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.
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。