不同糖皮质激素用药方法对准分子激光原位角膜磨镶术后弥漫性板层角膜炎的预防作用

The value of corticosteroid in the prevention of diffuse lamellar keratitis after laser in situ keratomileusis

目的探讨糖皮质激素对准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)后弥漫性板层角膜炎(diffuse lamellar keratitis,DLK)的预防作用及不同用药方法的效果。方法设计前瞻性研究,对接受LASIK手术的近视患者208例(416眼)根据术后用药不同,随机分为实验组和对照组各104例。实验组术后使用碘必殊滴眼液4次/d,用药1周,再用0.1%氟美瞳滴眼液3次/d、2次/d、1次/d,用药各1周。对照组术后用0.1%氟美瞳滴眼液4次/d、3次/d、2次/d、1次/d,用药各1周,加托百士滴眼液1周。观察指标:在术后第1周、第1个月进行眼压检测,用裂隙灯观察术眼,统计DLK发生率并进行临床分期。结果LASIK术后第1周和第1个月,实验组与对照组比较,眼压差异无统计学意义,个别眼压增高者停用激素眼药后眼压很快恢复正常。术后第3天,实验组有7眼(3.3%)发生DLK,全为Ⅰ期;对照组有25眼(12.0%)发生DLK,其中Ⅰ期20眼(80.0%),Ⅱ期5眼(20.0%)。术后第7天,实验组有1眼发生DLK,对照组有18眼(8.6%)发生DLK,其中Ⅰ期15眼(83.3%),Ⅱ期3眼(16.7%)。对两组的DLK发生率进行比较,差异有显著统计学意义。结论LASIK术后短期应用强效糖皮质激素可明显降低DLK的发生率并缩短病程,眼压升高作用不明显,是一种安全有效的预防方法。

Objective To evaluate the effects of different corticosteroid medications in the prevention of diffuse lamellar keratitis （DLK） after laser in situ keratomileusis （LASIK）. Methods Two hundred and eight cases （416 eyes） were randomly divided into two groups. The study group was treated with TobraDex eye drops for one week, and then with 0.1% Flurometholon in the succeeding 3 weeks, three, two and one time per day respectively. The control group was treated in successive weeks four, three, two and one time per day with 0.1% Flurometholon, and then treated with Trobex for a week. Intraocular pressure （IOP）, DLK and clinical stages were assessed postoperation. Results No significant difference in IOP were found at different stages postoperation. There were 7 eyes （3.3%） with DLK 3 days after the operation, all in stage Ⅰ, as well as 25 eyes （12.0%） in the control group, among which 20 eyes were in stage Ⅰ（80.0%） and 5 eyes in stage Ⅱ（20.0%）. There was 1 eye （3.3%） with DLK 7 days after surgery in study group, and 18 eyes （8.6%） in control group, among which 15 eyes were in stage Ⅰ（83.3%） and 3 eyes in stage Ⅱ（16.7%）. There was a statistically significant difference in the incidence of DLK between the two groups. Conclusion Short-term corticosteroid eye drop treatment is a safe and effective procedure after LASIK surgery for myopia, which can decrease the incidence of DLK and promote clinical progress. The drops have no obvious effect on elevating IOP.