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Steroid-induced glaucoma

机译：类固醇诱导的青光眼

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CASEAbout a decade ago, I was referred the case of a 12-year-old Asian female. At the time, she wore contact lenses to correct -5.00 D of myopia. The patient had reported to her treating optometrist irritation from her contact lenses; the optometrist in turn offered palliative measures aimed at reducing the intolerance. Unbeknownst to the treating optometrist, however, the patient’s mother obtained a medication while traveling in Asia that she gave to her daughter. In 2005, the FDA shut down the OTC manufacturer of this formulation, called “Bright Eyes” for numerous infractions, including the safety of some of its products and manufacturing deficiencies.1The patient subsequently used this formulation for more than a year, likely multiple times a day. Upon further investigation, I discovered that this medication contained three active ingredients: an antibiotic, a vasoconstrictor and dexamethasone.During my initial examination, I found pressures in both eyes over 40 mm Hg, significant optic nerve damage and moderate visual field loss. We immediately discontinued use of the formulation and placed the patient on topical glaucoma therapy. Later in the treatment course, we added an oral medication to attempt to control the pressure. She also underwent a trabeculotomy by internal approach (Trabectome, NeoMedix) after a pressure spike to more than 40 mm Hg. This brought her IOP down to the high teens, but by age 13, she had progressive visual field loss and required a trabeculectomy in both eyes.Since the initial referral, we have continued to follow this patient. Her pressures are maintained in the low teens, although she recently required the use of a topical medication to maintain the target pressure. During the most recent examination, the patient, now 22 years old, exhibited functioning filtration blebs but with some degree of fibrosis and scarring around the site of the trabeculectomies.
机译：案例大约十年前，我被转介为一名12岁的亚洲女性。当时，她戴了隐形眼镜以矫正-5.00 D的近视眼。该患者向她的隐形眼镜报告了正在治疗的验光师刺激症状。验光师反过来提供了旨在减轻不宽容度的姑息措施。但是，对于治疗验光师来说并不为人所知，患者的母亲在亚洲旅行时获得了她送给女儿的药物。 2005年，FDA因许多违规行为（包括其某些产品的安全性和制造缺陷）关闭了该配方的OTC制造商，称其为“亮眼”。1患者随后使用该配方一年以上，可能多次一天。经过进一步的调查，我发现这种药物包含三种活性成分：抗生素，血管收缩药和地塞米松。在我的初次检查中，我发现两只眼睛的压力都超过40毫米汞柱，严重的视神经损伤和中度视野丧失。我们立即停止使用该制剂，并将患者置于局部青光眼治疗中。在治疗过程的后期，我们添加了口服药物以试图控制压力。在压力峰值超过40毫米汞柱后，她还通过内部方法（Trabectome，NeoMedix）进行了小梁切开术。这使她的IOP降到了十几岁，但到了13岁，她的视野逐渐丧失，需要双眼进行小梁切除术。自初次转诊以来，我们一直在追踪该患者。尽管最近她需要使用局部药物来维持目标压力，但她的压力仍保持在十几岁左右。在最近的检查中，现年22岁的患者表现出功能性滤过泡，但在小梁切除部位周围有一定程度的纤维化和瘢痕形成。

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