联合应用地塞米松与长春新碱致急性B淋巴细胞白血病患儿急性继发性青光眼

Acute secondary glaucoma due to concomitant use of dexamethasone and vincristine in a child with acute B lymphoblastic leukemia

1例6岁男童因急性B淋巴细胞白血病采用VDLD化疗方案(地塞米松0.75 mg/d口服,1~7 d;长春新碱1.45 mg静脉注射,第7、15、22、29天;柔红霉素29 mg静脉滴注,第8、15天;左旋门冬酰胺酶4850 U肌内注射,第8、11、14、17、20、23、26、29天)。口服地塞米松第7天同时静脉注射长春新碱1.45 mg,约7 h后,患儿出现双眼胀痛、视物模糊、头痛和呕吐等症状,双眼眼压测量结果示左眼62 mmHg(1 mmHg=0.133 kPa)、右眼61 mmHg。诊断为双眼急性继发性青光眼,考虑与地塞米松和长春新碱有关。中止该方案化疗,给予降眼压及青光眼常规治疗,1周后患儿眼压恢复正常。此后改变化疗方案,患儿未再出现青光眼的症状。

A 6⁃year⁃old boy received VDLD chemotherapy regimen(oral dexamethasone 0.75 mg once daily on days 1⁃7;intravenous injection of vincristine 1.45 mg on the 7th,15th,21th,and 29th day;intravenous infusion of daunorubicin 29 mg on the 8th and 15th day;intramuscular injection of L⁃asparaginase 4850 U on the 8th,11th,14th,17th,20th,23rd,26th,and 29th day)for acute B lymphoblastic leukemia.On the 7th day,vincristine was injected intravenously after oral administration of dexamethasone.About 7 hours later,the child developed distending pain in both eyes,blurred vision,headache,and vomi-ting.The measurement of binocular intraocular pressure showed 62 mmHg in the left eye and 61 mmHg in the right eye.It was diagnosed as acute secondary glaucoma in both eyes,which was considered to be related to dexamethasone and vincristine.Above⁃mentioned chemotherapy regimen was stopped and the treatment of reduction of intraocular pressure and conventional therapy for glaucoma were given.One week later,the child′s intraocular pressure returned to normal.Then chemotherapy regimen was changed and his symptoms of glaucomadid did not recur.