三种糖皮质激素滴眼液预防LASIK术后弥漫性层间角膜炎短期效果比较

The short-term comparison of three kinds of cortisteriod eye drops for the provention of DLK after LASIK

目的比较三种不同糖皮质激素滴眼液在LASIK术后的应用效果。设计回顾性病例系列。研究对象2009年12月至2010年2月在宁波市眼科医院行LASIK手术的300例患者(600眼)。方法根据术后用药方案不同分为氯替泼诺组、氟米龙组和地塞米松组,每组100例。在LASIK术后,三组分别使用0.5%氯替泼诺滴眼液1周,0.1%氟米龙滴眼液1个月,0.1%地塞米松滴眼液1周,三组患者除术后所使用的糖皮质激素不同外,术前准备、手术方法及术后其他用药均相同。分别观察术后第1天、第1、3周及第3个月的眼部症状和体征,随访3个月或以上,分析比较患者裸眼视力(UCVA)、等效球镜(SE)、弥漫性层间角膜炎(DLK)评级、眼干评分及眼压。主要指标UCVA、SE、DLK评级、眼干评分和眼压。结果各组手术前后UCVA、SE的变化及术后眼干评分、眼压均无统计学差异(P均>0.05);术后第1周,氯替泼诺组与地塞米松组DLK的发生率分别为1%和2%(P>0.05),而该二组DLK的发生率均低于氟米龙组(15%),均存在统计学差异(χ2=26.6,21.7;P均<0.01)。随访期间,地塞米松组2例出现激素性高眼压,氯替泼诺组与氟米龙组均未出现。结论与氟米龙滴眼液相比,氯替泼诺滴眼液在LASIK术后短期使用可达到与地塞米松滴眼液相似的减少DLK的效果,同时在本研究中未发现激素性高眼压发生。

Objective To compare the effects of three kinds of cortisteriod eye drops after laser in situ keratomileursis （LASIK） for myopia. Design Retrospective case series. Participants 300 patients （600 eyes） who accepted LASIK and were followed up for three month or more from Dec. 2009 to Feb. 2010 in Ningbo Eye Hospital were included. Methods The patients were divided into three groups according to the different post-operative medicines： Loteprednol group, Dexamethasone group and Flumetholon group. There were 100 patients in each group. For all the three groups, uncorrected visual acuity （UCVA）, spherical equivalent （SE）, diffuse lamellar keratitis （DLK）, the sensation of dry eye, intraocular pressure （IOP） were observed preoperatively and at 1st day, 1st week, 3rd week, 3rd month postoperatively. Main Outcome Measures UCVA, SE, the grade of DLK, the score of sensation of dry eye, and IOP. Resuits It was similar on the changes of UCVA and SE, the score of eye dry sensation and IOP after operation among three groups at different time point （all P〉0.05）. At 1st week after LASIK, the incidence of DLK was similar between Loteprednol group（1%） and Dexamethasone group （2%）, but significantly lower than Flumetholon group （15%, X2=26.6 and 21.7, respectively, both P 〈0.01 ）. Corticosteroid-induced ocular hypertension happened in 2 cases in Deamethasone group, while there was none in Loteprednol group and Flumetholon group. Conclusion Comparing with the Flumetholon eye drops, transient usage of Loteprednol eye drops after LASIK for myopia is effective to reduce DLK, which had similar effects as Dexamethasone eye drops, and corticosteroid-induced ocular hypertension was not observed.