CAJ | 학술논문

角膜磨镶术/激光原位%激光/准分子%马来酸噻吗洛尔/用药,局部%滴眼液%近视/手术,药物疗法%眼屈光/药物作用%眼压/药物作用%前瞻性研究角膜磨鑲術/激光原位%激光/準分子%馬來痠噻嗎洛爾/用藥,跼部%滴眼液%近視/手術,藥物療法%眼屈光/藥物作用%眼壓/藥物作用%前瞻性研究
각막마양술/격광원위%격광/준분자%마래산새마락이/용약,국부%적안액%근시/수술,약물요법%안굴광/약물작용%안압/약물작용%전첨성연구
Keratomileusis/laser in situ%Lasers/excimer%Timolol/administration,topical%Ophthalmic solutions%Myopia/surgery,drug therapy%Refraction,ocular/drug effect%Intraocular pressure/drug effect%Prospective study

背景屈光回退是高度近视眼准分子激光角膜原位磨镶术(LASIK)术后较常见的并发症,影响手术的长期稳定性.目前尚无预防LASIK术后屈光回退的方法. 目的观察马来酸噻吗洛尔滴眼液对高度近视眼LASIK术后屈光回退的预防效应.方法采用前瞻性干预性临床随机对照研究.选取2012年2-9月在遵义医学院附属医院行LASIK的高度近视患者60例60眼,屈光度为(-7.16±0.95)D.将患者按随机数字表法分成试验组和对照组,2个组患者术后均给予常规抗炎用药,试验组患者在术后第1天开始滴加质量分数0.5％马来酸噻吗洛尔滴眼液,每日2次,1个月后改为每天晨起点眼1次.测量2个组患者术前,术后1周及1、3、6个月的裸眼视力、最佳矫正视力(BCVA)、等效球镜度(SE)、角膜前表面曲率和眼压,并测量术前及术后1、3、6个月术眼的中央角膜厚度(CCT),术前测算残余角膜基质厚度.采用重复测量方差分析、独立样本t检验和Bonferroni检验对2个组在不同时间点间的数据进行分析. 结果试验组及对照组间患者术前的年龄、裸眼视力、BCVA、SE、眼压、角膜前表面曲率、CCT及残余角膜基质厚度的差异均无统计学意义(P＞0.05).2个组间手术后不同时间点的裸眼视力差异有统计学意义(F分组=3.91,P＜0.05；F时间=3.80,P＜0.05),其中术后6个月试验组裸眼视力优于对照组(t=2.97,P＜0.05),试验组术后6个月裸眼视力优于术后7d,差异有统计学意义(P＜0.05).2个组术眼在术后不同时间点BCVA的差异无统计学意义(F分组=2.44,P＞0.05；F时间 =2.31,P＞0.05).2个组间术眼术后SE的有统计学意义(F分组=11.52,P＜0.05),术后不同时间点术眼SE的整体比较差异有统计学意义(F时间=22.06,P＜0.05),术后6个月试验组术眼SE高于对照组(t=2.47,P＜0.05),术后7d及术后1个月、3个月试验组术眼的校正眼压明显低于对照组(F分组=14.83,P＜0.05),术后2个组间CCT的增幅差异无统计学意义(F分组=0.04,P＞0.05).术后试验组角膜前表面曲率变化平稳,但对照组随着时间的延长角膜前表面曲率逐步增加(F时间=18.73,P＜0.05).结论高度近视眼LASIK术后早期局部使用0.5％马来酸噻吗洛尔滴眼液能减少屈光回退,提示0.5％马来酸噻吗洛尔滴眼液通过降低眼压而阻止角膜膨隆,其可能是预防术后屈光回退的主要机制. 揹景屈光迴退是高度近視眼準分子激光角膜原位磨鑲術(LASIK)術後較常見的併髮癥,影響手術的長期穩定性.目前尚無預防LASIK術後屈光迴退的方法. 目的觀察馬來痠噻嗎洛爾滴眼液對高度近視眼LASIK術後屈光迴退的預防效應.方法採用前瞻性榦預性臨床隨機對照研究.選取2012年2-9月在遵義醫學院附屬醫院行LASIK的高度近視患者60例60眼,屈光度為(-7.16±0.95)D.將患者按隨機數字錶法分成試驗組和對照組,2箇組患者術後均給予常規抗炎用藥,試驗組患者在術後第1天開始滴加質量分數0.5％馬來痠噻嗎洛爾滴眼液,每日2次,1箇月後改為每天晨起點眼1次.測量2箇組患者術前,術後1週及1、3、6箇月的裸眼視力、最佳矯正視力(BCVA)、等效毬鏡度(SE)、角膜前錶麵麯率和眼壓,併測量術前及術後1、3、6箇月術眼的中央角膜厚度(CCT),術前測算殘餘角膜基質厚度.採用重複測量方差分析、獨立樣本t檢驗和Bonferroni檢驗對2箇組在不同時間點間的數據進行分析. 結果試驗組及對照組間患者術前的年齡、裸眼視力、BCVA、SE、眼壓、角膜前錶麵麯率、CCT及殘餘角膜基質厚度的差異均無統計學意義(P＞0.05).2箇組間手術後不同時間點的裸眼視力差異有統計學意義(F分組=3.91,P＜0.05；F時間=3.80,P＜0.05),其中術後6箇月試驗組裸眼視力優于對照組(t=2.97,P＜0.05),試驗組術後6箇月裸眼視力優于術後7d,差異有統計學意義(P＜0.05).2箇組術眼在術後不同時間點BCVA的差異無統計學意義(F分組=2.44,P＞0.05；F時間 =2.31,P＞0.05).2箇組間術眼術後SE的有統計學意義(F分組=11.52,P＜0.05),術後不同時間點術眼SE的整體比較差異有統計學意義(F時間=22.06,P＜0.05),術後6箇月試驗組術眼SE高于對照組(t=2.47,P＜0.05),術後7d及術後1箇月、3箇月試驗組術眼的校正眼壓明顯低于對照組(F分組=14.83,P＜0.05),術後2箇組間CCT的增幅差異無統計學意義(F分組=0.04,P＞0.05).術後試驗組角膜前錶麵麯率變化平穩,但對照組隨著時間的延長角膜前錶麵麯率逐步增加(F時間=18.73,P＜0.05).結論高度近視眼LASIK術後早期跼部使用0.5％馬來痠噻嗎洛爾滴眼液能減少屈光迴退,提示0.5％馬來痠噻嗎洛爾滴眼液通過降低眼壓而阻止角膜膨隆,其可能是預防術後屈光迴退的主要機製.
배경 굴광회퇴시고도근시안준분자격광각막원위마양술(LASIK)술후교상견적병발증,영향수술적장기은정성.목전상무예방LASIK술후굴광회퇴적방법. 목적 관찰마래산새마락이적안액대고도근시안LASIK술후굴광회퇴적예방효응.방법 채용전첨성간예성림상수궤대조연구.선취2012년2-9월재준의의학원부속의원행LASIK적고도근시환자60례60안,굴광도위(-7.16±0.95)D.장환자안수궤수자표법분성시험조화대조조,2개조환자술후균급여상규항염용약,시험조환자재술후제1천개시적가질량분수0.5％마래산새마락이적안액,매일2차,1개월후개위매천신기점안1차.측량2개조환자술전,술후1주급1、3、6개월적라안시력、최가교정시력(BCVA)、등효구경도(SE)、각막전표면곡솔화안압,병측량술전급술후1、3、6개월술안적중앙각막후도(CCT),술전측산잔여각막기질후도.채용중복측량방차분석、독립양본t검험화Bonferroni검험대2개조재불동시간점간적수거진행분석. 결과 시험조급대조조간환자술전적년령、라안시력、BCVA、SE、안압、각막전표면곡솔、CCT급잔여각막기질후도적차이균무통계학의의(P＞0.05).2개조간수술후불동시간점적라안시력차이유통계학의의(F분조=3.91,P＜0.05；F시간=3.80,P＜0.05),기중술후6개월시험조라안시력우우대조조(t=2.97,P＜0.05),시험조술후6개월라안시력우우술후7d,차이유통계학의의(P＜0.05).2개조술안재술후불동시간점BCVA적차이무통계학의의(F분조=2.44,P＞0.05；F시간 =2.31,P＞0.05).2개조간술안술후SE적유통계학의의(F분조=11.52,P＜0.05),술후불동시간점술안SE적정체비교차이유통계학의의(F시간=22.06,P＜0.05),술후6개월시험조술안SE고우대조조(t=2.47,P＜0.05),술후7d급술후1개월、3개월시험조술안적교정안압명현저우대조조(F분조=14.83,P＜0.05),술후2개조간CCT적증폭차이무통계학의의(F분조=0.04,P＞0.05).술후시험조각막전표면곡솔변화평은,단대조조수착시간적연장각막전표면곡솔축보증가(F시간=18.73,P＜0.05).결론 고도근시안LASIK술후조기국부사용0.5％마래산새마락이적안액능감소굴광회퇴,제시0.5％마래산새마락이적안액통과강저안압이조지각막팽륭,기가능시예방술후굴광회퇴적주요궤제.
Background Refractive regression is a common complication of high myopia after laser in situ keratomileusis (LASIK),and it affects the stability of surgery.Objective This study was to observe the preventive effect of timolol on refractive regression in high myopia after LASIK.Methods A perspective randomized controlled trial was performed under the approval of Affiliated Hospital of Zunyi Medical College and the informed consent of the patients.Sixty eyes of 60 patients with high myopia (-7.16±0.95) D for LASIK were randomized into experimental group and control group.Regular eye drops were topically administered in the patients after LASIK in both groups,and timolol 0.5 ％ was added topically from 1 day after LASIK.The uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),spherical equivalent (SE),corneal anterior surface curvature,intraocular pressure (IOP),central corneal thickness (CCT) were measured before LASIK,1 week,1 month,3 months and 6 months after LASIK,respectively.Residual stromal bed thickness was calculated before LASIK.The differences of above-mentioned indexes were analyzed and compared between the two groups and among the various time points using repetitive measurements analysis of variance,independent simple t test and Bonferroni test.Results No significant differences were found in the demography between the experimental group and the control group,including age,UCVA,BCVA,SE,IOP,corneal anterior surface curvature,CCT and residual stromal bed thickness (all at P＞0.05).UCVA was significantly different between the two groups among various time points (Fgroup =3.91,P＜0.05 ; Ftime =3.80,P＜0.05),and the UCVA was significantly higher in the experimental group than the control group 6 months after LASIK (t=2.97,P＜0.05),and UCVA was gradually increased as the lapse of postoperative time with the significant difference between 7 days and 6 months after LASIK in the experimental group (P＜0.05).No significant difference was seen in the BCVA between the two groups at various postoperative time points (Fgroup =2.44,P＞0.05;Ftime =2.31,P＞0.05).SE refraction in both groups were significantly reduced from 7 days through 6 months after LASIK,showing significant difference between the groups at various time points after LASIK(Fgroup =11.52,P＜0.05;Ftime =22.06,P＜0.05).The SE refraction was higher in the experimental group than that in the control group 6 months after LASIK (t =2.47,P＜0.05).Corrected IOP in the experimental group was lower than that of the control group at 7 days,1 month and 3 months after LASIK,respectively (Fgroup =14.83,P＜0.05).The change of CCT was not statistically different between the control group and the experimental group (Fgroup =0.04,P＞0.05).The anterior corneal surface curvature was steady in the experimental group during the following-up duration after LASIK,while the control group was growing gradually (Ftime =18.73,P＜0.05).Conclusions The study data show that topical administration of 0.5％ timolol early in high myopia following LASIK is effective for the reduction of the refractive regression.It is suggested that 0.5％ timolol can prevent cornea ectasia by lowering IOP.Reduction of the IOP may contribute to improving the regression after keratorefractive surgery in high myopic eyes.