LASIK术后弥漫性板层角膜炎的药物预防

The pharmaceutical prevetion of diffuse lamellar keratitis after LASIK

目的探讨糖皮质激素对准分子激光原位角膜磨镶术(LASIK)后弥漫性板层角膜炎(DLK)的预防作用。设计前瞻性随机对照临床研究。研究对象接受双眼LASIK手术的近视患者101例(202眼),按眼别分为处理组(101眼)和对照组(101眼)。方法 LASIK术中,处理组局部用糖皮质激素(0．001％地塞米松)进行角膜瓣层间冲洗,对照组则用平衡盐液进行冲洗。主要指标术前、术后第1、3、7天及1个月的裸眼视力、最佳矫正视力、屈光度、眼压,术后DLK的发病率及临床分期。结果 LASIK术后各时期,处理组和对照组的裸眼视力、最佳矫正视力、平均屈光度、眼压差异均无统计学意义(P>0．05)。术后第1天,处理组DLK发病率为4．0％(4眼),全部为Ⅰ期,对照组17．8％(18眼),其中Ⅰ期占88．9％,Ⅱ期占11．1％;术后第 3天,处理组DLK发病率为5．0％(5眼),全部为Ⅰ期,对照组为21．8％(22眼),其中Ⅰ期占86．4％,Ⅱ期占13.6％。两组间比较, DLK的发病率差异有显著统计学意义(P<0．01)。结论 LASIK术中应用O．001％的地塞米松进行角膜瓣层间冲洗,能够明显降低DLK的发病率,是一种安全、有效的预防方法。

Objective To evaluate the regulating effect of topical intrastromal corticosteroids to diffuse lamellar keratitis （DLK） during laser in situ keratomileusis（LASIK）. Design Prospective, randomized, comparative clinical study. Participants 101 myopic patients （202 eyes） after LASIK were divided into the experimental group and the contrast group according to the left and the right eye. Methods Irrigation of 0.001% dexamethasone was performed under the flap in experimental group and irrigation of balanced salt solution was used under the flap in contrast group. Main Outcome Measures The uncorrected visual acuity（UCVA）, bost corrected visual acuity（BCVA）, IOP, refractive power preoperatively and 1,3,7 and 30 days postoperatively, the incidence and staging of DLK. Results There are no significant differences of UCVA, BCVA, IOP and average refractive power between the experimental group and the contrast group postoperatively （P〉0.05）. At 1 day after operation, the incidence of DLK was 4.0% （4 eyes） in experimental group, all of them were grade Ⅰ. The incidence of DLK was 17.8%（18 eyes） in contrast group. Among them, grade Ⅰ contribute 88.9% （16 eyes ） and gradeⅡ was 11.1% （2 eyes）. At 3 days, the incidence of DLK was 5.0% （5 eyes） in experimental group, all of them were grade Ⅰ, and the incidence of DLK was 21.8%（22 eyes） in contrast group. Among them, grade Ⅰ contribute 86.4% （19 eyes ） and gradeⅡ was 13.6% （3 eyes）. The incidence of DLK was significant difference between the two groups （P〈0.01）. Conclusions If 0.001% dexamethasone is used to irrigate the interface during LASIK, it can significantly reduce the incidence and severity of DLK. It＇s a safe and effective prophylaxis method. （Ophthalmol CHN, 2006, 15： 50-54）