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。

The clinical analysis of corticosteroid ocular hypertension and corticosteroid glaucoma after photorefractive keratectomy

Objective To inquire into the incidence, clinical characteristics and therapeutic effects of corticosteroid hypertension and corticosteroid glaucoma after photorefractive keratectomy (PRK). Methods The authors completed a follow up study on 1 590 eyes on which this procedure was performed and corticosteroid (0.1% fluoromethalone, FML) eye drops were applied 4 to 6 months postoperatively to observe intraocular pressure at 1, 3, 6, 12 and 24 months, and treated the eyes with increase of intraocular pressure. Results Corticosteroid ocular hypertension or corticosteroid glaucoma occurred in 2.70% of 1 590 eyes. The intraocular pressure of the eyes was recovered to normal in all patients after treatments of stopping FML eye drops, using topical 0.5% timolol (or 0.5% levobunolol hydrochloride), taking diamox orally or receiving trabeculectomy. Conclusions Topical application of corticosteroid may cause corticosteroid hypertension and corticosteroid glaucoma after PRK, and visual function damage may occur in a few eyes. Under this situation, the corticosteroid eye drops should be stopped and glaucomatous treatment should be given.