Two Cases of Sudden Intraocular Pressure Elevation in Children after Steroid Treatment

Minjeong Kim, K. Kim, J. Jeong, Nam Ju Moon, Y. Chun
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Abstract

Purpose: We report two cases of sudden intraocular pressure (IOP) elevation in children after steroid treatment.Case summary: (Case 1) An 8-year-old boy visited the hospital with vomiting and headache that had begun 3 days after application of dexamethasone eyedrops. IOPs were 55 and 62 mmHg in the right and left eyes, respectively; both anterior chambers were normal. The eyedrops were stopped and timolol/dorzolamide was applied twice daily. After intravenous mannitol injection, the IOPs of both eyes decreased to 18 mmHg within 24 hours. (Case 2) A 10-year-old boy diagnosed with coronavirus disease 2019 three days prior had been prescribed methylprednisolone 4 mg twice daily; he visited the hospital with headache, eye pain, and decreased vision that began 1 day after medication. IOPs were 41 and 54 mmHg in the right and left eyes, respectively; both anterior chambers were normal. After drug discontinuation, timolol/dorzolamide, brimonidine, and latanoprost eyedrops were applied. Subsequently, after intravenous mannitol injection, the IOPs decreased within 24 hours to 7 and 16 mmHg in the right and left eyes, respectively; they remained stable. However, thinning was observed in the retinal nerve fiber and ganglion cell-inner plexiform layer.Conclusions: Children can develop rapid IOP elevation after even 1 day of steroid use; residual structural damage may be present, despite prompt treatment. Clinicians must closely monitor such patients for atypical IOP elevation.
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两例类固醇治疗后眼压突然升高的儿童病例
目的:我们报告了两例儿童在接受类固醇治疗后眼压突然升高的病例。病例摘要:(病例 1)一名 8 岁男孩在使用地塞米松眼药水 3 天后因呕吐和头痛到医院就诊。右眼和左眼的眼压分别为 55 和 62 毫米汞柱,两个前房均正常。停用眼药水后,每天使用两次噻吗洛尔/度冷丁。静脉注射甘露醇后,双眼的眼压在 24 小时内降至 18 毫米汞柱。(病例 2)一名 10 岁男孩在 3 天前被诊断为 2019 年冠状病毒病,医生给他开了甲基强的松龙 4 毫克,每天两次。右眼和左眼的眼压分别为 41 毫米汞柱和 54 毫米汞柱,两个前房均正常。停药后,使用了噻吗洛尔/多佐胺、溴莫尼丁和拉坦前列素眼药水。随后,在静脉注射甘露醇后,右眼和左眼的眼压在 24 小时内分别降至 7 毫米汞柱和 16 毫米汞柱,并保持稳定。然而,在视网膜神经纤维层和神经节细胞内丛状层观察到变薄:结论:使用类固醇一天后,儿童的眼压就会迅速升高;尽管治疗及时,但仍可能存在残余的结构性损伤。临床医生必须密切监测此类患者的非典型眼压升高。
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126
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