儿童及成人葡萄膜炎患者糖皮质激素滴眼液所致高眼压特点的比较分析

Clinical features of glucocorticoid eye drops induced ocular hypertension in pediatric and adult uveitic eyes

目的 探讨和比较糖皮质激素滴眼液所致高眼压在儿童及成人葡萄膜炎患者中的发病特点.方法 回顾性病例对照研究.选取2013年3月至2017年8月于北京协和医院眼科就诊的葡萄膜炎患者的临床登记资料,比较糖皮质激素滴眼液相关性高眼压在成人及儿童葡萄膜炎患者中的发生率.分析1%醋酸泼尼松龙滴眼液相关性高眼压在儿童与成人葡萄膜炎患者间用药频率、用药时间、眼压值及降眼压药物治疗效果的差异.儿童与成人患者间结果的比较采用Mann-Whitney检验及x2检验.结果 共查阅677例(1 138只眼)曾应用糖皮质激素滴眼液的葡萄膜炎患者的临床资料,其中男性331例,女性346例;年龄(31±16)岁.包括儿童葡萄膜炎患者143例(246只眼),成人葡萄膜炎患者534例(892只眼).糖皮质激素滴眼液相关性高眼压在儿童患眼中的发生率为39.8%(98/246),而在成人患眼中仅为29.1%(260/892),二者差异有统计学意义(x2=9.880,P=0.002).共75例(130只眼)患者为1%醋酸泼尼松龙滴眼液相关性高眼压,其中儿童患者28例(49只眼),男性15例,女性13例,年龄(11±3)岁;成人患者47例(81只眼),男性22例,女性25例,年龄(34±12)岁.1%醋酸泼尼松龙滴眼液相关性高眼压儿童与成人患眼比较,引起眼压升高的用药频率在儿童及成人患眼分别为4.60(3.46,5.36)次/日与4.00(3.30,4.88)次/日,差异无统计学意义(Z=-1.675,P=0.094);引起眼压升高所需用药时间分别为4.71(2.79,6.36)周与6.00(4.86,9.00)周,儿童较成人患眼显著缩短(Z=-3.446,P<0.001);用药后儿童与成人患眼眼压分别为26.00(24.00,31.00)mrnHg(1 mmHg=0.133 kPa)与26.00(23.30,31.15)mrnHg,差异无统计学意义(Z=-0.231,P=0.818);79.6%(39/49)的儿童葡萄膜炎患眼高眼压需应用降眼压药物控制,成人患眼中这一比例仅为54.3%(44/81),差异有统计学意义(x2=8.447,P=0.004);72.7%(32/44)的成人患眼可在随访期间逐渐停用降眼压药物,而在儿童患眼中这一比例仅为48.7%(19/39),差异有统计学意义(x2=5.031,P=0.025).结论 与成人葡萄膜炎患者比较,儿童葡萄膜炎患者应用糖皮质激素滴眼液后更容易出现眼压升高,且高眼压更难控制。(中华眼科杂志,2018.54:839-842)。

Objective To investigate the clinical features of glucocorticoid eye drops induced ocular hypertension in pediatric and adult uveitic eyes.Methods Retrospective survey of consecutive uveitic patients attending referral service at Peking Union Medical College Hospital from March 2013to August 2017.Incidences of glucocorticoid eye drops induced ocular hypertension were compared between the pediatric and adult uveitic groups.The clinical patterns of 1%prednisolone acetate eye drops induced ocular hypertension in pediatric and adult uveitic eyes were also investigated.Data were analyzed using the Mann-Whitney test and the X^2test.Results The clinical data of I 138uveitic eyes [677patients;331males and 346females;mean age (31±16)years]receiving corticosteroid eye drops were reviewed,among which 246eyes (143patients)had pediatric uveitis and 892eyes (534patients)had adult uveitis.The incidence of glueocorticoid eye drops induced ocular hypertension was higher in pediatric eyes (39.8%,98/246)as compared to adults (29.1%,260/892)(X^2=9.880,P=0.002).One hundred and thirty eyes (75patients)with 1%prednisolone acetate induced ocular hypertension were included in the clinical pattern analysis, including 49[28patients;15males and 13females;mean age (11_+3)years]pediatric and 81[47patients;22 males and 25females;mean age (34+12)years]adult uveitie eyes.No differences were found in daily doses of 1%prednisolone acetate between the pediatric group [4.60(3.46,5.36)drops/day]and the adult group [4.00 (3.30,4.88)drops/day;Z=-1.675,P=0.094].But the duration of medication in pediatric eyes [4.71(2.79, 6.36)weeks]was significantly shorter as compared to the adults [6.00(4.86,9.00)weeks;Z=-3.446,P< 0.001].The intraocular pressure (IOP)was 26.00(24.00,31.00)mmHg (1mmHg =0.133kPa)in pediatric uveitic eyes and 26.00(23.30,31.15)mmHg in the adults,which showed no statistical significance (Z= -0.231,P=0.818).To achieve effective IOP control,79.6%(39/49)of pediatric and 54.3%(44/81)of adult eyes received lOP-lowering drug therapy (X^2=8.447,P=0.004).And during the follow-up,the withdrawal rate of IOP-lowering drugs was much lower in pediatric eyes (48.7%,19/39)as compared to the adult group (72.7%,32/44)(X^2=5.031,P=0.025).Conclusion Compared with adult patients with uveitis,children with uveitis are more prone to IOP elevation,which is more difficult to control after the use of glucocortieoid eye drops.(Chin J Ophthalmol,2018,54:839-842).