Abstract：
OBJECTIVE: Treatment with glucocorticoids following paediatric cataract surgery is crucial to prevent inflammation, but may lead to secondary glaucoma, and hypothalamic-pituitary-adrenal axis suppression. We wish to compare glaucoma outcomes following high-dose and low-dose glucocorticoid treatment after paediatric cataract surgery.
METHODS: This cohort study included Danish children undergoing cataract surgery before 10 years of age, receiving either a low-dose or high-dose postoperative glucocorticoid treatment. Case identification and collection of a standardized dataset were retrospective, from 1 January 2010 to 31 December 2016, and prospective thereafter, until 31 December 2021. High-dose treatment included 0.5-1.0 mg subconjunctival depot dexamethasone or methylprednisolone, followed by 6-8 drops of dexamethasone for 1 week, tapered by one drop weekly. Low-dose treatment included 6 drops for 3 days, followed by 3 drops for 18 days. Sustained (>3 months) ocular hypertension or glaucoma was compared between the two groups.
RESULTS: Overall, 267 children (388 eyes) were included in the study. Ninety-five children (133 eyes) had received high-dose treatment and had a median follow-up time of 89 months (IQR: 57.2-107.4), while 173 children (255 eyes) had received the low-dose treatment and had a median follow-up time of 40.5 months (IQR: 22.9-60.4). Survival curves showed a lower risk of glaucoma in the low-dose group for children with axial lengths ≥18 mm.
CONCLUSIONS: Low-dose glucocorticoid treatment was associated with a lower risk of glaucoma in children with axial lengths ≥18 mm. The same effect was not observed in children with shorter eyes. High-dose glucocorticoid should be limited in children undergoing cataract surgery.
METHODS: This cohort study included Danish children undergoing cataract surgery before 10 years of age, receiving either a low-dose or high-dose postoperative glucocorticoid treatment. Case identification and collection of a standardized dataset were retrospective, from 1 January 2010 to 31 December 2016, and prospective thereafter, until 31 December 2021. High-dose treatment included 0.5-1.0 mg subconjunctival depot dexamethasone or methylprednisolone, followed by 6-8 drops of dexamethasone for 1 week, tapered by one drop weekly. Low-dose treatment included 6 drops for 3 days, followed by 3 drops for 18 days. Sustained (>3 months) ocular hypertension or glaucoma was compared between the two groups.
RESULTS: Overall, 267 children (388 eyes) were included in the study. Ninety-five children (133 eyes) had received high-dose treatment and had a median follow-up time of 89 months (IQR: 57.2-107.4), while 173 children (255 eyes) had received the low-dose treatment and had a median follow-up time of 40.5 months (IQR: 22.9-60.4). Survival curves showed a lower risk of glaucoma in the low-dose group for children with axial lengths ≥18 mm.
CONCLUSIONS: Low-dose glucocorticoid treatment was associated with a lower risk of glaucoma in children with axial lengths ≥18 mm. The same effect was not observed in children with shorter eyes. High-dose glucocorticoid should be limited in children undergoing cataract surgery.
摘要：
目的：小儿白内障手术后使用糖皮质激素治疗对预防炎症至关重要，但可能会导致继发性青光眼，和下丘脑-垂体-肾上腺轴抑制。我们希望比较小儿白内障手术后高剂量和低剂量糖皮质激素治疗后的青光眼结局。
方法：这项队列研究包括在10岁之前接受白内障手术的丹麦儿童，接受低剂量或高剂量的术后糖皮质激素治疗。病例识别和标准化数据集的收集是回顾性的，从2010年1月1日至2016年12月31日，以及此后的预期，直到2021年12月31日。高剂量治疗包括0.5-1.0mg结膜下储库地塞米松或甲基强的松龙，随后6-8滴地塞米松1周，每周减少一滴。低剂量治疗包括6滴3天，随后是3滴18天。比较两组持续(>3个月)高眼压或青光眼。
结果：总体而言，267名儿童（388只眼）被纳入研究。95名儿童（133只眼）接受了大剂量治疗，中位随访时间为89个月（IQR：57.2-107.4）。而173名儿童(255只眼)接受了低剂量治疗,中位随访时间为40.5个月(IQR:22.9-60.4).生存曲线显示，对于轴长≥18mm的儿童，低剂量组的青光眼风险较低。
结论：低剂量糖皮质激素治疗与眼轴长度≥18mm的儿童青光眼风险降低相关。在眼睛较短的儿童中未观察到相同的效果。大剂量糖皮质激素应限制在接受白内障手术的儿童中。
方法：这项队列研究包括在10岁之前接受白内障手术的丹麦儿童，接受低剂量或高剂量的术后糖皮质激素治疗。病例识别和标准化数据集的收集是回顾性的，从2010年1月1日至2016年12月31日，以及此后的预期，直到2021年12月31日。高剂量治疗包括0.5-1.0mg结膜下储库地塞米松或甲基强的松龙，随后6-8滴地塞米松1周，每周减少一滴。低剂量治疗包括6滴3天，随后是3滴18天。比较两组持续(>3个月)高眼压或青光眼。
结果：总体而言，267名儿童（388只眼）被纳入研究。95名儿童（133只眼）接受了大剂量治疗，中位随访时间为89个月（IQR：57.2-107.4）。而173名儿童(255只眼)接受了低剂量治疗,中位随访时间为40.5个月(IQR:22.9-60.4).生存曲线显示，对于轴长≥18mm的儿童，低剂量组的青光眼风险较低。
结论：低剂量糖皮质激素治疗与眼轴长度≥18mm的儿童青光眼风险降低相关。在眼睛较短的儿童中未观察到相同的效果。大剂量糖皮质激素应限制在接受白内障手术的儿童中。
