溴芬酸钠与氟米龙在LASEK术后应用的疗效比较  

Comparison of the Clinical Effects of Bromfenac Sodium and Fluorometholone after LASEK Surgery

作　　者：杨琨[1] 耿维莉[1] Kun Yang;Weili Geng(Tianjin Eye Hospital,Tianjin Eye Institute,Tianjin Key Laboratory of Ophthalmology and Visual Science,Tianjin 300020,China)

机构地区：[1]天津市眼科医院天津市眼科研究所天津市眼科学与视觉科学重点实验室,300020

出　　处：《中华眼视光学与视觉科学杂志》2019年第7期507-513,共7页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的:比较溴芬酸钠与氟米龙滴眼液在准分子激光角膜上皮瓣下磨镶术(LASEK)后对眼部刺激症状的效果及其临床应用的安全性。方法:前瞻性随机对照研究。选取2017年4月至2018年2月在天津市眼科医院接受LASEK手术的近视及近视散光患者60例(120眼)作为研究对象,参照随机数字表法分为溴芬酸钠组和氟米龙组,每组各30例(60眼)。术后第1周,除常规用药外,溴芬酸钠组给予0.1%溴芬酸钠滴眼液每日2次,1周后改为每日4次,1个月后改为每日2次,再滴眼1个月后停药。术后第1周,氟米龙组给予0.3%玻璃酸钠滴眼液每日2次,1周后停用0.3%玻璃酸钠滴眼液,改用0.1%氟米龙滴眼液,每日4次,每月递减1次,4个月后停药。于术后1、2、3、5d观察2组角膜刺激症状及上皮愈合情况。术后1周、1个月、3个月行裸眼视力(UCVA)、最佳矫正视力(BCVA)、综合验光、裂隙灯显微镜、泪液分泌试验(SⅠT)、泪膜破裂时间(BUT)和角膜上皮完整性评估等检查。术后1周、2周、1个月、3个月、4个月行非接触式眼压测量。采用重复测量方差分析、独立样本t检验和Mann-WhitneyU检验对数据进行统计分析。结果:术后溴芬酸钠组角膜刺激症状评分明显低于氟米龙组,差异均有统计学意义(F组别=7.8,P=0.018;F时间=121.7,P<0.001;F交互作用=273.4,P<0.001)。术后1个月时,2组患者LogMAR视力均优于0.0以上,2组各时间点UCVA及BCVA对比差异无统计学意义。术后2组患者屈光度稳定,2组间比较差异无统计学意义(F组别=1.0,P=0.137;F时间=1.3,P=0.121;F交互作用=1.1,P=0.272)。术后1个月时,溴芬酸钠组6眼(10%)发生角膜上皮下混浊(haze),氟米龙组2眼(3%)发生haze。术后溴芬酸钠组各时间点眼压校正值均<21mmHg;氟米龙组术后2周时有5眼(9%)眼压升高,术后1个月时有3眼(5%)眼压升高。术后3个月,2组的SⅠT和BUT均大致恢复到正常水平,差异无统计学意义。术后3个月,2组中大部Objective: To compare the effectiveness of bromfenac sodium and fluorometholone eye drops on relieving corneal irritation and its safety in clinical applications after laser epithelial keratomileusis (LASEK) surgery. Methods: This was a prospective randomized, controlled study. A total of 60 patients (120 eyes) who underwent LASEK surgery from April 2017 to February 2018 in Tianjin Eye Hosptial were divided randomly into a bromfenac sodium group and a fluorometholone group according to the random number table, 30 patients (60 eyes) were included in each group. In the first week after the surgery, the bromfenac sodium group was given 0.1% bromfenac sodium eye drops twice a day, and then from the second week, this eye drops changed to 4 times per day for 1 month and 2 times per day in the following month. While the fluorometholone group was given 0.3% sodium hyaluronate eye drops twice a day in the first week after the surgery, then the eye drops changed to 0.1% fluorometholone by giving 4 times per day, which was gradually tapered in every month to the end. Corneal irritation and epithelial healing were evaluated at 1 d, 2 d, 3 d and 5 d after surgery. Examinations of uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction, slit lamp, Schirmer Ⅰ test (SⅠT), tear film break-up time (BUT) and corneal epithelium integrity evaluation were performed 1 week, 1 month and 3 months after surgery. An intraocular pressure (IOP) examination was performed 1 week, 2 weeks, 1 month, 3 months and 4 months. The data were analyzed by repeated measures ANOVA, independent sample t-test and Mann-Whitney U test. Results: The scores for corneal irritation in the bromfenac sodium group were significantly lower than those in the fluorometholone group after surgery (Fgroups=7.8, P=0.018;Ftimes=121.7, P<0.001;Finteraction=273.4, P<0.001). At 1 month after surgery, the mean visual acuity of both groups recovered to 1.0 or better. There were no statistically significant differences in UCVA, BCVA or refraction bet

关 键 词：溴芬酸钠 非甾体类抗炎药 糖皮质激素 准分子激光角膜上皮瓣下磨镶术 激素性青光眼 

分 类 号：R779.63[医药卫生—眼科]