Corticosteroid-induced glaucoma in pediatric patients with hematological malignancies
Corticosteroid-induced glaucoma in pediatric patients with hematological malignancies
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DOI：
10.1002/pbc.27977
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发表时间：
2019-09-06
影响因子：
3.2
通讯作者：
Manabe, Atsushi
中科院分区：
文献类型：
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作者：
Sugiyama, Minako;Terashita, Yukayo;Manabe, Atsushi
背景皮质类固醇激素，尤其是地塞米松，在儿童恶性血液病的化疗中起着关键作用。我们先前观察到，在皮质类固醇给药期间主诉头痛或头痛恐惧症的患者具有高眼内压（IOP）。我们测量了2016年1月至2018年12月在我院接受治疗的15例急性白血病或淋巴瘤患者在皮质类固醇给药期间的IOP。在开始使用标准剂量皮质类固醇后7天内由眼科医生测量IOP，标准剂量皮质类固醇定义为泼尼松龙60 mg/m2/d，地塞米松10 mg/m2/d。结果15例患者接受了52个疗程含糖皮质激素的化疗。28个疗程中13例眼压超过21 mmHg。13例患者中有12例接受了局部治疗，12例患者中有6例需要额外的利尿剂。地塞米松化疗组的眼压明显高于泼尼松龙化疗组。仅有2例患者主诉头痛、恐怖等症状，其中1例行小梁切开术。所有患者的眼底镜检查结果均正常。随着地塞米松剂量的降低，IOP呈剂量相关性降低。结论：即使在无症状的患者中，也应该在大量皮质类固醇给药期间测量IOP。需要进一步研究用于干预的IOP水平。
Background Corticosteroids, especially dexamethasone, play a critical role in chemotherapy for pediatric hematological malignancies. We previously observed that patients with complaints of headache or photophobia during corticosteroid administration had high intraocular pressure (IOP). Procedure We measured IOP during corticosteroid administration in 15 patients with acute leukemia or lymphoma undergoing treatment at our institution from January 2016 to December 2018. IOP was measured by an ophthalmologist within seven days of the initiation of standard dose of corticosteroid, which was defined as 60 mg/m(2)/day for prednisolone and 10 mg/m(2)/day for dexamethasone. Results Fifteen patients received 52 courses of chemotherapy containing corticosteroids. IOP exceeded 21 mmHg among 13 patients in 28 courses. Twelve of the 13 patients were administered topical treatment, and six of the 12 patients needed additional diuretic agents. IOP during the chemotherapy courses containing dexamethasone was significantly higher compared with IOP during the chemotherapy courses containing prednisolone. Only two patients complained of symptoms, such as headache and photophobia, and one of the two patients underwent trabeculotomy. Funduscopic findings were normal in all patients. There was a dose-associated decrease in IOP with reduction of dexamethasone dose. Conclusions IOP should be measured during administration of substantial corticosteroid doses even in patients with no symptoms. Further investigations regarding the level of IOP for intervention need to be conducted.