冷敷疗法缓解经上皮准分子激光角膜切削术后疼痛的效果

Effect of Cold Compress Therapy on Patients after Transepithelial Excimer Laser Keratectomy

目的:观察经上皮准分子激光角膜切削术(TPRK)后眼罩冷敷缓解患者术后不适的临床疗效。方法:前瞻性随机对照研究。选取2018年10月至2019年4月在温州医科大学附属眼视光医院之江院区行TPRK的患者87例(174眼),根据随机数字表随机分成冷敷组和对照组,2组均选取右眼进行观察。冷敷组在术后留观期间给予4℃冷藏硅胶眼罩冰敷袋,冷敷20 min,其余处理同对照组。对照组常规用药不冷敷。分别于术后2 h、1 d、2 d、3 d、5 d每天相对固定时间填写眼部不适感评分量表,包括视物模糊、畏光、异物感、流泪、眼痛、眼痒、眼部分泌物等术后不适情况。并于术后5 d、12 d、1个月、3个月分别评估角膜上皮愈合情况、裸眼视力(UCVA)、等效球镜度(SE)、角膜上皮下雾状混浊(haze)、调制传递函数截止频率(MTF cutoff)、客观散射指数(OSI)等指标。采用重复测量方差分析、独立样本t检验对数据进行分析。结果:术后2 h时,畏光、异物感、眼痛评分等指标在2组间差异均有统计学意义(F=15.93,P<0.001;F=9.52,P=0.003;F=13.57,P<0.001)。2组间视物模糊、流泪、眼痒、眼部分泌物差异均无统计学意义。术后1 d视物模糊指标在2组间差异有统计学意义(F=9.69,P=0.003),畏光、异物感、流泪、眼痛、眼痒、眼部分泌物等指标差异无统计学意义。术后2、3、5 d所有不适症状组间差异均无统计学意义。术后5 d、12 d、1个月、3个月,2组间角膜上皮愈合情况、UCVA、SE、Haze等差异均无统计学意义。术后3个月2组间客观光学质量评估差异均无统计学意义。结论:TPRK术后冷敷疗法能够改善术后早期疼痛、畏光、异物感等刺激症状,但对术后远期视力恢复没有明显作用,且对术后角膜上皮修复、视觉质量恢复等无负面影响。

Objective:To observe the clinical efficacy of cold compresses on eye masks after transepithelial excimer laser keratectomy(TPRK)to relieve postoperative discomfort.Methods:This was a prospective randomized controlled study.Eighty seven patients undergoing TPRK surgery in the Eye Hospital,Wenzhou Medical University at Zhijiang were randomly divided into a cold compress group and a control group from October 2018 to April 2019.The right eye was selected for observation in both groups.The cold compress group was given a 4℃frozen silicone eye mask ice pack for 20 minutes during the postoperative observation period,and the rest was treated the same as the control group.The control group was routinely treated with no cold compress.Filled in the eye discomfort scale at 2 h,1 d,2 d,3 d,and 5 d after surgery at a relatively fixed time each day,including blurred vision,photophobia,foreign body sensation,tearing,eye pain,itching,secretions and other postoperative discomforts.Corneal epithelial healing,vision,equivalent sphericity,haze,MTF cutoff,OSI and other indicators were evaluated on the 5 d,12 d,1 month and 3 months after surgery.Data were analyzed by repeated measures of variance,and independent sample t test.Results:At 2 hours after surgery,the photophobia,foreign body sensation,and eye pain scores between the two groups.There were statistically significant differences between the two groups(F=15.93,P<0.001;F=9.52,P=0.003;F=13.57,P<0.001).There was no statistically significant difference in blurred vision,tearing,itching,and secretions between the two groups.At 1 day after surgery,there was a statistically significant difference in visual blur between the two groups(F=9.69,P=0.003).There was no statistically significant difference in indicators of photophobia,foreign body sensation,tearing,eye pain,itching,and secretions.There was no statistically significant difference between the two groups at 2 days,3 days,and 5 days after surgery.There were no significant differences in corneal epithelial healing,UCVA,equivalent spherical power,and corneal subepithelial haze between the two groups at 5 d,12 d,1 month,and 3 months.There was no significant difference in objective optical quality assessment between the two groups at 3 months after surgery.Conclusions:TPRK postoperative cold compress therapy can improve early postoperative pain,photophobia,and foreign body sensation.It has no significant effect on long-term vision recovery,and has no negative effect on corneal epithelial repair and visual quality recovery.