CAJ | 학술논문

目的比较非甾体与甾体类抗炎药物在薄瓣准分子激光原位角膜磨镶术(LASIK)后使用的有效性与安全性,为非甾体类抗炎药物在角膜屈光手术后的使用提供临床依据.方法前瞻性随机对照临床研究.收集第三军医大学大坪医院野战外科研究所眼科行薄瓣LASIK手术患者314例(628眼),采用随机数字法分为氯替泼诺组和溴芬酸钠组各157例(314眼).分别于术前,术后3d、15 d、1个月、3个月行视力、电脑验光、眼压(IOP)和裂隙灯显微镜检查.采用重复测量两因素方差分析比较不同观察时间点2组间裸眼视力(UCVA)、球镜度、柱镜度和IOP的差异;混合线性模型分析不同观察时间点UCVA达术前最佳矫正视力(BCVA)的比例;x2检验比较2组术后弥漫性板层角膜炎(DLK)发生率.结果氯替泼诺组与溴芬酸钠组在观察时间点达到术前BCVA的UCVA比例差异无统计学意义(F=0.717,P＞0.05).术后15 d氯替泼诺组与溴芬酸钠组球镜度分别为(0.04±0.68)D和(0.16±0.58)D,差异有统计学意义(F=6.184,P＜0.05);IOP分别为(14.67±4.00)mmHg(1 mmHg=0.133 kPa)和(10.91 ±2.40)mm Hg,差异有统计学意义(F=204.232,P＜0.01).术后15 d氯替泼诺组高眼压累计发生35眼(11.2％),溴芬酸钠组无一例发生高眼压.2组间Ⅲ级以下DLK发生率差异无统计学意义(x2=0.53,P＞0.05).结论溴芬酸钠滴眼液替代氯替泼诺滴眼液用于薄瓣LASIK术后有良好的抗炎效果,并且减少了术后激素性高眼压的发生率,更有利于术后获得较稳定的屈光状态.
목적 비교비치체여치체류항염약물재박판준분자격광원위각막마양술(LASIK)후사용적유효성여안전성,위비치체류항염약물재각막굴광수술후적사용제공림상의거.방법 전첨성수궤대조림상연구.수집제삼군의대학대평의원야전외과연구소안과행박판LASIK수술환자314례(628안),채용수궤수자법분위록체발낙조화추분산납조각157례(314안).분별우술전,술후3d、15 d、1개월、3개월행시력、전뇌험광、안압(IOP)화렬극등현미경검사.채용중복측량량인소방차분석비교불동관찰시간점2조간라안시력(UCVA)、구경도、주경도화IOP적차이;혼합선성모형분석불동관찰시간점UCVA체술전최가교정시력(BCVA)적비례;x2검험비교2조술후미만성판층각막염(DLK)발생솔.결과 록체발낙조여추분산납조재관찰시간점체도술전BCVA적UCVA비례차이무통계학의의(F=0.717,P＞0.05).술후15 d록체발낙조여추분산납조구경도분별위(0.04±0.68)D화(0.16±0.58)D,차이유통계학의의(F=6.184,P＜0.05);IOP분별위(14.67±4.00)mmHg(1 mmHg=0.133 kPa)화(10.91 ±2.40)mm Hg,차이유통계학의의(F=204.232,P＜0.01).술후15 d록체발낙조고안압루계발생35안(11.2％),추분산납조무일례발생고안압.2조간Ⅲ급이하DLK발생솔차이무통계학의의(x2=0.53,P＞0.05).결론 추분산납적안액체대록체발낙적안액용우박판LASIK술후유량호적항염효과,병차감소료술후격소성고안압적발생솔,경유리우술후획득교은정적굴광상태.
Objective To compare the efficacy between non-steroidal and steroidal anti-inflammatory drugs after a thin-flap LASIK procedure.Methods This was a prospective, randomized and controlled clinical study.Three hundred fourteen patients (628 eyes) who were undergoing thin-flap LASIK were enrolled in the study.They were randomly divided into a loteprednol group and a bromfenac group.Best uncorrected visual acuity, refractive status, intraocular pressure (IOP) and the cornea were examined preoperatively and 3 days, 15 days, 1 month and 3 months after the LASIK procedure.The differences in visual acuity, refraction and IOP between the groups were compared using repeated measures categorical data analysis.The ratios of uncorrected visual acuity (UCVA) to best corrected visual acuity (BCVA) at the time points after surgery were compared using a mixed linear model, and the incidence of diffuse lamellar keratitis (DLK) was compared with a chi-square test.Results The ratios of UCVA to BCVA between the groups were not statistically significant (F=0.717, P＞0.05).The spherical lens power and IOP in the loteprednol and bromfenac groups were 0.04±0.68 D and 0.1658 D, and 14.67±4.00 mmHg (1 mmHg=0.133 kPa) and 10.91±240 mmHg,respectively.The differences were statistically significant (F=6.184, P＜0.05;F=204.232, P＜0.01).High IOP occurred in 35 eyes (11.2％) within 15 days postoperatively in the loteprednol group but did not occur in any eye in the bromfenac group.The DLK ratio between the two groups was not statistically significant (x2=0.53, P＞0.05).Conclusion Bmmfenac can be a safe and effective substitute for loteprednol as anti-inflammation eyedrops after thin-flap LASIK.By reducing the incidence of a postoperative spike in IOP, bromfenac is beneficial for stabilizing refractive status in patients.