Ocular Hypertension Induced By Systemic Glucocorticoids In Children With Primary Nephrotic Syndrome And Its Effect On Ocular Development

Objectives To observe the changes of intraocular pressure(IOP)after systemic glucocorticoid in children with primary nephrotic syndrome and the effects of ocular hypertension on the development of ocular and visual function in children.Methods From January 2015 to January 2017,102 children with primary onset who met the diagnostic criteria of nephrotic syndrome and required systemic glucocorticoid application were selected as the research subjects.According to the intraocular pressure after systemic glucocorticoid,the patients were divided into hormone-induced ocular hypertension group and normal intraocular pressure group.The following ophthalmic examinations were performed before hormone application and the first day、the second day、the third day、the first week,the second weeks,the third weeks,the first month,the second month,the third month,the sixth month and full year after treatment: intraocular pressure,ocular biometrics parameters(ocular axial length,anterior chamber depth,corneal curvature),fundus,diopter and other parameters were recorded.All data were analyzed statistically by using Excel to establish a database to explore the changes of intraocular pressure caused by systemic glucocorticoid application in children with nephrotic syndrome and the effects of ocular hypertension on ocular development and refractive development in children.Results 1 The youngest of 102 children was 3 years old and the oldest was 13 years old,with an average age of(6.40±2.64).Among them,44 cases(43.1%)were male and 58 cases(56.9%)were female.Of the children,21 had ocular hypertension(ocular hypertension group),with an incidence rate of 20.6%.The average age of the group with high intraocular pressure was(6.67±2.20)years old,and that of the group with normal intraocular pressure was(6.33±2.75)years old.There were 14 male children(66.7%)and 7 female children(33.3%)in the ocular hypertension group,and 30 male children(37.0%)and 51 female children(63.0%)with normal intraocular pressure.Of the 21 children with ocular hypertension,17 had ocular hypertension in the right eye and 19 in the left eye,of which 15 had ocular hypertension in both eyes.2 Intraocular pressure in children with primary nephrotic syndrome increased after systemic glucocorticoid application,reaching a peak in 1-2 weeks,and then gradually decreased,but it was always higher than that before glucocorticoid application.the difference in intraocular pressure was statistically significant in time(P<0.05).the difference in intraocular pressure at each time point of the first week,the second weeks,the third weeks,the first month,the second month,the third month,the sixth months and full year was statistically significant compared with that before glucocorticoid application.The anterior chamber depth of both eyes deepened,and the difference of anterior chamber depth with time was statistically significant(P<0.05).After systemic hormone therapy,corneal curvature of both eyes in children with nephrotic syndrome decreased and cornea flattened,with statistically significant difference in time(P<0.05).The corneal curvature of the right eye at the sixth months and full year is statistically different from that before hormone therapy,while the corneal curvature of the left eye at the third month,the sixth months and full year is statistically different from that before hormone therapy.After systemic glucocorticoid treatment,the diopter of both eyes in children with nephrotic syndrome decreased and the eyeball showed a myopic trend.The difference in diopter changes with time was statistically significant.The diopters of the first week,the second week,the third week,the first month,the second month,the third month,the sixth month and full year were significantly different from those before hormone application.3 After application of glucocorticoids,the axial length of the eyes in the high intraocular pressure group is significantly different from that in the normal intraocular pressure group(P<0.05),and the axial length of the eyes in the high intraocular pressure group is larger than that in the normal intraocular pressure group.The time after intraocular pressure rise has influence on ocular axis change,and ocular axis lengthens with time change.There is interaction between grouping and time.As time goes on,the extension of ocular axis in high intraocular pressure group is larger than that in normal intraocular pressure group.All of which are the ocular axis length of the high intraocular pressure group is larger than that of the normal intraocular pressure group.The anterior chamber depth in the high intraocular pressure group was significantly different from that in the normal intraocular pressure group(P<0.05).the anterior chamber depth in the high intraocular pressure group was greater than that in the normal intraocular pressure group.Time has an effect on the change of anterior chamber depth,which deepens with time.There is interaction between grouping and time.As time goes on,the increase of anterior chamber depth in high intraocular pressure group is more significant than that in normal intraocular pressure group.The anterior chamber depth of both eyes was statistically different between the two groups at the first week,the second week,the third week,the first month,the second month,the third month,the sixth month and full year time points,both of which were higher than normal intraocular pressure group.There was no significant difference in corneal curvature between the high intraocular pressure group and the normal intraocular pressure group.Time has an effect on the change of corneal curvature,and the cornea tends to flatten with the change of time.Whether intraocular pressure increases or not has an interaction with time.With time prolonging,the corneal curvature flattening trend in the high intraocular pressure group is more significant than that in the normal intraocular pressure group.There was no significant difference in corneal curvature between the two groups at all time points.After systemic application of glucocorticoid in children with primary nephrotic syndrome,the diopter difference between the high intraocular pressure group and the normal intraocular pressure group is statistically significant(P<0.05).the diopter of the high intraocular pressure group is lower than that of the normal intraocular pressure group.The diopter changes are different in time,and the eyeball becomes myopic gradually with the change of time.The diopter of the group with high intraocular pressure decreased more than that of the group with normal intraocular pressure,and the tendency of myopia became more obvious with time prolonging.There were statistical differences in binocular diopter between the two groups at the first week,the second week,the third week,the first month,the second month,the third month,the sixth month and full year.The refractive state of the high intraocular pressure group tended to be myopia.Conclusions 1 Intraocular pressure increase in children with primary nephrotic syndrome after systemic glucocorticoid administration;2 Increased intraocular pressure affects eyeball biological parameters and diopter;3 The myopic trend in the hormonal hypertensive group was more significant than that in the normal intraocular group.Figure 13;Table 13;Reference 93.