Ophthalmology Department, Faculty of Medicine, Cairo University, 16 Abd El-Hady Street Manial, Cairo, 114511, Egypt.
Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Graefes Arch Clin Exp Ophthalmol. 2021 Oct;259(10):3159-3165. doi: 10.1007/s00417-021-05221-0. Epub 2021 May 6.
Cushingoid features are occasionally encountered in infants after pediatric cataract surgery. The aim of this study is to evaluate whether the use of topical glucocorticoids (GCs) following congenital cataract surgery can result in endogenous adrenal suppression and/or systemic side effects similar to those seen with systemic steroids.
A prospective study was performed on 20 infants with bilateral congenital cataract. All infants received a single subconjunctival betamethasone injection of 1 mg at the end of surgery in addition to topical dexamethasone eye drops 1 mg/ml for 6 weeks. All infants had anthropometric measurements and blood pressure measurements, serum cortisol, and ACTH level measurements before surgery and 2 months after. In addition, the total administered glucocorticoid adjusted per weight was calculated.
The mean age of the infants was 4.93 ± 2.58 months. Thirteen were males (65%). The total administered glucocorticoid dose was 18.7 mg and the mean cumulative dexamethasone equivalent dose administered was 2.75 ± 1.31 mg/kg. There was a statistically significant increase in the adjusted weight percentile for age (P = 0.009). Both the systolic and diastolic blood pressure were significantly elevated (P = 0.005 and P = 0.025 respectively). There was a statistically significant reduction in both the morning and afternoon serum ACTH levels (P = 0.023 and P = 0.014). The reduction in serum cortisol levels was statistically non-significant.
Topical steroids following pediatric cataract surgery can result in both subclinical and clinical changes in the hypothalamic-pituitary-adrenal axis that can be easily overlooked and need careful attention and follow-up.
小儿白内障手术后偶尔会出现库欣样特征。本研究旨在评估先天性白内障手术后局部使用糖皮质激素（GCs）是否会导致内源性肾上腺抑制和/或全身副作用，类似于全身类固醇引起的副作用。
对 20 例双侧先天性白内障婴儿进行前瞻性研究。所有婴儿在手术结束时均接受 1mg 单剂量球结膜下倍他米松注射，此外还接受 1mg/ml 地塞米松滴眼剂治疗 6 周。所有婴儿在术前和术后 2 个月均进行体格测量和血压测量、血清皮质醇和 ACTH 水平测量。此外，还计算了每体重调整的总糖皮质激素剂量。
婴儿的平均年龄为 4.93±2.58 个月。其中男性 13 例（65%）。总给药剂量为 18.7mg，平均累积地塞米松等效剂量为 2.75±1.31mg/kg。年龄调整体重百分位有统计学显著增加（P=0.009）。收缩压和舒张压均显著升高（P=0.005 和 P=0.025）。清晨和下午的血清 ACTH 水平均有统计学显著降低（P=0.023 和 P=0.014）。血清皮质醇水平降低无统计学意义。
小儿白内障手术后局部使用类固醇可导致下丘脑-垂体-肾上腺轴出现亚临床和临床变化，这些变化很容易被忽视，需要密切关注和随访。
