硅水凝胶角膜接触镜在LASIK术后早期的应用

Clinical application of silicone hydrogel contact lens as a bandage immediately after LASIK

目的评价硅水凝胶角膜接触镜在准分子激光原位角膜磨镶术(LASIK)后早期应用的临床安全性和有效性。方法 30例近视患者(60眼)自身对照,每例患者在LASIK手术结束时随机选取一眼佩戴Pure Vision角膜接触镜,术后第1天取出,分别记录术后1 d、3 d、7 d的主观症状评分、角膜荧光素染色(FL)、泪膜破裂时间(BUT)以及泪液分泌试验(SIt)。戴镜眼组和未戴镜眼组之间以及两眼各自分别进行上述时间点不同观察指标的统计学分析。结果主观症状戴镜眼组在术后1 d比未戴镜眼组轻(Z=2.60,P<0.01),在术后3 d、7 d两组差异无统计学意义;戴镜眼组在术后1 d角膜荧光素染色(FL)阳性率比未戴镜眼组低(χ2=12.912,P<0.01);在术后3 d、7 d两组差异无统计学意义。戴镜眼组在术后1 d(t=2.51,P<0.05)、3 d(t=2.03,P<0.05)、7 d(t=1.94,P<0.05)泪膜破裂时间(BUT)均比未戴镜眼组长,差异有统计学意义。两组术后3天、7天BUT值均比术后1天增加(F=3.02,P<0.05;F=4.77,P<0.01)。戴镜眼组在术后1 d(t=2.06,P<0.05)、3 d(t=1.89,P<0.05)比未戴镜眼组基础泪液分泌量多,差异有统计学意义。术后7天两组差异无统计学意义。结论硅水凝胶角膜接触镜对于促进角膜愈合、缓解疼痛刺激有显著疗效,适宜于LASIK术后早期配戴。

Objective To evaluate the safety and effectiveness of silicone hydrogel contact lenses applied immediately after laser in situ keratomileusis（LASIK）. Methods 30 myopic patients （60 eyes） randomly received one Pure Vision lens in one eye and nothing in the fellow eye immediately after LASIK. The contact lenses were removed in the next day. The subjective score, fluorescein staining （ FL）, tear film break up time （BUT） and Schirmer I test （Sit） were assessed 1 day, 3 day and 7 day after operation. All values were compared between the treated eyes and the control eyes at the above time points. Results Subjective scores of the treated eyes were lower at 1 day （ Z = 2.60, P 〈 0.01 ） postoper- atively compared to the control eye, but there was no significant difference by 3 day and 7day postoperatively. The fluoreseein staining of the trea- ted eye showed improvement at 1 day （ X2 = 12. 912, P 〈 0.01 ） postoperatively comparing with the control eye, but there was no significant differ- ence by 3 day and 7day afterwards. Compared with the control eyes, tear break up time of the treated eye showed an increase 1 day （ t =2.51, P 〈 0.05 ）, 3 day （ t = 2.03, P 〈 0.05 ） and 7 day （ t = 1.94, P 〈 0.05 ） after LASIK. Both eyes showed the same increase wherl compared with postoperalive 1 day levels and at 3 day, 7 day postoperatively （ F = 4.64, P 〈 0.05 ; F = 5.77, P 〈 0.05 ）. The Schirnmr I test showed an increase 1 day （ t = 2.06, P 〈 0.05 ） ,3 day （ t = 1.89, P 〈 0.05 ） after LASIK, but there was no significant difference by 7 day postoperatively. Conclusion Silicone hydrogel contact lens exhibit prominent efficiency in promoting corneal healing and pain relief, the lens is suitable to be ap- plied immediately after LASIK.