准分子激光角膜屈光术后皮质类固醇性高眼压临床相关因素分析

目的 探讨准分子激光角膜屈光术后皮质类同醇性高眼压的发生率、临床相关因素及预后。方法 对2005.12-2006.12间行LASIK或LASEK的2060例4060只眼滴皮质类固醇眼液（0.1%地塞米松及0.1%氟米龙）2-3月,术后1周、1、2、3、6月及1年观察眼压变化,对高眼压者进行治疗,并采用Logistic方法分析高眼压与年龄、性别、眼别、最大径线屈光度、最大径线角膜曲率、角膜切削深度和眼底垂直径C/D值的相关性。结果 有88例143眼发生了高眼压,发生率为3.5%,所有高眼压患者经药物治疗眼压均降至正常。Logistic回归分析,眼底C/D值与高眼压相关性P值为0.015,OR值为3.071,其他因素P值均大于0.1。眼底C/D值大于等于0.4者发生皮质类固醇性高眼压的几率是小于0.4者的3.071倍。结论 准分子激光角膜屈光术后应用糖皮质激素眼液可引起小部分患者发生皮质类固醇性高眼压,眼底垂直径C/D值与皮质类闹醇性高眼压有强相关性,大于等于0.4是皮质类固醇性高眼压的高危因素,对眼底C/D值人于等于0.4者术后可酌情减少激素用量和/或加用降眼压药物。     

准分子激光角膜屈光术后皮质类固醇性高眼压的临床分析

目的:探讨准分子激光角膜屈光术后皮质类固醇性高眼压的发生率、临床特点及临床相关因素分析,为临床诊疗提供帮助。方法:对2005/2009年间我院行准分子激光原位角膜磨镶术(laser in situkeratomileusis,LASIK)或准分子激光上皮瓣下角膜磨镶术(laser subepithelial keratomileusis,LASEK)的1580例3160眼术后皮质类固醇性高眼压患者的病历进行回顾性分析总结。结果:有38例68眼发生了高眼压,其中男20例,女18例,年龄18~33岁,术前屈光度为-4.00~-12.00D,发病时间为手术后14~30d,发生率为2.2%。其中LASIK术后继发皮质类固醇性高眼压的患者16例30眼,LASEK术后继发皮质类固醇性高眼压的患者22例38眼,38例68眼中均为局部使用氟米龙或百力特滴眼液,用药时间20~90d,视力不同程度下降及眼压升高,个别患者伴有角膜上皮水肿。停用糖皮质激素后根据眼压情况采用局部或全身降眼压药物治疗,所有患者视力恢复正常,症状消失,待眼压下降后将皮质类固醇滴眼液逐渐减量和停药。结论:准分子激光角膜屈光术后应用糖皮质激素滴眼液可引起部分患者发生皮质类固醇性高眼压,应根据不同的临床特点给予充分的警惕,以免误诊漏诊。     

准分子激光屈光性角膜切削术后皮质类固醇性高眼压和青光眼的临床分析

目的探讨准分子激光屈光性角膜切削术（ｐｈｏｔｏｒｅｆｒａｃｔｉｖｅｋｅｒａｔｅｃｔｏｍｙ,ＰＲＫ）后皮质类固醇性高眼压（ｃｏｒｔｉｃｏｓｔｅｒｏｉｄｏｃｕｌａｒｈｙｐｅｒｔｅｎｓｉｏｎ）及皮质类固醇性青光眼（ｃｏｒｔｉｃｏｓｔｅｒｏｉｄｇｌａｕｃｏｍａ）的发生率、临床特征及治疗效果。方法用美国ＶＩＳＸ２０／２０准分子激光系统,对ＰＲＫ术后１５９０只眼滴用皮质类固醇（０．１％氟米龙）眼液４～６个月,分别于术后１个月、３个月、６个月、１年及２年观察眼压变化,对于高眼压者给予治疗。结果本组１５９０只眼中４３只眼发生皮质类固醇性高眼压或皮质类固醇性青光眼,发生率为２．７％。经停用皮质类固醇眼液,滴用０．５％噻吗心安（或０．５％盐酸左布诺洛尔）眼液,必要时口服醋氮酰胺或行小梁切除术等,眼压均降至正常。结论ＰＲＫ术后滴用皮质类固醇眼液可发生皮质类固醇性高眼压及皮质类固醇性青光眼,个别患者视功能损害严重。对此,应停用皮质类固醇眼液,滴用β受体阻滞剂眼液或和口服碳酸酐酶抑制剂等;对视功能严重损害、停用降眼压药后眼压仍较高的患眼应行小梁切除术,经治疗眼压均可降至正常。     

准分子激光屈光性角膜切削术后皮质类固醇性高眼压和青光眼的 …

目的 探讨准分子激光屈光性角膜切削术（ｐｈｏｔｏｒｅｆｒａｃｔｉｖｅｋｅｒａｔｅｃｔｏｍｙ,ＰＲＫ）后皮质类固醇性高眼压（ｃｏｒｔｉｃｏｓｔｅｒｏｉｄｏｃｕｌａｒｈｙｐｅｒｔｅｎｓｉｏｎ）及皮质类固醇性青光眼（ｃｏｒｔｉｃｏｓｔｅｒｏｉｄｇｌａｕｃｏｍａ）的发生率,临床特征及治疗效果。方法 用美国ＶＩＳＸ２０／２０准分子激光系统,对ＰＲＫ术后１５９０只眼滴用皮质类固醇（０．１％氟米龙）眼液４－６个     

LASEK术后皮质类固醇性高眼压的临床观察

目的探讨准分子激光上皮瓣下角膜磨镶术（LASEK）后皮质类固醇性高眼压的发生情况及治疗结果。方法对行LASEK术的416眼术后滴用皮质类固醇（0．1％氟米龙）滴眼液4个月,观察眼压变化,对高眼压者给予治疗。结果18眼发生了皮质类固醇性高眼压,发生率为4．33％,经停用皮质类固醇滴眼液,给予0．5％噻吗心安滴眼液滴眼,仅1例加服醋甲唑胺,眼压均降至正常,视力完全恢复。结论术后定期随访,及时发现皮质类固醇性高眼压,治疗后不影响视力恢复。术前认真检查发现可疑病人,术后定期随访,有助于提高LASEK治疗近视的安全性。     

糖皮质激素滴眼液对PRK疗效及并发症的影响

目的：探讨不同糖皮质激素滴眼液及不同使用方法对准分子激光屈光性角膜切削术（PRK）疗效的影响，分析PRK术后因使用糖皮质激素滴眼液而致高眼压的发生、发展情况及防治措施。方法：分析分别使用地塞米松、爱氟龙和拂炎的3组PRK术后病人，在术后3月内视力、屈光度、眼压及角膜浊情况并进行统计学处理。结果：地塞米松及拂炎滴眼液比受氟龙抑制角膜增生的作用稍强，但无统计学意义；地塞米松和拂炎滴眼液引起皮质类固醇性高眼压的比例较爱氟龙高，具有统计学差异。不同的个体对相同的糖皮质激素滴眼液的反应有一定的差异。结论：PRK术后糖皮质激素滴眼液的使用对维持手术疗效十分重要。不同的糖皮质激素滴眼液对PRK术后角膜增生的报制作用以及引起皮质类固醇性高眼压的比例不同；PRK术后应根据不同情况选择糖皮质激素滴眼液及不同的使用时限。     

LASIK术后皮质类固醇性高眼压临床分型

目的探讨准分子激光角膜原位磨镶术(laser in situ keratomileusis,LASIK)后皮质类固醇性高眼压的临床特点,并根据其特点分型,为临床诊疗提供帮助。方法回顾性分析我中心2002年以来LASIK术后皮质类固醇性高眼压患者的病历(包括外院病例),对其临床特点进行总结。LASIK术后继发皮质类固醇性青光眼的患者34例64眼,男18例,女16例,年龄18~35岁,手术前等值球镜为-3.50~-14.00D,发病时间为术后6~28d。结果根据其临床特点分为普通型、上皮水肿型、层间积液型、弥漫性板层角膜炎型、角膜扩张型。其中普通型46眼,其临床仅表现为高眼压;上皮水肿型4眼,除高眼压外,裂隙灯检查可见全角膜上皮水肿;层间积液型2眼,裂隙灯下可见角膜层间有积液,角膜中央测出为低眼压,但从周边测可发现眼压升高;弥漫性板层角膜炎型4眼,其特点为高眼压,裂隙灯检查可见类似弥漫性板层角膜炎表现,皮质类固醇治疗加重病情,降眼压治疗有效;角膜扩张型8眼,临床表现为高眼压,角膜地形图可发现角膜扩张。结论LASIK术后继发皮质类固醇性青光眼有不同的临床特点,临床医师应加以重视,以免误诊漏诊。     

准分子激光屈光性角膜手术后激素性高眼压药物干预后的眼压观察

目的 观察准分子激光屈光性角膜手术后激素性高眼压患者短时间药物干预后的眼压情况.方法 回顾分析2004年5月至2006年2月我院眼屈光外科中心LASIK及LASEK手术病例,其中17例23眼术后眼压较术前眼压升高超过5 mmHg(1 kPa=7.5 mmHg),经短时间药物干预眼压降低至正常后.对眼压进行24-36个月的随访观察.结果 23眼中激素中度反应性19眼,激素高反应性4眼,停用皮质类固醇滴眼液并短时间应用药物降眼压至正常,在24-36个月的随访中17眼眼压保持稳定,6眼眼压停药后短期内再次升高,在激素中度反应性19眼中有3眼眼压再次升高,发生率15.7%.在激素高反应性的4眼中发生眼压再次升高3眼,占75%;统计学分析差异有显著性.随访期内没有观察到视野和视盘的改变.结论 皮质类固醇激素性高眼压早期应用药物降压后,多数患眼在近期及中长期随访中眼压稳定;激素高反应性患者近期眼压再次升高的发生率高于激素中度反应性患者.     

准分子激光原位角膜磨镶术后皮质类固醇性高眼压研究进展

准分子激光原位角膜磨镶术（laser in situ ker-atomileusis,LASIK）是治疗屈光不正的主要方法之一,由于该手术是在相对健康眼上进行,手术后的并发症引起了广泛重视。皮质类固醇性高眼压是手术后并发症之一。LASIK手术中需要制作角膜瓣,手术后由于角膜瓣的存在,改变了原有角膜的解剖和生理特点,使LASIK术后皮质类固醇性高眼压的临床表现呈现出多样性和复杂性的特点。角膜上皮水肿、角膜瓣水肿、角膜层间积液、弥漫性板层角膜炎性反应、角膜扩张及＂低眼压＂等表现,使早期诊断困难,易造成漏诊、误诊。对皮质类固醇性高眼压进行分型有利于增加对该病的认识,有助于早期正确诊断,避免严重并发症的发生。     

准分子激光角膜切削术后并发皮质类固醇性高眼压或青光眼

目的探讨准分子激光角膜切削术（ＰＲＫ）后伴发皮质类固醇性高眼压或青光眼的临床意义。方法ＰＲＫ治疗近视１０９８眼，术后使用氟美龙（ＦＭＬ）点眼４～６个月，防止术后并发症发生。结果使用ＦＭＬ而诱致激素性高眼压或青光眼共３５例６７眼，发生率为６．１％。结论为减少该病发生：①术前详细检查，询问有无青光眼家族史；②术后注意眼压变化；③改进手术方式     

Efficacy of ripasudil in reducing intraocular pressure and medication score for ocular hypertension with inflammation and corticosteroid

AIM: To investigate the efficacy of ripasudil, a Rho kinase inhibitor, in reducing intraocular pressure (IOP) and medication scores of anti-glaucoma drugs in patients with ocular hypertension with inflammation and corticosteroid. METHODS: The study included 11 patients diagnosed with ocular hypertension with inflammation and corticosteroid, all of whom were prescribed ripasudil eye drops and followed up for at least 2y after the initiation of treatment. IOP was measured using a non-contact tonometer before enrollment and at each follow-up visit. The medication score of glaucoma eye drops was calculated for each patient. RESULTS: The mean IOP (26.4±2.9 mm Hg before treatment) significantly decreased after ripasudil therapy (13.7±3.3 mm Hg at 3mo) and remained stable in the low-teens during the 2-year follow-up period (P<0.0001). A significant decrease in the medication score was observed at 12mo or later after the initiation of ripasudil therapy (P<0.05). Both baseline medication scores and glaucomatous optic disc change rates were significantly higher in the five eyes that required glaucoma surgery during the 2-year observation period than the 10 eyes that did not require surgery. CONCLUSION: Our results demonstrate the efficacy of ripasudil, in reducing IOP and the medication score over a 2-year treatment period in patients with ocular hypertension with inflammation and corticosteroid. Our findings also suggest that ripasudil could reduce the IOP in uveitic glaucoma patients with both lower baseline medication score and lower glaucomatous optic disc change rate.     

白内障术后激素性高眼压危险因素的临床分析

目的:研究白内障术后激素性高眼压发生的危险因素,期望对临床白内障术后糖皮质激素的使用具有一定的指导作用。方法:回顾性分析2005-01/2006-12行白内障超声乳化联合人工晶状体植入术患者糖皮质激素使用后眼压情况。结果:使用糖皮质激素眼液的患者1459例中24例发生糖皮质激素性高眼压,男14例,女10例,年龄、高度近视、糖尿病、术前眼外伤、术前色素膜炎为白内障摘除联合人工晶状体植入术后糖皮质激素性高眼压的危险因素。结论:白内障摘除联合人工晶状体植入术后糖皮质激素性高眼压的发生率为1.36%。眼局部长期大量使用激素是其发生的重要危险因素。     

Intraocular pressure-induced interlamellar keratitis after LASIK surgery

PURPOSE: To describe a case of interlamellar stromal keratitis induced by increased intraocular pressure (IOP) after LASIK surgery. METHODS: Case report and review of the literature. RESULTS: A 53-year-old white man with a history of treated ocular hypertension underwent uncomplicated LASIK surgery. The postoperative course was complicated by markedly elevated IOP induced by topical corticosteroid drops used to treat what appeared to be diffuse lamellar keratitis. Because IOPs remained uncontrolled despite maximal therapy, topical steroids were discontinued after a total of 9 weeks. The IOP rapidly returned to normal range with complete resolution of the corneal findings. Humphrey visual field analysis, confocal scanning laser imaging of the optic nerve, and stereoscopic disc photographs all demonstrated that significant glaucomatous field loss and optic atrophy developed over this 8-week period. DISCUSSION: The IOP should be immediately evaluated in patients who present with interlamellar stromal keratitis more than 1 week after LASIK. If the IOP is elevated, corticosteroid drops should be discontinued to prevent permanent visual loss. Furthermore, if a glaucoma specialist examines a patient with a history of LASIK and unexplained visual field loss, the medical record should be reviewed to determine if the postoperative course was complicated by this diffuse lamellar keratitis-like phenomenon.     

原发性开角型和闭角型青光眼眼压降低前后视盘改变和筛板顺应性的对比研究

目的比较降跟压前后原发性慢性闭角型青光眼（PACG）与原发性开角型青光眼（POAG）的视盘结构改变,了解两者间筛板顺应性是否存在差异。设计前瞻性对比研究。研究对象PACG36例49眼和POAG35例49眼。方法眼压降低前全部患者进行海德堡视网膜断层扫描（HRT—II）及Humphrey静态视野检查。根据病情选择手术、激光或药物治疗,使眼压降至正常范围。眼压降低后1个月重复HRT检查和视野检查。比较POAG和PACG眼压降低前后HRT视盘参数的变化,采用多元线性逐步回归法校正治疗前眼压、眼压降低幅度、年龄、杯盘比等因素影响。主要指标眼压降低前后HRT视杯面积、盘沿面积、视杯容积、平均视杯深度的差值。结果PACG及POAG组的视杯面积、视杯容积、平均视杯深度等指标在眼压降低后均明显降低（P〈0．05）,盘沿面积在眼压降低后均明显增加（P〈0．05）。视杯面积、盘沿面积、视杯容积、平均视杯深度在跟压降低前后的差值两组间无显著性差异（P〉0．05）。眼压降低前后这4个参数的差值与眼压降低幅度及杯盘比有关（P〈0．05）;与年龄及治疗前眼压无关（P〉0．05）。结论眼压降低后青光眼视盘形态结构有一定回复;但在PACG和POAG间,视盘形态结构回复的程度无明显差异,PACG和POAG的筛板顺应性可能无差异。（眼科,2009,18：264—269）     

Longitudinal changes in optic disc topography of adult patients after trabeculectomy.

OBJECTIVE: To study longitudinal changes in optic disc topography after trabeculectomy in adult patients. DESIGN: Prospective case series. PARTICIPANTS: Twenty-five eyes of 25 patients undergoing trabeculectomy were enrolled. INTERVENTION: Images of the optic disc were obtained preoperatively and approximately 2 weeks, 4 months, and 8 months after surgery by use of a confocal scanning laser ophthalmoscope (Heidelberg Retina Tomograph). MAIN OUTCOME MEASURES: The topographic optic disc parameters (cup volume, cup area, rim volume, rim area, cup-disc area ratio, mean cup depth, maximum depth, cup shape, and height variation contour) were measured automatically for each image with the Heidelberg Retina Tomograph Software (version 1.11). RESULTS: Approximately 2 weeks after surgery, the mean preoperative intraocular pressure (IOP) of 19.3 mmHg (SD, 6.4 mmHg) decreased to 6.0 mmHg (SD, 3.6 mmHg), cup volume and mean cup depth decreased, height variation contour increased, and the cup shape parameter became more negative. Approximately 4 months after surgery, mean IOP was 9.7 mmHg (SD, 4.2 mmHg), and the only statistically significant change from preoperative values of optic disc parameters was in the cup shape measure. Approximately 8 months after surgery, there was no statistically significant change in any of the optic disc parameters compared with preoperative values, although IOP was 10.4 mmHg (SD, 5.9 mmHg). CONCLUSIONS: Changes in the optic disc that may be present 2 weeks after a trabeculectomy do not appear to persist 4 and 8 months later in eyes with advanced glaucomatous optic nerve damage, except for cup shape, which was different from preoperative values at 4 months but not at 8 months.     

Potential risk factors and treatment of IOP elevation after operation in retinal detachment eyes of diabetic patients

AIM: To observe the intraocular pressure (IOP) fluctuation at the early stage of pars plana vitrectomy (PPV) and silicon oil tamponade in high myopia with rhegmatogenous retinal detachment (RRD) eyes in diabetic patients and analyze the potential risk factors and effective treatment. METHODS: One hundred consecutive diabetic patients of RRD in highly myopic eyes were retrospectively reviewed. Patients were divided into two groups: the experimental group, those who used Tobramycin Dexamethasone Eye Drops (TDED), and control group. Pre- and postoperative IOPs, retinal nerve fiber thickness (RNFL) and optic nerve head parameters were recorded before and after IOP elevation, and in the contralateral eye before the operation. Graphpad 7.01 was used for data analysis. RESULTS: IOP elevation occurred in 42 eyes within 1wk after vitrectomy in all diabetic participants. Ocular hypertension (OHTN) was observed in 31 of 53 eyes in experimental group and 11 eyes of 47 eyes in control group at the early stage after operation. Significant differences were found between groups in 5d-1wk and 1mo after vitrectomy. In addition, IOP of 39 eyes had decreased by proper treatment and 3 eyes received glaucoma filtration surgery. Compared to the optic disc parameters before IOP elevation, the average and inferior RNFL thickness were thinner and rim area decreased as well as cup volume and vertical C/D radio increased after IOP elevation. The RNFL thickness of the opposite eyes in patients with IOP elevation was found thinner than the ones who never suffered ocular hypertension. CONCLUSION: Continual use of glucocorticoid after vitrectomy is a potential risk factor of IOP elevation in high myopia with diabetes, and doubtful open angle glaucoma should be focused on its sensibility to glucocorticoid and IOP elevation.     

糖尿病合并视网膜脱离术后高眼压的处理及危险因素探讨

目的：观察糖尿病合并孔源性视网膜脱离患者行玻璃体切割术后短期内眼压的波动情况并探讨可能的危险因素及有效的治疗方法。

方法：连续收集100例糖尿病合并高度近视及孔源性视网膜脱离的患者并分为两组：试验组和对照组,试验组患者术后使用妥布霉素地塞米松滴眼液。分别监测术眼玻璃体切割术术前及术后的眼压情况,神经纤维层厚度(RNFL)和视盘参数,同时记录对侧眼术前的情况。实验数据采用Graphpad 7.0进行分析。

结果：所有的糖尿病患者中有42眼在玻璃体切割术后1wk内出现眼压升高,其中试验组31眼,而对照组11眼。术后5d-1wk及1mo时两组间差异有显著统计学意义。随后,39眼经过治疗后眼压下降,3眼接受了青光眼滤过手术。与眼压升高前的视盘各参数相比,眼压升高后,平均及下方RNFL厚度变薄,盘沿面积变小,同时视杯容积和垂直杯盘比增加。眼压升高患者对侧眼的RNFL厚度相比于从未出现高压眼的患者明显变薄。

结论：玻璃体切割术术后连续使用激素类药物是糖尿病合并视网膜脱离患者术后眼压升高的危险因素,并且可疑青光眼患者使用激素后眼压更易升高。     

Evaluating target intraocular pressures in primary congenital glaucoma

Purpose:The aim of this study was to evaluate long-term intraocular pressures that provide stabilization/reversal of glaucomatous neuropathy after surgery in primary congenital glaucoma (PCG).Methods:Prospective evaluation of consecutive PCG patients who underwent trabeculectomy-trabeculotomy and followed up for ≥2 years. Records of regularly performed examination under anesthesia were maintained to ascertain intraocular pressure, (IOP), fundus, refraction and corneal diameter. Outcomes – Primary: cup: disc ratio and intraocular pressure, Secondary: corneal changes and refractive errorResults:A total of 174 eyes of 108 children with PCG had a preoperative IOP of 22.44 ± 9.5 mm Hg. Postoperative review IOP was 11.8 ± 4.5 mm Hg, cup-disc-ratio was 0.52 ± 0.23 and corneal diameter was 12.75 ± 0.9 mm. Primary outcomes: Linear regression analysis showed a significant positive correlation of review IOP with cup disc ratio, P = 0.004. 67.9%, of eyes at a review IOP range of 6-12 mm Hg showed reversal, 14.1%, were stable, at 6-15 mm Hg, while 3.84% showed an increase in cup: disc ratio 16-22 mm Hg. Patients operated before 6 months of age had a significantly smaller final cup-disc ratio, P = 0.0013. Patients with a final cup: disc ratio of >0.9 were significantly older at surgery, P < 0.001. Secondary outcomes: There was a positive correlation of final myopia with review IOP on linear regression analysis, P = 0.012. The final spherical error in eyes having cup disc ratio of ≤ 0.5 was –0.96 ± 4.5 diopters, as against -3.45 ± 7.7 diopters in eyes having cup-disc ratio of 0.6-0.8 and -3.8 ± 6.9 diopters in eyes with cup disc ratio of ≥0.9, P = 0.015. There was no significant change in corneal diameter.Conclusion:Patients operated after 6 months of age had a larger final cup: disc ratio, while postoperative review intraocular pressures over 2 years of at least ≤15 mm Hg in primary congenital glaucoma eyes, commonly lead to reversal/stability of the neuropathy, and a lower incidence and degree of myopia.     

Changes in optic disc parameters after intraocular pressure reduction in adult glaucoma patients.

PURPOSE: To quantitatively evaluate the change in the optic disc topographic parameters associated with reduction in the intraocular pressure (IOP) after trabeculectomy in adult patients with glaucoma. METHODS: A series of 22 patients (mean age: 45.7+/-15.1 years) with several types of glaucoma were examined for various parameters of optic disc before and after trabeculectomy. Cup area, cup-to-disc area ratio, cup volume, rim volume, mean cup depth, and maximum cup depth were determined by means of laser scanning tomography (LST), and the parameters were correlated with the degree of postsurgical IOP decrease. RESULTS: The IOP in adult glaucoma patients showed significant reductions after trabeculectomy. The values for all topographic parameters examined. except cup volume, showed statistically significant postsurgical changes as compared to the presurgical values. Of all postsurgical changes in parameters. the increase in the rim volume was the most noticeable; it was remarkably evident in those eyes with postsurgical IOP levels less than 15 mm Hg. It was also demonstrated that the anterior displacement of the glaucomatous cupping may occur after surgery. CONCLUSIONS: It is obvious that optic disc parameters can change after IOP reduction after successful surgery in adult glaucoma patients as well as in infantile glaucoma patients. The site of changeable glaucomatous optic cupping is topographically variable among patients and it may be related to the presurgical shape of the optic cup.