Krag Susanne, Larsen Dorte, Albertsen Birgitte Klug, Glerup Mia
Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark.
Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
Acta Ophthalmol. 2021 Dec;99(8):e1430-e1434. doi: 10.1111/aos.14820. Epub 2021 Feb 24.
To investigate the risk of steroid-induced ocular hypertension in children treated with systemic glucocorticoid.
Prospective cohort study of children treated with high-dose systemic glucocorticoid (prednisolone-equivalent >0.5 mg/kg/day) for more than 2 weeks. Intraocular pressure (IOP) was measured by an Icare tonometer. An intraocular hypertensive response was defined as a net increase in IOP ≥6 mmHg from baseline or a peak IOP ≥21 mmHg in either eye. Patients with a peak IOP ≥31 mmHg or a net increase in IOP ≥15 mmHg were considered as high responders.
Sixteen children with median age 12 years (range 5-17) were included in the study. Nine children (56%) developed a steroid-induced ocular hypertensive response. Two children (12%) were high responders with peak IOP between 32 and 44 mmHg and a net increase in IOP between 15 and 23 mmHg. All children were asymptomatic and IOP was normalized in all after withdrawal of steroid. Steroid responders were significantly younger than nonresponders (p = 0.03). No associations were found between net IOP increase and time to peak pressure, steroid dose at peak pressure or accumulated prednisolone dose at peak IOP.
Systemic treatment of children with glucocorticoid can cause a significant increase in IOP which indicates the need for IOP screening of these children. The risk of steroid-induced ocular hypertension may depend on age and ethnicity. In this perspective, further studies on Caucasian children are needed.
探讨全身应用糖皮质激素治疗的儿童发生类固醇性青光眼的风险。
对接受高剂量全身糖皮质激素（泼尼松龙等效剂量>0.5mg/kg/天）治疗超过2周的儿童进行前瞻性队列研究。采用Icare眼压计测量眼压。眼压升高反应定义为眼压较基线净升高≥6mmHg或任一眼眼压峰值≥21mmHg。眼压峰值≥31mmHg或眼压净升高≥15mmHg的患者被视为高反应者。
16名年龄中位数为12岁（范围5 - 17岁）的儿童纳入研究。9名儿童（56%）出现类固醇性眼压升高反应。2名儿童（12%）为高反应者，眼压峰值在32至44mmHg之间，眼压净升高在15至23mmHg之间。所有儿童均无症状，停用类固醇后眼压均恢复正常。类固醇反应者明显比无反应者年轻（p = 0.03）。未发现眼压净升高与眼压峰值时间、眼压峰值时的类固醇剂量或眼压峰值时的累积泼尼松龙剂量之间存在关联。
儿童全身应用糖皮质激素可导致眼压显著升高，这表明需要对这些儿童进行眼压筛查。类固醇性青光眼的风险可能取决于年龄和种族。从这个角度来看，需要对白人儿童进行进一步研究。
