摘要
目的:比较飞秒激光小切口角膜基质透镜取出术(SMILE)后不同效价激素治疗下的角膜光密度值和角膜上皮厚度(CET)的差异。方法:前瞻性临床研究。连续性收集2020年7月至2021年10月就诊于中国医科大学附属盛京医院近视诊疗中心的近视及近视散光患者101例(197眼)。将患者根据随机数字表法,随机分为地塞米松组51例(99眼)和氟米龙组50例(98眼)。地塞米松组术后使用妥布霉素地塞米松滴眼液4次/d点眼,每次1滴,用药1周,1周后改为氟米龙滴眼液3次/d,每次1滴,每周减量1次,至术后1个月时停药。氟米龙组术后使用氟米龙滴眼液和妥布霉素滴眼液,均4次/d点眼,每次1滴,1周后停用妥布霉素滴眼液,并继续使用氟米龙滴眼液3次/d,每次1滴,每周减量1次,至术后1个月时停药。在术前及术后1 d、1周、1个月分别测量2组患者手术层面的角膜光密度值、CET、眼压及视力等。采用独立样本t检验或U检验比较2组数据间不同随访时间点的差异。结果:最终地塞米松组和氟米龙组分别有42例(82眼)和43例(84眼)完成随访。2组基本信息、术前等效球镜度差异均无统计学意义(P>0.05)。在术前和术后1 d、1个月时,2组角膜光密度值差异无统计学意义(P>0.05);在术后1周时,地塞米松组角膜光密度值低于氟米龙组,差异有统计学意义(t=-3.96,P=0.011)。在术前和术后1个月时,2组眼压值差异无统计学意义(P>0.05);在术后1周时,地塞米松组眼压明显高于氟米龙组,差异有统计学意义(Z=-3.86,P<0.001)。术前和术后1 d、1个月时,2组CET差异均无统计学意义(P>0.05);术后1周时,地塞米松组在0~2 mm(t=-2.89,P=0.005)和>2~5 mm区域(t=-3.48,P=0.001)CET低于氟米龙组。术前时,2组在亮环境和暗环境下的对比敏感度差异无统计学意义(P>0.05);在术后1周时和1个月时,地塞米松组的对比敏感度优于氟米龙组,差异有统计学意义(P<0.05)。2组术前及术后不同时间点的裸眼视力、总高阶像差、术后有效指数和安全指数的差异均无统计学意义(均P>0.05)。结论:与使用低效价糖皮质激素相比,SMILE术后早期使用高效价激素明显抑制了角膜上皮重塑,角膜光密度值和对比敏感度恢复更快。SMILE术后患者使用高效价激素眼压升高更明显。术后高效价与低效价糖皮质激素相结合的给药方案,能够帮助患者获得更快、更安全有效的术后恢复。
Objective:To compare the effect of different potency glucocorticosteroids on corneal densitometry and corneal epithelial thickness after small incision lenticule extraction(SMILE).Methods:In this prospective clinical study,totally 101 patients(197 eyes)were collected from July 2020 to October 2021 and randomly assigned to dexamethasone group(51 patients,99 eyes)and fluorometholone group(50 patients,98 eyes).For the dexamethasone group,patients were treated with topical dexamethasone eye drops 4 times daily for 1 week,changed to topical fuorometholone eye drops 3 times to 1 time per day with a drop decrease per week for 3 weeks after SMILE.For the fuorometholone group,patients were treated with topical fuorometholone eye drops 4 times to 1 time per day with a drop decrease per week for 1 month postoperatively.The corneal densitometry of surgical plane,corneal epithelial thickness,intraocular pressure,uncorrected visual acuity,total high order aberrations and contrast sensitivity were examined before SMILE and at 1 day,1 week,1 month postoperatively.t test or U test were used to compare the differences between two groups.Results:Finally,42 patients(82 eyes)in dexamethasone group and 43 patients(84 eyes)in fuorometholone group completed follow-up.There was no statistical difference in preoperative basal data,spherical equivalent refraction,central corneal thickness and other surgical parameters between two groups(P>0.05).There were no significant differences of corneal densitometry between two groups at preoperatively,1 day and 1 month postoperatively(P>0.05).The corneal densitometry of dexamethasone group was lower than fluorometholone group at 1 week postoperatively(t=-3.96,P=0.011).At preoperatively and 1 month postoperatively,there were no differences in intraocular pressure between two groups(P>0.05).At 1 week postoperatively,intraocular pressure of dexamethasone group was remarkably higher than fluorometholone group(Z=-3.86,P<0.001).At preoperatively and 1 day and 1 month postoperatively,there were no differences in corneal epithelial thickness between two groups(P>0.05).Corneal epithelial thickness of dexamethasone group in 0-2 mm region(t=-2.89,P=0.005)and>2-5 mm region(t=-3.48,P=0.001)were thinner than the fuorometholone group at 1 week postoperatively.At 1 week and 1 month after surgery,contrast sensitivity was better than in dexamethasone group(P<0.05).No differences were found in postoperative uncorrected visual acuity,total higher order aberration,the effective index and safety index between two groups at any following-up time points(P>0.05).Conclusions:Comparing of low potency steroids,high potency steroids inhibited corneal epithelial remodeling obviously,had better effects in recovery of corneal densitometry and contrast sensitivity at early postoperation.However,high potency steroids had a tendency increase intraocular pressure.The postoperative dosing regimen combining high-efficiency and low-acting corticosteroids can help patients achieve faster,safer and more effective postoperative recovery.
作者
任雪文
夏丽坤
Xuewen Ren;Likun Xia(Clinic Center of Myopia,Shengjing Hospital of China Medical University,Shenyang 110000,China)
出处
《中华眼视光学与视觉科学杂志》
CAS
CSCD
2023年第2期96-103,共8页
Chinese Journal Of Optometry Ophthalmology And Visual Science
基金
2020年度辽宁省重点研发计划联合计划项目(2020JH2/10300135)。
