摘要
背景采用准分子激光角膜屈光手术矫正屈光不正可减少患者对框架眼镜的依赖，其术后抗炎药物使用过程中不良反应的防治一直是临床关注的问题。氯替泼诺混悬滴眼液是糖皮质激素类抗炎药，已广泛用于准分子激光角膜屈光术后，以缓解和减轻术眼术后的炎症反应，但其长期应用后对眼压影响的报道较少。目的探讨准分子激光角膜屈光手术后使用质量分数0．5％氯替泼诺混悬滴眼液对眼压的影响。方法采用回顾性病例分析研究设计，收集2011年1月至2012年1月在唐山市眼科医院行准分子激光角膜屈光手术并有完整随访资料的近视患者1552例1552眼，其中行准分子激光角膜原位磨镶术（LASIK）者321眼，行准分子激光前弹力层下角膜原位磨镶术（SBK）者608眼，行飞秒激光制瓣准分子激光角膜原位磨镶术（FS—LASIK）者623眼。所有患者术后均应用0．5％氯替泼诺混悬滴眼液点眼，每日4次，每周递减1次，共1个月。术前及术后1、2、3、4周分别用非接触眼压计测量眼压，并根据眼压升高的幅度分为〈5mmHg（1mmHg=0．133kPa）、5～15mmHg和〉15mmHg三种糖皮质激素反应。术后发现眼压升高及眼压恢复正常1个月时采用海德堡视网膜断层扫描仪进行视盘参数的检测和观察，并进行比较。结果纳入的1552眼中，术后1个月内眼压升高者47眼，其中行LASIK者用药后眼压升高者占3．12％（10／321），行SBK者占3．29％（20／608），行FS—LAStK者占2．73％（17／623），三者间比较差异无统计学意义（x2=1．95，P〉0．05）。停用0．5％氯替泼诺混悬滴眼液或加用降眼压药物治疗后，术眼眼压降至正常水平，仅1眼出现轻度反弹，视力无下降。术后眼压升高与眼压恢复后1个月时，受检眼的盘沿面积分别为（1．65±0．44）mm2和（1．66±0．44）mm2，盘沿容积分别为（0．40±0．09）mm2和（0．39±0．08）mm2，平均神经纤维层厚度分别为（0．28±0．08）mm和（0．29±0．07）mm，差异均无统计学意义（t=0．34、0．81、0．48，P〉0．05）。结论准分子激光角膜屈光手术后使用0．5％氯替泼诺混悬滴眼液进行抗炎治疗导致的眼压升高为可逆性，用药期间应定期监测眼压变化。
Background Excimer laser corneal refractive surgery is widely used because it reduces the dependency of refractive error eye to glasses. However, the adverse effects of anti-inflammatory drugs is a problem after operation. Lotcmax eyedrops is a kind of steroidal anti-inflammatory drug,with a good effect on the operative eye. But its influence on intraocular pressure （IOP）after long-term topical administration is less studied. Objective This study was to investigate the influence of lotemax eyedrops on IOP after long-term topical administration in myopic eyes received excimer laser corneal refractive surgery. Methods An one-month retrospective case serial study was adopted. The case history data of 1552 eyes from 1552 Patients who received excimer laser corneal refractive surgery were collected in Tangshan Eye Hospital from 2011 January to 2012 January,including 321 eyes with laser in situ keratomileusis（LASIK）, 608 eyes with sub-Bowman keratomileusis （SBK）and 623 eyes with femtosecond laser for flap cxcimer laser in situ keratomileusis（FS-LASIK）. Lotemax eyedrops was topically administered after operation 4 times per day initial and then decreased 1 time weekly for 1 month. IOP was measured in before, 1 week,2 weeks, 3 weeks,4 weeks after operation with non-contact tonometer. The increasing range of IOP was divided into 〈5 mmHg, 5-15 mmHg and 〉15 mmHg after operation. Optical head parameters were measured by Heidelberg retina tomography when IOP increasing after operation. Results Within 1 month,elevated IOP was found in 47 of 1552 eyes after administration of lotemax eyedrops, including 3.12% （ 10/321 ） in the LASIK group, 3.29% （ 20/608 ） in the SBK group and 2.73% （17/623）in the FS-LASIK group, without significant difference among them（x2 = 1.95, P〉0. 05 ）. The IOP elevated 1 week after operation and remained normal after that till drug withdrawal in all eyes. There were no significant differences in the disk area （ 1.65 ±0.44 ）mm2 vs. （ 1.66 ± 0. 44 ）mm2 , disk volume （ 0.40± 0.09 ）mm3 vs. （0. 39±0. 08）mm3 and mean nerve fiber layer thickness （0.28±0.08 ）mm vs. （0, 29±0.07 ）mm in IOP elevation duration compared with 1 month after IOP recovery （ t = O. 34,0.81, O. 48, P 〉 0.05 ）. Conclusions Topical administration of O. 5% lotemax eyedrops after excimer laser corneal refractive surgery leads to reversible high IOP. It is very important to monitor the IOP during use of the drug.
出处
《中华实验眼科杂志》
CAS
CSCD
北大核心
2013年第6期551-554,共4页
Chinese Journal Of Experimental Ophthalmology
