准分子激光角膜屈光术后皮质类固醇性高眼压的临床分析.doc

　　准分子激光角膜屈光术后皮质类固醇性高眼压的临床分析 【摘要】 　　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、临床特点及临床相关因素分析，为临床诊疗提供帮助。方法：对2005/2009年间我院行准分子激光原位角膜磨镶术（laser in situ keratomileusis, LASIK）或准分子激光上皮瓣下角膜磨镶术（laser subepithelial keratomileusis, LASEK）的1580例3160眼术后皮质类固醇性高眼压患者的病历进行回顾性分析 总结 。结果：有38例68眼发生了高眼压，其中男20例，女18例，年龄18～33岁，术前屈光度为4.00～12.00D,发病时间为手术后14～30d，发生率为2.2%。其中LASIK术后继发皮质类固醇性高眼压的患者16例30眼，LASEK术后继发皮质类固醇性高眼压的患者22例38眼，38例68眼中均为局部使用氟米龙或百力特滴眼液，用药时间20～90d，视力不同程度下降及眼压升高，个别患者伴有角膜上皮水肿。停用糖皮质激素后根据眼压情况采用局部或全身降眼压药物 治疗 ，所有患者视力恢复正常，症状消失，待眼压下降后将皮质类固醇滴眼液逐渐减量和停药。结论：准分子激光角膜屈光术后应用糖皮质激素滴眼液可引起部分患者发生皮质类固醇性高眼压，应根据不同的临床特点给予充分的警惕，以免误诊漏诊。 【关键词】 皮质类固醇；高眼压；准分子激光角膜屈光手术 　　AbstractAIM: To analyse and explore the incidence, clinical characteristics and correlated factors of steroids induced high intraocular pressure (IOP ) after excimer laser cornea refractive surgery, then make a help for clinic.METHODS: Retrospective study of high IOP of 1580 patients (3160 eyes) after laser in situ keratomileusis (LASIK) or laser subepithelial keratomileusis (LASEK) from 2005 to 2009 ed in our hospital. RESULTS:Sixtyeight eyes in 38 cases of steroids induced high IOP ale cases and 18 female cases. The age of the patients ranged from 1833 years old. The spherical equivalent refraction 1430 days after excimer laser cornea refractive surgery. There etholone or prednisolone acetate eye drops e 20 days to 90 days. The eyesight of 38 patients 68 eyes decreased e patients had corneal epithelium edema. The eyesight of all patients recovered to normal and the symptoms of them disappeared after stoping the steroids, and giving topical or systemic antiglaua agents according to patients’ intraocular pressure.CONCLUSION: There er laser cornea refractive surgery.The clinician should pay more attention to these cases to avoid misdiagnosis.  　　KEYoria M2板层角膜刀制作角膜瓣，LASEK手术分离上皮瓣后，均使用VISX STAR S4准分子治疗仪治疗。术后用药及随访：手术后常规应用爱丽及泰利比妥滴眼液，LASIK患者用1g/L艾氟龙滴眼液，qid，每周递减1次，用1mo；LASEK患者用百力特（10g/L醋酸泼尼松龙）滴眼液，tid或qid，1mo递减1次，用3mo。手术后1，3，7，15d；1，3，6mo复诊，复诊时行视力、验光