降眼压药物预防LASIK术后屈光回退

目的探讨降眼压药物20g·L-1盐酸卡替洛尔眼液对LASIK术后屈光回退的预防作用及其可能机制。方法将2008年11月至2009年1月在我院眼科行LASIK的200例(394眼)患者随机分为试验组(加用20g·L-1盐酸卡替洛尔眼液)和对照组,根据术前屈光度将试验组和对照组分为低度、中度、高度和超高度四个亚组,根据角膜基质床厚度分为A(<300μm)、B(300～350μm)和C(≥350μm)三个亚组,分别对两组的各亚组术后各时间点的裸眼视力(uncorrect visual acuity,UC-VA)、屈光度和角膜曲率进行比较。对两组术后6个月的屈光回退比率比较进行χ2检验,两组术后1d、1周、1个月、3个月、6个月的UCVA、屈光度和角膜曲率比较分别进行t检验。结果 139例(275眼)患者完成有效观察。试验组术后6个月的回退率低于对照组(0.71%、5.19%)。两组术后1d、1周、1个月和3个月UCVA差异无统计学意义,术后6个月试验组高于对照组(P<0.05);其中两组的低度、中度、B亚组和C亚组病例术后各时间点差异均无统计学意义(均为P>0.05);而两组的高度、超高度和A亚组病例术后1d差异也无统计学意义(均为P>0.05),术后1周、1个月和3个月试验组低于对照组,术后6个月试验组高于对照组(均为P<0.05)。术后过矫屈光度方面,两组的高度、超高度和A亚组病例术后1d差异均无统计学意义(均为P>0.05),试验组其他各时间点均高于对照组(均为P<0.05)。两组的高度、超高度和A亚组病例的角膜曲率术后1d差异无统计学意义(均为P>0.05),试验组其他各时间点均低于对照组(均为P<0.05)。结论降眼压药物可减少LASIK术后屈光回退的发生率,提高手术效果,特别对于高度、超高度近视以及角膜基质床厚度偏薄的患者来说,还可以增加术后屈光度和角膜曲率的稳定性,可能在预防屈光回退方面起着积极作用。

Preventive effect IOP-lowering medication for refraction regression after LASIK

Objective To discuss the preventive effect and mechanism of IOP-lowering medication(20 g·L-1 carteolol eye drops) on refraction regression after laser in situ keratomileusis(LASIK).Methods Two hundreds cases(394 eyes) underwent LASIK in our hospital from November 2008 to January 2009 were divided into experimental group(added 20 g·L-1 carteolol eye drops) and control group,the two groups were sub-divided into low subgroup,moderate subgroup,high subgroup and over-high subgroup according to preoperative diopter,and sub-divided into A subgroup(<300 μm),B subgroup(300-350 μm) and C subgroup(≥350 μm) according to corneal stroma bed thickness.The refraction regression rate was compared between two groups at postoperative 6 months by χ2-test.At the same time,the uncorrected visual acuity(UCVA),diopter and corneal curvature were compared between two groups at postoperative 1 day,1 week,1 month,3 months and 6 months by t-test.Results One hundred and thirty-nine cases(275 eyes) could be observed effectively.The regression rate in experimental group(0.71%) was lower than that in control group(5.19%) at postoperative 6 months.There was no statistical difference in UCVA between two groups at postoperative 1 day,1 week,1 month and 3 months,but which at postoperative 6 months in experimental group was higher than that in control group,there was statistical difference(P<0.05).There was no statistical difference among low,middle,B,C subgroups at all time-point after surgery(all P>0.05),and also no difference among high,over-high and A subgroups at postoperative 1 day(all P>0.05),UCVA in experimental group at postoperative 1 week,1 month and 3 months were lower than that in control group,but higher at postoperative 6 months(all P<0.05).There was no statistical difference in diopter among high,over-high and A subgroup at postoperative 1 day(all P>0.05),but at other time points,the experimental group were higher than the control group,there were statistical differences(all P<0.05).There was no statistical difference in corneal curvature among high,over-high and A subgroup at postoperative 1 day(all P>0.05),but at other time points,the experimental group were lower than the control group,there were statistical differences(all P<0.05).Conclusion The IOP-lowering medication can reduce the refraction regression rate after LASIK and improve operative effect.Especially for the cases with high,over-high myopia or thinner corneal stroma bed thickness,it can increase the stability of diopter and corneal curvature,which may play the positive effect in preventing the refraction regression.