Hámor Andrea, Markó Roland, Rák Tibor, Csutak Adrienne
1 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ, Szemészeti Klinika Pécs, Rákóczi út 2., 7633 Magyarország.
2 Petz Aladár Egyetemi Oktató Kórház Győr Magyarország.
Orv Hetil. 2022 Aug 21;163(34):1345-1352. doi: 10.1556/650.2022.32548.
Glucocorticosteroids are key anti-inflammatory agents in the treatment of ophthalmic and systemic inflammatory diseases. However, prolonged use may result in an increase in intraocular pressure followed by a potentially vision -threatening ocular complication as glaucomatous neuropathy ultimately leading to blindness. Steroid therapy can increase intraocular pressure not only with ophthalmic preparations, but also with other routes of administration such as inhalational, intranasal and systemic. The aim of this paper is to provide a summary of the etiology, diagnosis, and treatment options for steroid-induced iatrogenic glaucoma, based on key literature findings and our own clinical experience, with a detailed comparison of different corticosteroid treatments. The application of steroid therapy can be avoided in a small number of medical fields, so it is crucial that where prolonged steroid therapy is required, all physicians should consider the intraocular pressure-enhancing effects of steroids. The intraocular pressure-increasing effect of steroids depends on the type of active substance, the route of administration and the time of administration. Regardless of the application of a certain medical field, regular ophthalmic examination is necessary, especially with a history of glaucoma, as persistent elevations in intraocular pressure can cause irreversible damage to ganglion cells and optic nerve fibers, ultimately leading to blindness. The difficulty in recognizing the complication is exacerbated by the fact that the intraocular pressure usually rises asymptomatically and painlessly. When steroid therapy cannot be avoided, the least possible intraocular pressure-increasing agent should be selected for the shortest possible dosage at the lowest possible dose. If the increase in intraocular pressure cannot be controlled conservatively, a surgical solution may be considered.
糖皮质激素是治疗眼科和全身性炎症性疾病的关键抗炎药物。然而，长期使用可能导致眼压升高，继而引发潜在威胁视力的眼部并发症，如青光眼性神经病变，最终导致失明。类固醇疗法不仅可通过眼科制剂升高眼压，还可通过其他给药途径，如吸入、鼻内和全身给药途径。本文旨在根据关键文献研究结果及我们自身的临床经验，对类固醇诱导的医源性青光眼的病因、诊断和治疗选择进行总结，并对不同皮质类固醇治疗方法进行详细比较。在少数医学领域可避免使用类固醇疗法，因此，在需要长期使用类固醇疗法的情况下，所有医生都应考虑类固醇升高眼压的作用，这一点至关重要。类固醇升高眼压的作用取决于活性物质的类型、给药途径和给药时间。无论在哪个医学领域应用，定期眼科检查都是必要的，尤其是有青光眼病史者，因为眼压持续升高可导致神经节细胞和视神经纤维发生不可逆损伤，最终导致失明。眼压通常无症状、无痛地升高，这一事实加剧了识别该并发症的难度。当无法避免使用类固醇疗法时，应选择升高眼压作用最小的药物，以尽可能低的剂量、尽可能短的疗程使用。如果眼压升高无法通过保守方法控制，则可考虑手术治疗。
