1g/L溴芬酸钠水合物滴眼液联合糖皮质激素在高度近视LASEK术后的应用

目的:观察准分子激光上皮下角膜磨镶术(laser subepithelial keratomileusis,LASEK) 后用1g/L溴芬酸钠水合物滴眼液部分替代糖皮质激素的安全性及有效性.方法:前瞻性对患者104例208眼高度近视眼,根据术后用药的不同分为研究组与对照组.研究组给予1g/L溴芬酸钠水合物滴眼液联合1g/L妥布霉素地塞米松滴眼液及1g/L氟米龙滴眼液,对照组仅给予1g/L妥布霉素地塞米松滴眼液及1g/L氟米龙滴眼液.观察两组术后患者疼痛感、术后视力、眼压(intraocular pressure,IOP) 变化以及术后角膜上皮下雾状混浊(haze)发生情况.结果:两组术后1、2、3d疼痛感评分,研究组分别为1.70±0.35、1.25±0.34、0.82±0.32分,对照组分别为2.30±0.43、1.68±0.44、1.12±0.33分,两组比较差异均有统计学意义(P<0.05).术前、术后2wk,1、3mo,研究组裸眼视力分别为0.035±0.02、0.71±0.13、0.89±0.17、0.88±0.18,对照组各个时间点分别为0.037±0.015、0.73±0.15、0.87±0.14、0.86±0.15,两组比较差异无统计学意义(P>0.05);研究组术前、术后1、2wk,1、3mo时眼压分别为17.33±1.58、7.54±1.28、7.23±1.58、7.26±1.47、7.30±1.36mmHg,对照组分别为17.53±1.43、7.57±1.32、7.73±1.55、7.80±1.38、7.86±1.43mmHg,术前、术后1wk两组眼压比较,差异无统计学意义(P>0.05),术后2wk,1、3mo两组比较,差异有统计学意义(P<0.05);研究组术后1、3mo haze≤1级的分别占全部haze的91.7%、93.3%,对照组术后1、3mo haze≤1级的分别占全部haze的92.0%、92.9%,各时间点两组差异均无统计学意义(P>0.05).结论:1g/L溴芬酸钠水合物滴眼液部分替代糖皮质激素在LASEK术后效果安全、有效,术后眼压水平更低,术后视力、抗炎等方面获得与糖皮质激素相似的效果.

Clinical observation on 1g/L bromfenac sodium hydrate ophthalmic solution associated with glucocorticoid in high myopia after LASEK

AIM:To observe the efficacy and safety of 1g/L bromfenac sodium hydrate ophthalmic solution in the partial substitution of glucocorticoid after laser subepithelial keratomileusis(LASEK).

METHODS: Totally 104 cases(208 eyes)were received LASEK, which were selected and divided into study group and control group. The study group were adopted 1g/L bromfenac sodium hydrate ophthalmic solution combined with tobramycin dexamethasone eye drops and fluorometholone eye drops, the control group were adopted tobramycin dexamethasone eye drops and fluorometholone eye drops. The changes of visual acuity and intraocular pressure of two groups were recorded before and after surgery, and the score of painness and the occurrence of haze were observed after surgery.

RESULTS: At postoperative 1, 2, 3d, respectively, the pain score of the study group were 1.70±0.35, 1.25±0.34, 0.82±0.32, the pain score of the control group were 2.30±0.43, 1.68±0.44, 1.12±0.33, the differences were significant(P<0.05). Before and at 2wk, 1, 3mo after surgery, respectively, uncorrected visual acuity of study group were 0.035±0.02, 0.71±0.13, 0.89±0.17, 0.88±0.18, while which of control group were 0.037±0.015, 0.73±0.15, 0.87±0.14, 0.86±0.15(P>0.05), and the differences were not significant(P>0.05). At preoperative and postoperative 1, 2wk, 1 and 3mo of surgery, respectively, the intraocular pressure of study group were 17.33±1.58, 7.54±1.28, 7.23±1.58, 7.26±1.47, and 7.30±1.36 mmHg; the intraocular pressure of control group were 17.53±1.43,7.57±1.32,7.73±1.55,7.80±1.38,7.86±1.43 mmHg,the differences were not significant between before and at 2wk after surgery(P>0.05), the differences were significant between the two groups at 2wk, 1mo and 3mo(P<0.05). At postoperative 1, 3mo of surgery, the score of haze level of the study group were 91.7% and 93.3%, respectively and which in control group were 92.0% and 92.9%, respectively, and the differences were not significant between the two groups at every time point(P>0.05).

CONCLUSION: It is safe and effective that 1g/L bromfenac sodium hydrate ophthalmic solution in the partial substitution of glucocorticoid after laser subepithelial keratomileusis. The patient has a lower intraocular pressure, has similar therapeutic effect as glucocorticoid in vision and antiinflammatory.