噻吗洛尔对高度近视眼准分子激光原位角膜磨镶术后屈光回退的影响

发布时间：2018-06-18 00:51

本文选题：角膜磨镶术 + 激光原位　；参考：《郑州大学》2011年硕士论文

【摘要】：背景和目的准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)治疗近视眼具有较好的安全性、有效性和可预测性,是目前最为常见的一种手术方式。然而,部分高度近视眼LASIK术后会发生屈光回退。近视眼LASIK术后屈光回退的机制非常复杂,目前还不是完全清楚,预防高度近视眼LASIK术后屈光回退还没有肯定有效的方法。先前研究表明LASIK手术切削了角膜组织,眼内压作用于较薄的角膜组织使角膜前移是LASIK术后屈光回退的一个重要因素。本研究对高度近视眼LASIK术后可能发生屈光回退眼应用降眼压药物,观察角膜前移的变化,评估其预防屈光回退的效果。方法选取2010年1月～2010年10月在郑州大学第一附属医院准分子激光中心接受LASIK手术治疗的高度近视眼,术后第1天主觉验光等值球镜屈光度在0～-0.75D之间的共50人(78眼),随机分为研究组24人(36眼)和对照组26人(42)。对照组术后常规应用抗生素滴眼液点眼10天和皮质类固醇滴眼液点眼1个月。研究组术后常规用药外,术后第1天增加使用马来酸噻吗洛尔滴眼液每天2次点眼1个月。术后10天、1个月、3个月检查眼压、等值球镜屈光度、和角膜地形图等,由角膜地形图获取角膜后表面曲率半径、diff值(角膜后表面中心高度)及Diff差值(角膜后表面前移量)。Diff差值是由术后角膜地形图与术前角膜地形图差异图中央点(0。,0 mm)的读数获得(选取直径为7 mm到10 mm的外环带作为差异图的对位适配带)。对两组术后1天屈光度,术后10天、1个月、3个月眼压、角膜后表面Diff差值、角膜后表面曲率半径及屈光度等分别进行独立样本t检验。P0.05为差异有统计学意义。结果 1.研究组术后10天、1个月眼压是分别是(9.61±2.90) mmHg、(9.97±2.45) mmHg,低于对照组术后10天、1个月的眼压(分别是11.69mmHg±2.6mmHg; 11.99 mmHg±3.07mmHg),两组比较差异有统计学意义(t=-2.37,P=0.023；t=2.22,P=0.033),研究组和对照组术后3个月的眼压分别是(10.61±2.90)mmHg、(10.92±2.65) mmHg,两组比较差异无统计学意义(t=0.35,P=0.73)。 2.研究组术后10天、1个月和3个月角膜后表面Diff差值分别是(9.56±6.66)μm、(10.72±6.70)μm、(14.11±4.66)μm,低于对照组术后10天、1个月和3个月角膜后表面Diff差值(19.57±7.76)μm、(20.24±7.37)μm、(20.10±6.98)μm,两组比较差异有统计学意义(t=3.08, P=0.04;t=2.25, P=0.03;t=4.19, P=0.004)。 3.研究组术后10天、1个月和3个月角膜后表面曲率半径分别是(6.43±0.20)mm、(6.40±.25) mm和(6.35±0.13)mm,高于对照组术后10天、1个月和3个月角膜后表面曲率半径(6.25±0.30) mm、(6.25±0.25) mm和(6.21±0.18)mm,两组比较差异有统计学意义(t=2.19,P=0.04；t=2.21,P=0.03：t=2.64,P=0.012)。 4.研究组和对照组术后1天的屈光度分别是(-0.40±0.32)D、(-0.45±0.25)两组比较差异无统计学意义(t=0.53,P=0.579),研究组术后10天、1个月和3个月时屈光度分别为(-0.46±0.28)D、(-0.61±0.34)D和(-0.75±0.21)D,低于对照组术后10天、1个月和3个月时屈光度(-0.67±0.23)D、(-0.93±0.23)D和(-1.05±0.29)D，，两组比较差异有统计学意义(t=2.52, P=0.016; t=3.45, P=0.001;t=3.60, P=0.001)。结论高度近视眼LASIK术后早期应用噻吗洛尔滴眼液能减少角膜后表面前移,降低近视屈光度,是预防高度近视眼准分子激光原位角膜磨镶术后屈光回退的一种有效方法。
[Abstract]:Background and purpose
Excimer laser in situ keratomileusis (laser in situ keratomileusis, LASIK) has good safety, effectiveness and predictability in the treatment of myopia. It is the most common mode of operation at present. However, the refractive regression will occur after LASIK operation in some high myopia eyes. The mechanism of refraction in myopia after LASIK is very complicated. It is not completely clear that the prophylaxis of refraction in high myopia after LASIK has not been an effective method. Previous studies have shown that LASIK surgery cuts the cornea tissue and the intraocular pressure acts on the thinner corneal tissue to make the cornea move forward as an important factor in the refractive regression after LASIK. This study may have been possible after LASIK for high myopia. Ocular hypotensive drugs were used to observe the changes of corneal anterior movement and evaluate the effect of preventing refractive regression.
Method
From January 2010 to October 2010, the high myopia with LASIK surgery at the excimer laser center of the First Affiliated Hospital of Zhengzhou University was selected, and 50 people (78 eyes) with refractive index between 0 and -0.75D first days after operation were randomly divided into the study group 24 (36 eyes) and the control group (42). The control group was used for routine application after operation. The eye drops for 10 days and corticosteroid eye drops for 1 months. The study group increased the use of Timolol Maleate Eye Drops 2 times a day for 1 months after the operation, first days after the operation. The intraocular pressure was examined for 10 days, 1 months, 3 months after the operation, the refractive index of the sphere, and the topographic map of the cornea were obtained, and the corneal surface was obtained from the corneal topography. The surface curvature radius, the diff value (the posterior corneal surface center height) and the Diff difference (the posterior corneal surface shift).Diff difference was obtained by the reading of the central point (0., 0 mm) of the corneal topographic map and the preoperative corneal topographic map (0., 0 mm) (the outer band of 7 mm to 10 mm as the counterpart of the difference map). The 1 day postoperatively for the two groups was photometric, 10 days, 1 months, 3 months, 3 months of intraocular pressure, the difference of posterior corneal surface Diff, the radius of curvature of the posterior surface of the cornea and the diopter of the cornea were measured by independent sample t test, and the difference was statistically significant.
Result
1. the intraocular pressure of the study group was (9.61 + 2.90) mmHg and (9.97 + 2.45) mmHg respectively after 1 months of operation. The intraocular pressure of the study group and the control group was statistically significant (t=-2.37, P= 0.023; t=2.22, P=0.033). The intraocular pressure of the study group and the control group was respectively respectively. The intraocular pressure of the study group and the control group was respectively (9.61 + 2.90) and (9.97 + 2.45) mmHg respectively after the operation of the control group (11.69mmHg + 2.6mmHg, 11.99 mmHg + 3.07mmHg). It was (10.61 + 2.90) mmHg, (10.92 + 2.65) mmHg, and the difference between the two groups was not statistically significant (t=0.35, P=0.73).
2. after 10 days, 1 months and 3 months after operation, the Diff difference between the corneal surface and the posterior surface of the cornea was (9.56 + 6.66) mu m, (10.72 + 6.70) mu m and (14.11 + 4.66) mu m, lower than the Diff difference of the posterior corneal surface of the control group, 1 months and 3 months (6.70) mu m, and the difference was statistically significant (t=3.08, P=0.04; t=2). .25, P=0.03; t=4.19, P=0.004).
3. the radius of posterior corneal surface curvature was (6.43 + 0.20) mm, (6.40 +.25) mm and (6.35 + 0.13) mm respectively after 10 days, 1 months and 3 months after operation, which was higher than that of the control group after 10 days, 1 months and 3 months of corneal surface curvature radius (6.25 + 6.43) mm, (t=2.19, P=0.04; t=2), respectively (t=2.19, P=0.04; t=2). .21, P=0.03:t=2.64, P=0.012).
4. the diopter of the 4. group and the control group was (-0.40 + 0.32) D and (-0.45 + 0.25), respectively, and there was no significant difference between the two groups (t=0.53, P=0.579). The diopter of the study group was 10 days, 1 months and 3 months after operation (-0.46 + 0.28) D respectively, (-0.61 + 0.34) D and (-0.75 + 0.21) D, lower than that of the control group after operation, 1 months and 3 months. 0.67 + 0.23) D, (-0.93 + 0.23) D and (-1.05 + 0.29) D, the difference between the two groups was statistically significant (t=2.52, P=0.016, t=3.45, P=0.001, t=3.60, P=0.001).
conclusion
The early application of timolol eye drops after LASIK for high myopia can reduce the movement of the posterior corneal surface and reduce the diopter of myopia. It is an effective method to prevent the refraction of the high myopia after excimer laser in situ keratomileusis.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.63

【参考文献】