激素性高眼压对LASIK术后患者视功能影响的初步研究（英文）

Effects of steroid induced ocular hypertension on visual performance in post-LASIK patients: preliminary evidence

目的：探讨激素敏感者LASIK术后早期出现的异常眼压波动对视功能的影响及其潜在机制。 方法：共15例LASIK术后发生激素性高眼压的患者纳入试验组并给予及时有效治疗，另15例未出现高眼压的LASIK术后患者纳入正常对照组。两组患者均嘱定期随访，随访期间所有患者的裸眼视力、对比敏感度、波前像差、角膜地形图等数据被采集用于对比分析。 结果：试验组：患者术后高眼压与术前相比，眼压波动幅度达10.6±4.4mmHg（21.3~32.9mmHg）；患者术后眼压正常时与术后高眼压时相比，裸眼视力、对比敏感度、波前像差、角膜地形图等数据均存在统计学差异。1）裸眼视力：术后眼压正常时优于术后高眼压时的裸眼视力（P〈0.001）；2）对比敏感度：术后眼压正常时，患者在3、6、12、18 c/d各频率的对比敏感度均优于高眼压时的对比敏感度（均为P〈0.05）；3）波前像差：术后眼压正常时与术后高眼压时相比，患者在总高阶像差、三叶草像差、球差等指标上存在统计学差异（均为P〈0.05）；4）角膜地形图：术后眼压正常时与术后高眼压时相比，在Q值、后表面Diff 值、角膜中央厚度等指标上存在统计学差异（均为P〈0.05）。对照组：随访期内，除角膜中央厚度随时间而增厚外，其它检测指标均无明显变化。 结论：LASIK术后激素易感者发生的短期异常眼压波动可引起显著的视功能改变，而控制眼压波动则可明显改善患者的视觉表现。

AIM： To investigate the effect of intraocular pressure （ IOP ） fluctuations on the visual performance in steroid responders after laser in situ keratomileusis （ LASIK） . METHODS：Fifteen post-LASIK patients who underwent steroid-induced IOP fluctuations were enrolled as study group. And all received effective therapy when identified. Another 15 matched post-LASIK patients who used topical steroids for the same duration without developing hypertension were selected as control group. During the follow - up visits, uncorrected distant visual acuity （ UDVA ） , photopic contrast sensitivity, wavefront aberrations, and corneal topography, were measured. These aimed at comparing the differences in postoperative changes between the groups. RESULTS： In study group, comparison of preoperative and postoperative IOP, the amplitude of abnormal IOP fluctuations reached 10. 6±4. 4mmHg （ranged from 21. 3 to 32. 9mmHg ）. Compared with postoperative ocular hypertension, statistics demonstrated significant changes such as UDVA, photopic contrast sensitivity, and wavefront aberrations, and corneal topography under the condition of normal tension. 1 ） UDVA： a significant difference was seen in UDVA between ocular hypertension and normal tension （ P〈0. 001 ）; 2 ） Contrast sensitivity：results showed significant differences in 3, 6, 12, and 18 cycles/degree of photopic contrast sensitivity （ all P 〈0.05 ）; 3 ） Wavefront aberrations： statistics indicated significant differences in higher order aberrations （ HOA） , trefoil and spherical aberration （ P〈 0. 05 for all ）; 4 ） Corneal topography parameters such as Q - value,difference value （ Diff - value ） between the posterior corneal surface and the best fit sphere in the central region （Ф=6mm）, and central corneal thickness （CCT） showed significant differences （P〈0. 01 for all）. However, in control group, except for the increased CCT with time, no other significant changes were observed during the follow-up visits. CONCLUSION： Transient abnormal IOP fluctuations might induce remarkable optical and visual changes, and limiting the IOP fluctuations might improve the visual performance in steroid responders after LASIK.