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目的探讨皮质类固醇性青光眼的病因及防治。方法对我院2007年至2010年皮质类固醇性青光眼病例做系统回顾分析。结果确诊为皮质类固醇性青光眼患者30例60眼男16例,女14例,年龄6～30岁。长期使用药物为口服强的松,的确当眼药水点眼,氯地水点眼(氯霉素眼药水+地塞米松注射液)。所有病例均为连续用药,使用时间为1～6年。所有病例均有眼压增高(40～70mmHg)视乳头凹陷扩大(C/D=0.5～1.0)。视野不同程度缺损(环形暗点7例、鼻侧阶梯15例、管状视野6例,视力太差无法检查视野2例)。OCT检查显示视神经纤维层变薄。所有患者房角均为开角。立即停用皮质类固醇药物,采取降眼压治疗,对于全身病不能停用皮质类固醇药物的,联合降眼压药物,最终施行了抗青光眼手术后眼压恢复正常。随访6个月～2年,再次手术6例,治疗后视力提高4例,视野改善5例,视力下降6例。结论类固醇性青光眼临床表现与开角型青光眼相似,但有自愈倾向,如被忽视可造成永久性的视乳头和视野损害。患者具有长期应用类固醇的历史,病例临床表现呈慢性过程,在使用激素的过程中,我们各科医师一定要在注意药物的疗效的同时也要注意它的副作用,严格掌握适应证,严密的观察病人的局部及全身变化,对于需要长期应用的病人,应该应用副作用最小或替代药物疗法,要做到合理用药,安全用药。
Objective To investigate the etiology and prevention of corticosteroid glaucoma. Methods A retrospective analysis of corticosteroid glaucoma in our hospital from 2007 to 2010 was conducted. Results 30 patients were diagnosed as corticosteroid glaucoma in 60 eyes, 16 males and 14 females, aged 6 to 30 years. Long-term use of drugs for oral prednisone, indeed when the eye drops eye, chlorine water eye (chloramphenicol eye drops + dexamethasone injection). All cases are continuous medication, the use of time for 1-6 years. All cases were intraocular pressure increased (40 ~ 70mmHg) optic disc depression (C / D = 0.5 ~ 1.0). Different degrees of visual field defects (ring dark spots in 7 cases, 15 cases of nasal ladder, tubular field of vision in 6 cases, poor vision can not check the field of vision in 2 cases). OCT examination revealed thinning of the optic nerve fiber layer. All patients had an open angle. Immediate corticosteroid use of drugs to reduce intraocular pressure, corticosteroids can not be disabled for systemic disease, combined with antihypertensive drugs, the final implementation of anti-glaucoma surgery after intraocular pressure returned to normal. Follow-up 6 months to 2 years, 6 cases of reoperation, visual acuity improved in 4 cases, visual field improvement in 5 cases, vision loss in 6 cases. Conclusion The clinical manifestations of steroid-like glaucoma are similar to those of open-angle glaucoma, but there is a tendency of self-healing. If neglected, it can cause permanent damage to the optic nerve and visual field. Patients with long-term history of the use of steroids, the clinical manifestations of patients showed a chronic process, the use of hormones in the process, our physicians must pay attention to the efficacy of the drug must also pay attention to its side effects, strict indications, close observation Local and systemic changes in patients with long-term use of patients should be the application of minimal or alternative side effects of drug therapy, to be rational drug use, safe medication.