| Objectives To provide more clinical data for prevention and treatment of glucocorticoid-induced ocular complications,the clinical datas of children with primary nephrotic syndrome treated with glucocorticoid in a single center were retrospectively analyzed.We calculated the incidence rate of glucocorticoid-induced ocular complications,and investigated the correlation between glucocorticoid-induced cataract and cumulative dose and duration of corticosteroids,and observed the early onset time of glucocorticoid-induced ocular complications,and analysed the therapeutic effect of medication treatment for glucocorticoid-induced glaucoma and cataract extraction with intraocular lens implantation for glucocorticoid-induced cataract.Methods Medical records and follow-up records of children with primary nephrotic syndrome were retrospectively analyzed in a single center(Department of Pediatrics of Fuzhou General Hospital)during March 2011 to September 2011.We questioned and recorded the names,dosage and duration of glucocorticoid and other immunosuppressive drugs for each child in detail.We also evaluated the relationship between glucocorticoid-induced cataract and the onset age of primary nephrotic syndrome,the cumulative dosage and duration of glucocorticoid.Statistics was analyzed by the t test or approximate t test.A P value less than 0.05 was considered significant.Results Twenty-nine of 1063 children with primary nephrotic syndrome,23 males and 6 females,met the inclusion criteria and exclusion criteria of glucocorticoid-induced ocular complications.The incidence of glucocorticoidinduced ocular complications was 2.7%.There were 15 cases of simple glaucoma,6 cases of simple cataract,8 cases of glaucoma accompany with cataract.The average onset age of primary nephrotic syndrome was 5.8 ± 3.1 years old,and the average duration of glucocorticoid therapy was 22.8 ± 26.0 months,and the average follow-up time was 16.9 ± 17.0 months.Glucocorticoid-induced cataract was associated with the cumulative dosage and duration of glucocorticoid therapy(P value was 0.018 and 0.005,respectively),but it wasn’t associated with the onset age of primary nephrotic syndrome(P = 0.354).Among the 15 children with simple glaucoma,glaucoma occurred in 2 of them in 3 days after glucocorticoid treatment,including a child with headache,hypertension,hyperemia of bilateral eyes,edema and turbidity of the corneal epithelium.Eleven cases’ intraocular pressures were reduced to normal for 3 days to 5 months,but 4 patients’ intraocular pressures were always higher than normal following up for 5.9 to 30.3 months.Among the 6 children with simple cataract,cataract developed as early as 4.7 months.Five cases had decreased vision and 1 case had normal vision.Cataract phacoemulsification and intraocular lens implantation were performed in the left eye of an 8.2-year-old boy whose vision acuity was 0.15 and 0.2 in left and right eyes,respectively.Followed up 16.8 months,his left intraocular lens stayed clear and the eyes visual acuity was both 0.4.A 3-year-old boy treated with glucocorticoid for 20.1 month had mild cataract in both eyes,but lens opacity disappeared with pinokexin sodium eye drops treatment for 78 days.Among the 8 patients with glaucoma accompany with cataract,6 had decreased vision and 2 cases had normal vision.Ophthalmic cataract extraction and intraocular lens implantation were done in both eyes,and the posterior capsular laser section was done in left one of a 2.8-year-old boy whose vision acuity was 0.4 and 0.3 in left and right eye,respectively.His two intraocular lenses were clear,and his posterior capsular laser hole was formed in left eye,and his ocular visions were 0.6 in both eyes after a 31.7 months follow-up.Conclusions The incidence of glucocorticoid-induced ocular complications of children with primary nephrotic syndrome was 2.7% in our center.Glucocorticoid-induced glaucoma could occur in the earliest period of 3 days and glucocorticoid-induced cataract could appear in 4.7 months after glucocorticoid treatmentment.Glucocorticoid-induced cataract was associated with the cumulative dosage and duration of glucocorticoid treatment.These results suggest that children with primary nephrotic syndrome should perform a regular eye examination after glucocorticoid therapy,and timely treatment should be necessary for glucocorticoid-induced ocular complications once it comes out,and both the dosage and the duration of glucocorticoid treatment should be reduced as far as possible,and medication should be optimum selection for glucocorticoid-induced glaucoma,and surgical treatment shoud be performed for children with glucocorticoid-induced cataract with visual acuity no more than 0.4. |
