), B- Moderate (prednisolone), C- Weak (loteprednol, fluorometholone), D- Unknown drugs. Active/conservative interventions were done to control IOP. Corrected distance visual acuity (CDVA), IOP, anterior segment and fundus examinations were noted. One-way ANOVA test and post hoc Tukey HSD test were used to compare the groups.
Out of 1423 VKC patients, 240 were using topical steroid without prescriptions. 92 eyes of 47 patients had steroid induced glaucoma. Hence prevalence of this complication was 3.30% in this study population. Mean age was 14.1 ± 3.8 years. Mean IOP was 38 ± 12 mm of Hg and mean vertical cup disc ratio was 0.67 ± 0.25. IOP was controlled by withdrawal of steroids (9 eyes), with antiglaucoma medications (27), trabeculectomy (57) and glaucoma drainage device (1). Mean CDVA at presentation was better in group C (0.23 log MAR). Mean IOP was highest in group A (43.1 mm Hg) followed by group D (40.5 mm Hg). At presentation 17 were blind (CDVA <3/60). Post treatment marginal improvement in CDVA was found (P = 0.46). However, statistically significantly improvement was noticed in IOP (P < 0.00001).
Injudicious use of steroids leads to vision threatening complications like ocular hypertension and glaucoma in children of VKC. Weak steroids like loteprednol or fluorometholone should be used instead of higher potency drugs. Vision and IOP should be monitored fortnightly in children using topical steroids to detect steroid responders at the earliest.
了解春季角结膜炎（VKC）患者中皮质类固醇诱导性青光眼的表现模式和治疗结果。
纳入使用皮质类固醇且符合以下两项标准的 VKC 患儿：眼内压（IOP）>21mmHg、青光眼性视盘和视野缺损。将局部皮质类固醇误用分为 4 组；A-强效药物（地塞米松、倍他米松），B-中效（泼尼松龙），C-弱效（洛美他松、氟米龙），D-未知药物。对眼压进行积极/保守干预。记录最佳矫正远视力（CDVA）、IOP、眼前节和眼底检查。采用单因素方差分析和事后 Tukey HSD 检验比较各组。
在 1423 例 VKC 患者中，240 例未按处方使用局部皮质类固醇。47 例患者的 92 只眼患有皮质类固醇诱导性青光眼。因此，该研究人群中这种并发症的患病率为 3.30%。平均年龄为 14.1±3.8 岁。平均 IOP 为 38±12mmHg，平均垂直杯盘比为 0.67±0.25。通过停用皮质类固醇（9 只眼）、使用抗青光眼药物（27 只眼）、小梁切除术（57 只眼）和青光眼引流装置（1 只眼）控制了 IOP。就诊时，C 组（0.23 对数 MAR）的 CDVA 较好。A 组的平均 IOP 最高（43.1mmHg），其次是 D 组（40.5mmHg）。就诊时，17 人失明（CDVA<3/60）。治疗后 CDVA 略有改善（P=0.46）。然而，IOP 显著改善（P<0.00001）。
皮质类固醇的不当使用会导致儿童 VKC 出现威胁视力的并发症，如眼压升高和青光眼。应使用弱效皮质类固醇，如洛美他松或氟米龙，而不是强效药物。使用局部皮质类固醇的儿童应每两周监测一次视力和眼压，以尽早发现皮质类固醇反应者。
