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     

PRK术后局部使用艾氟龙或地塞米松安全性及疗效观察

目的评估准分子激光削融术（ＰＲＫ）后局部滴用艾氟龙（ｆｌｕｏｒｏｍｅｔｈｏｌｏｎｅ，ＦＭＬ）或地塞米松滴眼液（ｄｅｘａｍｅｔｈａｓｏｎｅ，ＤＥＸ）治疗后皮质类固醇性高眼压、角膜雾浊及屈光回退的发生率。方法追踪观察了ＰＲＫ治疗的１７７例患者（３４１眼）。患者自上皮愈合日始，随机分为滴０．１％艾氟龙或０．２５％地塞米松组。药物使用４次／ｄ，共１个月；从第２月始逐月每日减少１滴，总疗程４个月。随访时间分别在１０ｄ，１、２、３、４月。结果ＰＲＫ术后４月，皮质类固醇性高眼压发生率艾氟龙组为１４．８％，地塞米松组为３２．１％，差异有显著性（Ｐ＜０．０１）。角膜雾浊和屈光回退在两组间基本相似（Ｐ＞０．０５）。结论ＰＲＫ术后使用艾氟龙可有效降低皮质类固醇性高眼压的发生率，但对减轻角膜雾浊，防止屈光回退的效果两药相同。     

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     

准分子激光角膜切削术后皮质类固醇激素的应用

比较准分子激光角膜切削术（ｐｈｏｔｏｒｅｆｒａｃｔｉｖｅｋｅｒａｔｅｃｔｏｍｙ，ＰＲＫ）后皮质类固醇激素的应用方法。方法应用ＮｉｄｅｋＥｃ５０００型准分子激光机对６００只近视眼行ＰＲＫ，术后随机分为Ａ组（２２８只眼）和Ｂ组（３７２只眼），分别采用不同的方法应用皮质类固酵激素，随６个月。结果术后６个月裸眼视力大于０．８、１·０者，Ａ组分别为９７．９％、９３．２％；Ｂ组为９８．６％、９３．５％；Ａ、Ｂ两组发生过性高眼压分别为２．２％、２·７％，差异无显著性（Ｐ＞０．０５）１级以上角膜雾状混浊（ｈａｚｅ）的发生率在Ａ、Ｂ两组分别为１８．４％、５·４％两者差异有非常显著性（Ｐ＜０．０５）。结论合理使用皮质类固醇激素能有效地降低ＰＲＫ后ｈａｚｅ的形成及其所引起的近视回退，早期使用强效皮质类固醇激素，后期使用低浓度的皮质类固醇激素能减少激素性高眼压的发生率。     

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。     

准分子激光角膜切削术后眼压观察

目的探讨准分子激光角膜切削术（ＰＲＫ）术后眼压变化规律，皮质类固醇激素对眼压的影响及手术区和非手术区眼压差异情况。方法共随访７２例（１３８眼），其中轻度近视２３例（４４眼），中度近视３５例（６９眼），高度近视１４例（２５眼），于术前及术后２周、１月、２月、３月、４月用非接触式眼压计分别测量手术区（角膜中央）和非手术区（下方角膜周边部）眼压。结果（１）ＰＲＫ术后各阶段眼压普遍低于术前基础眼压，两者有显著性差异（Ｐ＜０．００１）。（２）手术区眼压均低于非手术区眼压，但两者无显著性差异（Ｐ＞０．０５）。（３）激素性高眼压最早出现在术后２周，多在术后３月。结论（１）由于ＮＣＴ本身的局限性可能导致的误差，应对ＰＲＫ术后ＮＣＴ所测的眼压值做综合分析、判断。（２）ＰＲＫ术后应在使用皮质类固醇激素２周开始定期监测眼压。     

准分子激光角膜切削术治疗近视致皮质类固醇性青光眼二例

准分子激光角膜切削术（ＰＲＫ）治疗近视,对大多数患者是安全的,但也会出现一些严重并发症,造成患者视功能永久丧失。我们发现两例ＰＲＫ后致皮质类固醇性青光眼患者,现报告如下。 病例 １：张×,男,２７岁,因高度近视于１９９７年１月２９日行双眼 ＰＲＫ。术前双眼视力 ０． ０２;眼压：右２２ ｍｍＨｇ（１ｍｍＨｇ＝０．１３３ ｋＰａ）,左１６ ｍｍＨｇ（Ｓｃｈｉｏｔｚ眼压计）。术后口服先锋Ⅵ,消炎痛,ＶｉｔＣ,ＶｉｔＢ２,滴用氟美松庆大霉素滴眼液、艾氟龙、双氯酚酸、素高捷疗,其中氟美松庆大霉素滴眼液与艾氟龙交…     

家兔PRK术后角膜的组织病理、免疫组化及超微结构的实验研究

目的 评价实验性家兔不同屈光度ＰＲＫ术后角膜创面愈合的过程及皮质类固醇对愈合的影响。方法 应用ＳＶＳ ＡＰＥＸ ＰＬＵＳ型准分子激光治疗系统对６只家兔双眼进行ＰＲＫ术,设定右眼－４．００Ｄ,左眼－８．００Ｄ。随机分为ＦＬＭ点眼组和ＣＭ点眼组,每组３只家兔,ＦＬＭ点眼组双眼滴皮质类固醇激素眼液（０．１％ｆｌｕｏｒｏｍｅｔｈｏｌｏｎｅ,ＦＬＭ,美国）;ＣＭ点眼组双眼滴０．２５％氯霉素眼液。分别于术后３     

准分子激光角膜切削术后角膜创面的愈合及皮质类固醇对愈合的影响

目的研究准分子激光角膜切削术（ｐｈｏｔｏｒｅｆｒａｃｔｉｖｅｋｅｒａｔｅｃｔｏｍｙ，ＰＲＫ）后创面愈合过程及皮质类固醇对愈合的影响。方法６只猕猴双眼行ＰＲＫ后，右眼滴皮质类固醇激素眼液，左眼滴新霉素眼液。于术后４天、１、２周、１、３及６个月测量角膜厚度，并取角膜做免疫组化染色，检测Ⅲ、Ⅳ、Ⅶ型胶原、纤维连结蛋白和层粘连蛋白。结果术后１个月角膜Ⅶ型胶原的分布恢复正常状态；应用皮质类固醇可降低Ⅲ型胶原和纤维连结蛋白的沉积，且术后中央角膜厚度的变化较对照组更接近期望值。结论ＰＲＫ后角膜上皮细胞与基质可达到紧密的附着；皮质类固醇对减少术后角膜雾状混浊和屈光回退有一定作用。     

PRK和LASIK后非接触式眼压值的改变及判断

目的 探讨和分析准分子激光屈光性角膜术后（Ｐｈｏｔｏｒｅ ｆｒａｃｔｉｖｅ Ｋｅｒａｔｅｃｔｏｍｙ,ＰＲＫ）和准分子激光原位角膜磨镶术（Ｌａｓｅｒ ｉｎｓｉｔｕＫｅｒａｔｏｍｉｌｅｕｓｉｓ,ＬＡＳＩＫ）治疗近视后非接触式眼压的变化。方法 对ＰＲＫ术后７０例１３０眼和ＬＡＳＩＫ术后３１例６０眼采用非接触式眼压计（Ｎｏｎｃｏｎｔａｃｔ Ｔｏｎｏｍｅｔｅｒ,ＮＣＴ）测量眼压,随访半年以上,将术前和术后眼     

LASIK术后应用不同糖皮质激素滴眼液对眼压的影响

目的：探讨不同糖皮质激素滴眼液对准分子激光辅助原位角膜磨镶术(LASIK)术后1m时眼压的影响。方法：将接受手术的360例600眼连续LASIK术后惑者分成3组，分别使用0.1％拂雷、0．5％帕利百、0.1％艾氟龙滴眼液行常规治疗，1m时测眼压并进行统计学处理。结果：不同糖皮质激素滴眼液引起眼压增高的发生率各异，拂雷组为36．0％，帕利百组为25．0％，艾氟龙组为14．5％。对相同的糖皮质激素滴眼液，高度和超高度组激素性高眼压发生率明显高于其他组。结论：0．1％拂雷滴眼液对眼压的影响最强，0．5％帕利百次之，0.1％艾氟龙对眼压的影响最小。对同一种药物，高度和超高度近视人群眼压增高比率大。     

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.     

妥布霉素地塞米松滴眼液致激素性青光眼

目的 探讨妥布霉素地塞米松滴眼液引起激素性青光眼的原因、治疗方法和预防措施.方法 回顾分析11例(20眼)局部长期应用妥布霉素地塞米松眼液致激素性青光眼患者的临床资料.结果 所有患者确诊后均停用妥布霉素地塞米松眼液,其中17眼(85%)停用后眼压降至正常,2眼(10%)经用抗青光眼药物治疗后眼压得到控制,1眼(5%)经药物降眼压处理后眼压仍控制不良,进行手术治疗.结论 长期不规范应用妥布霉素地塞米松眼液可引起激素性青光眼,因此强调合理用药.     

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固醇性高眼压的发生率、临床相关凶素及预后.方法:对2005-12/2006-12间行LASIK或LASEK的2060例4060眼滴糖皮质激素眼液(1g/L地塞米松及1g/L氟米龙)2～3mo,术后1wk;1,2,3,6mo及1α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杯/盘比值的相关性.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回归分析结果显示,眼底杯/盘比值与高眼压相关性P值为0.015,OR值为3.071,其他因素P值均大于0.1.眼底垂直径杯/盘比值大于等于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部分患者发生皮质类固醇性高眼压,眼底垂直径杯/盘比值与皮质类固醇性高眼压有较强相关性,大于等于0.4是皮质类固醇性高眼压的高危因素,对眼底杯/盘比值大于等于0-4者术后可酌情减少激素用量和/或加用降眼压药物.     

Subtenon's depot corticosteroid injections in patients with a history of corticosteroid-induced intraocular pressure elevation.

PURPOSE: To determine whether a history of intraocular pressure elevation from local corticosteroid administration could predict subsequent intraocular pressure elevation after posterior subtenon's corticosteroid injection. METHODS: A retrospective review was performed of 64 consecutive patients (64 eyes) receiving posterior subtenon's corticosteroid injection. Patients were categorized as either historical corticosteroid responders or nonresponders based on intraocular pressure response to topical corticosteroid drops in the same eye or to previous posterior subtenon's corticosteroid injection of the fellow eye. Historical responders were defined as having a relative intraocular pressure increase of 5 mm Hg and absolute intraocular pressure greater than 24 mm Hg with an anatomically open angle. Relative risk of intraocular pressure elevation was evaluated based on historical response and presenting diagnosis. RESULTS: Nine eyes were historical responders, and 55 eyes were historical nonresponders. A higher rate of recurrent intraocular pressure elevation developed in historical responder eyes (4 of 9, 44%) compared with nonresponders (7 of 55, 13%) after posterior subtenon's injection (P = .04, Fisher's test; P = .07, Kaplan-Meier analysis). Historical responders with uveitis were at significantly higher risk of intraocular pressure elevation than nonresponders without uveitis (hazard ratio = 10.8, P = .04, Cox proportional hazards). All but one eye that developed intraocular pressure elevation from posterior subtenon's injection was adequately controlled with topical antiglaucoma therapy. CONCLUSION: In nonglaucomatous eyes, a previous history of corticosteroid-induced intraocular pressure elevation is a relative, not absolute, contraindication to posterior subtenon's corticosteroid injection, because the risk of intraocular pressure elevation is not absolute, and because it can usually be well controlled with topical antiglaucoma therapy.     

准分子激光角膜切削术后皮质类固醇激毒的应用

比较准分子激光角膜切削术（ｐｈｏｔｏｒｅｆｒａｃｔｉｖｅｋｅｒａｔｅｃｔｏｍｙ，ＰＲＫ）后皮质 类固醇激光素的应用方法。方法应用ＮｉｄｅｋＥＣ５０００型准分子激光机对６００只近眼行ＰＲＫ，术后随机分为Ａ组和Ｂ组，分别采用不同的方法应用皮质类固醇激素，随访６个月。     

双氯酚酸钠对准分子激光角膜切削术后角膜上皮下混浊的影响

目的：探讨双氯酚酸钠对准分子激光角膜切削术后角膜上皮下混浊的影响。方法：对36只新西兰种兔行PRK,术后随机分为三组,即0．1％双氯酚酸钠治疗组（24眼）、0．1％艾氯龙治疗组（24眼）和空白对照组（24眼）。在术后1、3、6个月分别行裂灯、光镜、电镜及免疫组化检查。结果：术后1、3、6个月,双氯酚酸钠组及艾氯龙组角膜haze比对照组轻（P＜0．05）。双氯酚酸钠组成纤维细胞数比艾氯龙组和对照组少（P＜0．05）。Ⅲ胶原染色,双氯酚酸钠组和艾氟龙组比对照组弱（P＜0．01）。结论：双氯酚酸钠可减轻PRLK后haze的形成,且无副作用,是一种有效抑制haze形成的药物。     

Effects of tranilast on filtering blebs: a pilot study

PURPOSE: To investigate the effects of topical instillation of 0.5% tranilast eye drops on intraocular pressure (IOP) and bleb formation after glaucoma filtering surgery. PATIENTS AND METHODS: This was a prospective, randomized, double-masked, and controlled clinical trial. A total of 52 eyes of 52 patients were randomly assigned to receive either 0.5% tranilast eye drops (24 eyes) or vehicle saline solution (28 eyes) 4 times daily for 3 months after trabeculectomy. Features of the bleb, such as vascularization and size, and intraocular pressure were studied. RESULTS: The incidence of vascularized bleb and "pseudopod" formation 6 months post treatment were more common in tranilast-treated eyes than control eyes (P = 0.019 and P = 0.043, respectively). The bleb was significantly larger at 6 and 12 months (P = 0.024 and P = 0.049, respectively), and reduction of the IOP was more significant for 2 years postoperatively (P = 0.002 to P = 0.032) in tranilast-treated eyes than control eyes. No vision-threatening side reactions were associated with tranilast. CONCLUSIONS: The use of topical tranilast after filtering surgery alleviates ischemia of the filtering bleb, reduces IOP, and increases the size of the bleb.