硅水凝胶角膜接触镜在乙醇法-和机械法-激光上皮下角膜磨镶术术后的应用

Clinical evaluation of the Galyfilcon A silicon hydrogel contact lens as a bandage after LASEK or epi-LASIK

目的评价Galyfilcon A硅水凝胶软性角膜接触镜(acuve advance)作为乙醇法-准分子激光上皮下角膜磨镶术(laser subepithelial keratomileusis,LASEK)和机械法-激光上皮下角膜磨镶术(epi-laser in situ keratomileusis,epi-LASIK)术后绷带式接触镜应用的临床安全性和有效性。方法31例(58眼)行LASEK或epi-LASIK的患者参与了本前瞻性临床研究,其中9例双眼行LASEK手术者作acuve advance和月抛型镜片的对照研究,其余22例均使用acuve advance镜片。根据角膜上皮愈合的情况,镜片连续配戴3 d或7 d。在术后第1天、第3天和第7天,观察镜片的中心位置、移动度、湿润度和沉淀物,在裂隙灯下对角膜缘充血和角膜上皮水肿情况进行评分,并由患者对其不适感(疼痛和异物感)行主观量化评分。结果Acuve advance的镜片中心位置、移动度、湿润度均良好,常见散在沉淀物。大部分患者疼痛感无或很轻,而异物感是主要症状。与月抛型镜片相比,术后第1天和第3天的戴acuve advance者异物感更轻(Z=2.72,P=0.007;Z=2.37,P=0.018);戴acuve advance者术后第1天的疼痛感更轻(Z=2.60,P=0.009);戴acuve advance者术后角膜缘充血与角膜上皮水肿也略轻,但差异无显著性。未发生严重并发症。结论Galyfilcon A硅水凝胶软性角膜接触镜作为LASEK和epi-LASIK术后绷带式接触镜应用是安全有效的,与月抛型镜片相比,更适合于长期配戴。

Objective To evaluate the safety and effectivenees of a Galyfilcon A silicon hydrogel cpntact lens （acuve advance） as a bandage after LASEK or epi-LASIK. Methods Thirty-one patients （58 eyes） treated with LASEK or epi-LASIK were included in this prospective clinical study. The patients were fitted with an acuve advance lens, except for ten of them with bilateral LASEK who were fitted with an acuve advance, in one eye end a monthly disposable lens in the contralateral eye. The lenses were worn continuously for 3 or 7 days, depending on the condition of the epithelium. Movement, center placement, wettability and deposits on the lens as well as slit lamp evaluations of epithelial edema and limbal injection were recorded 1, 3 and 7 days after surgery. Subjective comfort was rated by the patints along with symptoms of pain or foreign body sensation （FB）. Results Center placement, movement and wettability of the acuve advance, were goad, frequently with scattered deposits. Symptoms of pain were either absent or very mild. FBS was the chief discomfort. FBS was milder in the acuve advance group than in the monthly disposable lens group at the 1st and 3rd postoperative days （Z=2.72, P=0.007; Z=2.37, P=0.018）. Pain was milder in the acuve advance group than in the monthly disposable lens group on the 1st pastoperative day （Z=2.60, P=0.009）. Limbal injection and epithelial edema were a little, milder in the acuve advance group, but the difference was not statistically significant. No severe complications were found. Conclusion Galyfilcon A siliconn hydrogel contact lenses are safe and effective as a bandage after LASEK or epi-LASIK. Galyfilcon A sihcon hydrogel contact lenses are more appropriate for continuoous wear than monthly disposable lenses.