Hipertensão ocular em pacientes pediátricos com leucemia linfoide aguda: um estudo de 5 anos

Abstract

Introduction: Acute lymphoblastic leukemia (ALL) is the most common malignancy in children under 19 years of age. With advances in treatment, the mortality rate has decreased sharply, and part of this success is due, among other drugs, to the use of high doses of glucocorticoid (GC), essential for the control and cure of the disease. Its use, however, is not without side effects and one of the most important is ocular hypertension (OH), the most common ocular manifestation in this population. In its natural evolution, it can permanently affect the optic nerve, then characterizing cortisonic glaucoma that, in the last stage, can lead to blindness. With the increase in survival of this population, today there is an increasing concern with the quality of life of these patients. Objectives: This study aims to evaluate intraocular pressure (IOP) in patients with ALL using CG, through quantitative IOP characterization, delineation of its temporal evolution, analysis of glucocorticoid response level, identification of possible risk factors for IOP elevation and individual response to GC, possibility of predicting HO through data from the first consultation and IOP use as prognostic factor in terms of CSF infiltration and mortality. Methods: A prospective cohort study was conducted between January 2013 and December 2017 with patients newly diagnosed with ALL. The patients underwent ophthalmic examination before the beginning of treatment (D0), after eight days (D8), at 28 days (D28) and after six months (D6m). HO was considered as IOP ≥ 21 mmHg and increased sensitivity to GC as increases of at least 6 mmHg in IOP. Results: Of the 58 patients included, 10 patients (17.2%) had OH, and the increases were significantly higher in D8 (p <0.001), with some isolated cases still in D28. Of 48 patients, 7 (14.6%) had increased sensitivity to the CG, all of which evolved with OH itself. All pressures normalized after CG cessation at D6m, and no patient was symptomatic. Sex, age, immunophenotyping and cerebrospinal fluid (CSF) infiltration did not act as a risk factor for OH; it was not possible to predict CSF mortality and infiltration from IOP values; it was not possible to predict HO with data from the first consultation. Conclusion: The high rate of OH pointed out in the study not only reinforces the importance of regular eye monitoring, but also directs the period in which these patients are most susceptible to HO. Therefore, we suggest ophthalmic follow-up of these patients at three moments: before the beginning of the use of GC, in D8 and D28. The LLA is a disease with high potential for cure and that mainly affects young individuals with high life expectancy. The high doses of GC used in treatment are a silent danger, as they are highly associated with HO, with an almost always asymptomatic course, which can ultimately result in irreversible vision loss, which is fundamental to any individual's quality of life.