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目的探讨糖皮质激素对准分子激光原位角膜磨镶术(LASIK)后弥漫性板层角膜炎(DLK)的预防作用。设计前瞻性随机对照临床研究。研究对象接受双眼LASIK手术的近视患者101例(202眼),按眼别分为处理组(101眼)和对照组(101眼)。方法 LASIK术中,处理组局部用糖皮质激素(0．001％地塞米松)进行角膜瓣层间冲洗,对照组则用平衡盐液进行冲洗。主要指标术前、术后第1、3、7天及1个月的裸眼视力、最佳矫正视力、屈光度、眼压,术后DLK的发病率及临床分期。结果 LASIK术后各时期,处理组和对照组的裸眼视力、最佳矫正视力、平均屈光度、眼压差异均无统计学意义(P>0．05)。术后第1天,处理组DLK发病率为4．0％(4眼),全部为Ⅰ期,对照组17．8％(18眼),其中Ⅰ期占88．9％,Ⅱ期占11．1％;术后第 3天,处理组DLK发病率为5．0％(5眼),全部为Ⅰ期,对照组为21．8％(22眼),其中Ⅰ期占86．4％,Ⅱ期占13.6％。两组间比较, DLK的发病率差异有显著统计学意义(P<0．01)。结论 LASIK术中应用O．001％的地塞米松进行角膜瓣层间冲洗,能够明显降低DLK的发病率,是一种安全、有效的预防方法。
Objective To investigate the preventive effect of glucocorticoid on diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK). Design prospective randomized controlled clinical study. Subjects 101 patients (202 eyes) with myopia undergoing bilateral LASIK were divided into treatment group (101 eyes) and control group (101 eyes). Methods In LASIK surgery, the treatment group was treated with glucocorticoid (0.001% dexamethasone) locally, while the control group was rinsed with balanced salt solution. The main indicators of preoperative and postoperative 1, 3, 7 days and 1 month of uncorrected visual acuity, best corrected visual acuity, refraction, intraocular pressure, incidence of postoperative DLK and clinical stage. Results There was no significant difference in uncorrected visual acuity, best corrected visual acuity, average refractive power and intraocular pressure between the treated group and the control group at each time after LASIK. On the first postoperative day, the incidence of DLK in treatment group was 4.0% (4 eyes), all of which were in stage I and 17.8% (18 eyes) in control group, of which stage Ⅰ accounted for 88.9% and stage Ⅱ 11 .1%. On the third postoperative day, the incidence of DLK in treatment group was 5.0% (5 eyes), all of which were in stage I and 21.8% (22 eyes) in control group, of which stage Ⅰ accounted for 86.4% , Ⅱ period accounted for 13.6%. The incidence of DLK was significantly different between the two groups (P <0.01). Conclusion The application of LASIK surgery O. 001% dexamethasone for corneal flap flushing can significantly reduce the incidence of DLK, is a safe and effective method of prevention.