双氯芬酸钠减轻准分子激光上皮下角膜磨镶术后反应

Reducement of postoperative reaction after laser epithelial keratomileusis （LASEK） by diclofenac sodium

目的准分子激光上皮下角膜磨镶术（LASEK）后早期使用双氯芬酸钠对术后炎性反应的作用。方法依据随机、双盲、对照原则分为两组，双氯芬酸钠组50例（50眼），均为左眼，采用双氯芬酸钠＋0．1％氟关瞳＋0．3％氧氟沙星；对照组50例（50眼），均为左眼，用0．1％氟关瞳＋0．3％氧氟沙星。术后观察疼痛、畏光、流泪、异物感、球结膜充血、角膜上皮混浊6项指标，按无、轻、中、重分别记为0、1、2、3分，术后1、2、3、5d观察术后反应并评分，术后1、2、3周检查视力，术后1、2、3个月观察角膜雾状混浊（Haze）发生情况，第5天开始根据指征尽早取镜。结果术后第1天和第2天双氯芬酸钠组术后反应较轻，差异有统计学意义（P〈0．05）。治疗组平均取镜时间为5．2d，对照组为6．15d，双氯芬酸钠组早于对照组。两组恢复最佳视力的时间比较差异无统计学意义，术后Haze的发生率和严重程度两组比较差异无统计学意义。结论双氯芬酸钠能减轻术后早期反应，缩短术后绷带镜片的佩戴时间，安全、无不良反应，有助于LASEK术后角膜上皮化学性和机械性损伤的修复。

Objective To evaluate the effect of diclofenac sodium eye drops on cutting section corneal epithelium recovery after laser epithelial keratomileusis （LASEK） by observing postoperative in- flammation clinically. Methods According to the principles of randomized, double - blindly and comparison, Diclofenac sodium group were controlled enrolled 50 patients（50 eyes,all left eyes） for diclofenac sodium group with therapy of diclofence sodium ＋ 0.1% fluorometholone ＋ 0.3% ofloxacin and 50 patients （50 eyes, all left eyes） for comparison group with therapy of 0.1% florometholone ＋ 0.3% ofloxa- cin. Pain,photophobia, tearing, foreign body sensation, conjunctival congest and corneal epithelial opaci- ty were observed at 1, 2, 3 and 5 days postoperatively and scored as 0, 1, 2 or 3 respectively according to negative, slight, moderate or severe degree. Visual acuity was measured at 1,2 and 3 weeks postoperatively. The corneal haze was exanined at 1,2 and 3 months postoperatively. The band contact lenses were removed as early as possible from 5 days postoperatively. Results Postoperative inflammation of di- elofenae sodium group was significantly slighter than comparison group at 1 and 2 days postoperatively （P 〈 0.05）. Average time of removing contact lens is 5.2 days and 6.2 days for treated two group re- spectively. There was no difference on the time of achieving best visual acuity and haze between the two groups. Conclusions Diclofenac sodium may relieve early inflammation postoperatively after LASEK and shorten the time of wearing contact lenses, beneficial to epithelium recovery from chemical and machinical injury.