CAJ | 학술논문

目的：通过检测近视患者准分子激光角膜原位磨镶术（ Laser in situ keratomileusis ， LASIK）前后，不同时间泪液中某些细胞因子的表达，观察其附加典必殊治疗后的变化规律，分析其与典必殊不同日用药量及疗程的关系，探讨该疗法对角膜愈合、视力及眼压的影响，以期指导术后合理用药。方法选取接受LASIK治疗的近视患者96例（189只眼），根据术后典必殊眼液疗程随机分为3个实验组，各组均自术后24 h开始接受典必殊眼液治疗，其中实验1组点眼治疗1周；实验2组点眼治疗2周；实验3组点眼治疗4周。各组患者分别于术前及术后24 h （未用典必殊治疗前），治疗后1、2及4周采集泪液标本，测定其中IL-1α、 IL-2和TNF-α3种细胞因子的浓度，分析典必殊不同日用药次数及疗程对疗效的干预及对患者角膜愈合、视力及眼压的影响。结果术后24 h 3组患者泪液中IL-1α、 IL-2和TNF-α的含量均显著升高，与术前相比有显著性差异（ P＜0.01）；典必殊治疗1周后，3组患者泪液中IL-1α、 IL-2和TNF-α的含量均降至术前水平（ P＞0.05）。3组患者术后24 h检查，角膜创面全部被上皮细胞覆盖，角膜瓣复位良好，术后1周创面愈合；术后2周与4周各组患者视力恢复良好，无显著性差异（P＞0.05）。术后激素性高眼压发生率：术后2周，3组发生率对比，差异具有统计学意义（P＜0.05）；术后4周，实验1组及实验2组患者的高眼压消失，但实验3组的激素性高眼压发生率仍高达13.16％，差异具有统计学意义（ P＜0.005）。结论 LASIK术后应用典必殊治疗1～2周，每日4次，可有效控制角膜局部创伤性炎症反应，日用药次数的增加和疗程的延长，具有诱发激素性高眼压的危险。
목적：통과검측근시환자준분자격광각막원위마양술（ Laser in situ keratomileusis ， LASIK）전후，불동시간루액중모사세포인자적표체，관찰기부가전필수치료후적변화규률，분석기여전필수불동일용약량급료정적관계，탐토해요법대각막유합、시력급안압적영향，이기지도술후합리용약。방법선취접수LASIK치료적근시환자96례（189지안），근거술후전필수안액료정수궤분위3개실험조，각조균자술후24 h개시접수전필수안액치료，기중실험1조점안치료1주；실험2조점안치료2주；실험3조점안치료4주。각조환자분별우술전급술후24 h （미용전필수치료전），치료후1、2급4주채집루액표본，측정기중IL-1α、 IL-2화TNF-α3충세포인자적농도，분석전필수불동일용약차수급료정대료효적간예급대환자각막유합、시력급안압적영향。결과술후24 h 3조환자루액중IL-1α、 IL-2화TNF-α적함량균현저승고，여술전상비유현저성차이（ P＜0.01）；전필수치료1주후，3조환자루액중IL-1α、 IL-2화TNF-α적함량균강지술전수평（ P＞0.05）。3조환자술후24 h검사，각막창면전부피상피세포복개，각막판복위량호，술후1주창면유합；술후2주여4주각조환자시력회복량호，무현저성차이（P＞0.05）。술후격소성고안압발생솔：술후2주，3조발생솔대비，차이구유통계학의의（P＜0.05）；술후4주，실험1조급실험2조환자적고안압소실，단실험3조적격소성고안압발생솔잉고체13.16％，차이구유통계학의의（ P＜0.005）。결론 LASIK술후응용전필수치료1～2주，매일4차，가유효공제각막국부창상성염증반응，일용약차수적증가화료정적연장，구유유발격소성고안압적위험。
Objective By testing the expression of some cytokines in tears at different time before and after re-ceiving Laser in situ keratomileusis ( LASIK) , to observe the rules of their change after receiving additional Tobradex treat-ment and analyze the relations between cytokines and daily dosage and treatment course .Also, to discuss the influence of this treatment on the healing of cornea , eyesight and eye pressure for guiding reasonable postoperative drug administration . Method All 96 patients with myopia ( 189 eyes ) who received LASIK treatment , were randomly divided into three test groups of different postoperative Tobradex treatment course .All groups began to receive Tobradex treatment 24h after surger-y, the first group was treated for one week the second two weeks and the third four weeks .The tear samples of each group were collected before and 24h after surgery, one week, two weeks and four weeks after treatment to determine the concentra-tion of 3 cytokines IL-1a, IL-2 and TNF-αand analyze the influence of different daily dosage and treatment course on the ef -ficacy, healing of cornea , eyesight and eye pressure .All data were processed statistically with SAS 6.12 statistic software package.Results The content of IL-1a, IL-2 and TNF-αin tears of patients in three groups 24 hours after surgery in-creased substantially and had significant difference ( P<0.01 ) comparing with that before surgery .After being treated with Tobradex for one week, the content of IL-1a, IL-2 and TNF-αin tears of patients of three groups decreased to the level be-fore surgery (P>0.05).In examination for 3 groups 24h after surgery, the wounds of cornea had all been covered by epi-thelial cells , the restoration of corneal flap was good and the wounds healed one week after surgery .Two weeks and four weeks after surgery, their eyesight improved and restored , without obvious difference ( P>0.05 ) .The occurrence rate of corticosteroid induced ocular hypertension was different in three groups two weeks after surgery , which was of statistical sig-nificance ( P<0.05 ) .Four weeks after surgery , ocular hypertension disappeared in test groups one and two , however the occurrence rate of corticosteroid induced ocular hypertension in test group three was still as high as 13.16%, the difference between groups was of statistical significance ( P<0.005) .Con clusion After LASIK surgery , treatment with Tobradex for one to two weeks, 4 times a day, can effectively control local inflammation of cornea .The incremental usage of daily dosage and prolonging of treatment course risk corticosteroid induced ocular hypertension .