Ma Yichen, Chen Zhengyuan, Ma Zengyi, Ye Hongying, Zhang Zhaoyun, Wang Yongfei, Yang Huiyin, Lu Zhaozeng, Wang Zhiliang, Qiao Nidan, Xiao Yiqin, Zhao Yao
Departments of Ophthalmology.
Neurosurgery.
J Glaucoma. 2022 Dec 1;31(12):941-946. doi: 10.1097/IJG.0000000000002113. Epub 2022 Aug 17.
An increased risk of ocular hypertension was seen in Cushing's disease.
Systemic steroid use is a significant risk factor for increased intraocular pressure (IOP). The incidence of ocular hypertension may rise to 30%-40% of the general population due to topical or systemic glucocorticoid usage. However, the incidence of ocular hypertension in endogenous hypercortisolemia, as well as the ophthalmological outcomes after endocrine remission due to surgical resection, remain unknown.
The IOP, visual field, and peripapillary retinal nerve fiber layer thickness were documented in all patients with Cushing's disease (CD) admitted to a tertiary pituitary center for surgery from January to July 2019. Patients with acromegaly and patients with nonfunctioning pituitary adenoma (NFPA) during the same study period served as controls. We calculated the odds ratio (OR), identified the risk factors of developing ocular hypertension, and presented postoperative trends of the IOP.
A total of 52 patients (38.4±12.4 y old) with CD were included. The IOP was higher in patients with CD (left 19.4±5.4 mm Hg and right 20.0±7.1 mm Hg) than in patients with acromegaly (left 17.5±2.3 mm Hg and right 18.6±7.0 mm Hg, P =0.033) and patients with NFPA (left 17.8±2.6 mm Hg and right 17.4±2.4 mm Hg, P =0.005). A total of 21 eyes (20.2%) in patients with CD were diagnosed with ocular hypertension compared with 4 eyes (4.7%) in the acromegaly group and 4 eyes (4.5%) in the NFPA group. The OR of developing ocular hypertension in patients with CD was 5.1 [95% confidence interval (CI), 1.3-25.1, P =0.029] and 6.6 (95% CI, 1.8-30.3, P =0.007) when compared with the 2 control groups. Among patients with CD, those with a higher urine-free cortisol were more likely to develop ocular hypertension (OR=19.4, 95% CI, 1.7-72.6). The IOP decreased at 1 month after surgery in patients with CD, and the change was sustained for 3 months after surgery.
An increased risk of ocular hypertension was seen in CD and suggests that endogenous hypercortisolemia should be considered as part of the glaucoma assessment. This result warrants the discretion of both ophthalmologists and neuroendocrinologists.
垂体库欣病患者发生高眼压的风险增加
全身使用类固醇是眼压升高的重要危险因素。由于局部或全身使用糖皮质激素，普通人群中高眼压的发生率可能升至30%-40%。然而，内源性皮质醇增多症患者中高眼压的发生率以及手术切除导致内分泌缓解后的眼科结局仍不清楚。
记录2019年1月至7月入住一家三级垂体中心接受手术的所有库欣病（CD）患者的眼压、视野和视乳头周围视网膜神经纤维层厚度。将同期的肢端肥大症患者和无功能垂体腺瘤（NFPA）患者作为对照。我们计算了比值比（OR），确定了发生高眼压的危险因素，并呈现了术后眼压的变化趋势。
共纳入52例CD患者（年龄38.4±12.4岁）。CD患者的眼压（左眼19.4±5.4 mmHg，右眼20.0±7.1 mmHg）高于肢端肥大症患者（左眼17.5±2.3 mmHg，右眼18.6±7.0 mmHg，P =0.033）和NFPA患者（左眼17.8±2.6 mmHg，右眼17.4±2.4 mmHg，P =0.005）。CD患者中共有21只眼（20.2%）被诊断为高眼压，而肢端肥大症组为4只眼（4.7%），NFPA组为4只眼（4.5%）。与两个对照组相比，CD患者发生高眼压的OR为5.1[95%置信区间（CI），1.3-25.1，P =0.029]，与NFPA组相比OR为6.6（95%CI，1.8-30.3，P =0.007）。在CD患者中，尿游离皮质醇水平较高的患者更易发生高眼压（OR=19.4，95%CI，1.7-72.6）。CD患者术后1个月眼压下降，且术后3个月持续下降。
CD患者发生高眼压的风险增加，提示内源性皮质醇增多症应被视为青光眼评估的一部分。这一结果值得眼科医生和神经内分泌医生重视。
