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.

Clinical analysis of corticosteroid-induced ocular hypertension after laser keratorefractive surgery

AIM:To study the incidence,clinical related factors and therapeutic effects of corticosteroid-induced ocular hypertension after laser keratorefractive surgery (LASIK and LASEK). METHODS:A follow-up study on 4 060 eyes after laser keratorefractive surgery between December 2005 and December 2006 was performed. Corticosteroid (1g/L dexamethasone and 1g/L fluoromethalone) eye drops were applied 2-3 months post-operatively and intraocular pressure was measured at 1 week,1,2,3,6 and 12 months,the eyes with increase of intraocular pressure were treated. Binary logistic regression was used to analyze the relationship between ocular hypertension and age,sex,eye,maximum diopter,maximum curvature,cornea cutting depth,and vertical cup/disc ratio. RESULTS:Corticosteroid-induced ocular hypertension occurred in 3.5% of the 4 060 eyes. The intraocular pressure (IOP) of the eyes dropped to normal level in all patients after drug treatments. Results of binary logistic regression showed significance (P value) between ocular hypertension and cup/disc ratio was 0.015 and all others exceeded 0.1,OR ratio:3.071,which mean that incidence of corticosteroid-induced ocular hypertension on patients with vertical cup/disc ratio exceeding 0.4 was more 3 times than those with cup/disc ratio less than 0.4. CONCLUSION:Topical application of corticosteroid drops may cause corticosteroid-induced hypertension in somebody after laser keratorefractive surgery. There is close correlation between corticosteroid-induced hypertension and vertical cup/disc ratio. Cup/disc ratio exceeding 0.4 is a risk factor to corticosteroid-induced ocular hypertension. To those with cup/disc ratio exceeding 0.4,we can reduce corticosteroid dosage and/or use drugs to lower IOP.