噻吗心安滴眼液在准分子激光原位角膜磨镶术后预防屈光回退的初步研究

目的 前瞻性地观察准分子激光原位角膜磨镶术(LASIK)术后早期应用噻吗心安滴眼液,患者屈光状态等方面的变化,从而评估预防性用药对减少术后屈光回退的作用.方法 选择2009年4至5月间于本院接受LASIK手术的患者共60例(60只眼),按随机化原则均分为试验组和对照组.所有术眼术后第1天开始使用复方妥布霉素滴眼液,4次/d,1周后停药.试验组停用复方妥布霉素滴眼液之后加用噻吗心安滴眼液,2次/d,术后1个月复诊嘱患者停药.术前、术后1周、1个月和3个月均进行裸眼视力(UCVA)、最佳矫正视力(BSCVA)、主觉验光、Orbscan Ⅱ和Goldman 压平眼压检查.进行重复测量方差分析、单因素方差分析和独立样本t检验.检验水准α=0.05.结果 试验组术后1周、1个月和3个月的等效球镜度分别为(-0.07±0.25)、(0.04±0.21)和(-0.05±0.12)D,对照组分别为(-0.08±0.22)、(-0.15±0.17)和(-0.14±0.18)D.重复测量方差分析结果显示两组组别间整体比较差异有统计学意义(F=5.68,P＜0.05).试验组在术后1周、1个月和3个月的眼压分别为(12.63±2.56)、(9.70±1.88)和(11.41±1.22)mm Hg(1 mmHg=0.133 kPa),对照组分别为(12.59±2.62)、(11.78±1.82)和(11.67±2.15)mm Hg.重复测量方差分析结果显示两组时间点间整体比较差异有统计学意义(F=34.62,P＜0.01).试验组术前和术后第3个月角膜地形图后表面差异图上前凸极值(Diff)为(35.73±14.55)μm,对照组为(45.80±19.86)μm(t=2.83,P＜0.05).结论 LASIK术后早期应用噻吗心安滴眼液可稳定患者屈光状态,从而起到减少屈光回退的作用.噻吗心安滴眼液的作用机制可能是通过降低眼压,减少角膜膨隆而发挥其治疗作用.

Abstract：

Objective To assess the preventive effects of early timolol eye drops application in patients after laser in situ keratomileusis ( LASIK). Methods Sixty patients (60 eyes) were randomly assigned to the treatment group and the control group. Timolol was administered topically twice per day to the treatment group from the second week through the end of the first month. We observed the changes of intraocular pressure (IOP) , spherical equivalent correction (SE) , stimulated curvature (Simk) , anterior chamber depth (ACD) and different value (Diff) both preoperatively and postoperatively, i. e. before and 1 week after LASIK, 1 month and 3 months after LASIK, respectively. All examinations were completed in person. Independent-samples T test, repeated-measures ANOVA, one-way ANOVA were used for statistical comparisons. Significance level was set to a =0. 05. Results The manifest refraction of treatment group was ( -0.07 ±0.25)D, (0. 04 ±0.21) D and ( -0. 05 ±0. 12) D, respectively, while the control group was ( -0. 08 ±0. 22)D, ( -0. 15 ±0. 17)D and ( -0. 14 ±0. 18)D, respectively, at 1 week, 1 and 3 months postoperatively. The difference between the two groups was significant ( F = 5. 68, P < 0. 05 ) regardless of time. The IOP of treatment group was (12.63±2.56) mm Hg( 1 mm Hg=0.133 kPa) , (9.70±1.88) mm Hg and (11.41 ±1. 22) mm Hg, respectively, at 1 week, 1 and 3 months postoperatively. The control group did not change significantly throughout follow-period. The changes of treatment group was significant in different periods ( F = 34. 62 ,P ＜0. 01). After surgery, the posterior comeal surface of the treatment group displayed mean forward shift of (35.73 ± 14. 55) μm and the control group did (45. 80 ± 19. 86) μm (t =2. 83, P ＜ 0. 05 ). The stimulated curvature ( Simk ) and anterior chamber depth ( ACD) was not significantly different between the two groups at any postoperative visit Conclusions Our prospective study demonstrates that timolol is effective to stabilize the refraction after LASIK. Reduction of IOP and corneal ectasia may play a significant role in preventing myopic regression.

Preliminary study on preventive effects of timolol on myopic regression after laser in situ keratomileusis

Objective To assess the preventive effects of early timolol eye drops application in patients after laser in situ keratomileusis ( LASIK). Methods Sixty patients (60 eyes) were randomly assigned to the treatment group and the control group. Timolol was administered topically twice per day to the treatment group from the second week through the end of the first month. We observed the changes of intraocular pressure (IOP) , spherical equivalent correction (SE) , stimulated curvature (Simk) , anterior chamber depth (ACD) and different value (Diff) both preoperatively and postoperatively, i. e. before and 1 week after LASIK, 1 month and 3 months after LASIK, respectively. All examinations were completed in person. Independent-samples T test, repeated-measures ANOVA, one-way ANOVA were used for statistical comparisons. Significance level was set to a =0. 05. Results The manifest refraction of treatment group was ( -0.07 ±0.25)D, (0. 04 ±0.21) D and ( -0. 05 ±0. 12) D, respectively, while the control group was ( -0. 08 ±0. 22)D, ( -0. 15 ±0. 17)D and ( -0. 14 ±0. 18)D, respectively, at 1 week, 1 and 3 months postoperatively. The difference between the two groups was significant ( F = 5. 68, P < 0. 05 ) regardless of time. The IOP of treatment group was (12.63±2.56) mm Hg( 1 mm Hg=0.133 kPa) , (9.70±1.88) mm Hg and (11.41 ±1. 22) mm Hg, respectively, at 1 week, 1 and 3 months postoperatively. The control group did not change significantly throughout follow-period. The changes of treatment group was significant in different periods ( F = 34. 62 ,P ＜0. 01). After surgery, the posterior comeal surface of the treatment group displayed mean forward shift of (35.73 ± 14. 55) μm and the control group did (45. 80 ± 19. 86) μm (t =2. 83, P ＜ 0. 05 ). The stimulated curvature ( Simk ) and anterior chamber depth ( ACD) was not significantly different between the two groups at any postoperative visit Conclusions Our prospective study demonstrates that timolol is effective to stabilize the refraction after LASIK. Reduction of IOP and corneal ectasia may play a significant role in preventing myopic regression.