| Objective:To compare the effect of fluoromethalone combined with pranoprofen eye drops in short and long courses after excimer laser subepithelial keratomileusis(LASEK),to understand its effect of postoperative effect and to provide a theoretical basis for the safety,efficacy and stability of LASEK.Methods:1 Case selection and study group: Myopia patients who underwent laser subepithelial keratomileusis(LASEK)in the Department of Laser Ophthalmology,The First Affiliated Hospital of Changjiang University were selected.According to the length of time about the use of fluorometholone after LASEK,fluorometholone eye drops were used for 4 months(long course)from March 2008 to March 2010 as the control group,and fluorometholone eye drops were used for one month(short course of treatment)from October 2012 to December 2012 were set as experimental group.2 Medication method:Control group:0.1% FML combined with 0.1% pranoprofen eye drops,0.1% FML four time per day for the first month,then decreased once a time for 4 months;but the usage of 0.1% pranoprofen is always four times per day,last for 4 month.Experimental group:0.1% FML combined with 0.1% pranoprofen eye drops,the usage of 0.1% FML is four times per day for the first two weeks,then two times per day for the next two weeks,a total of one month;the method of 0.1% pranoprofen eye drops is the same as the control group.3 Observation content: Results of the routine examinations were recorded including uncorrected visual acutiy(UCVA),best corrected visual acuity(BCVA),diopter,intraocular pressure(IOP),slit lamp examination and fundus before and after the surgery.Postoperative routine examinations at one week?three weeks?two months?three months?four months?six months?a year and five years.4 Statistical methods: To compare the differences of unccorrected visual acuity,diopter,intraocular pressure,slit lamp examination and the occurrence of corneal haze with different medication time.All data was processed and analyzed by the SPSS 20.0 software package.Results:1 Postoperative UCVA: In the control group,the uncorrected visual acuity reached preoperative BCVA at 2 months after operation and gradually stabilized.The average UCVA reached preoperative BCVA at each time point in the future.The uncorrected visual acuity decreased slightly after 5 years follow-up compared with that at 1 year after operation,and the uncorrected visual acuity was close to 1.0.The uncorrected visual acuity of the experimental group reached preoperative BCVA at 3 weeks after operation and gradually stabilized.The average UCVA reached preoperative BCVA at each time point in the future.The uncorrected visual acuity decreased slightly after 5 years of follow-up compared with that at 1 year after operation,and the uncorrected visual acuity was greater than 1.0.There was no significant difference in the mean UCVA between the two groups at each observation time point within 1 year and at the same time point after operation.After operation,UCVA reached or even exceeded the preoperative anticipated correction level.The 5-year follow-up showed no significant difference.2 Postoperative diopter:In the control group and the experimental group,the early postoperative diopter became mild hyperopia,and reached the peak at 3 weeks after operation.The diopter gradually regressed in the second month,and then retreated to the emmetropic state at 1 year.At 5 years after surgery,the diopter was slightly regressed compared with 1 year,which was <-0.50 D,and the difference was not statistically significant.There were no statistically significant differences in the mean diopter between the two groups at 1 and 5 years after surgery.3 Postoperative IOP:There was no significant difference in IOP measurements at 3 weeks after operation between the control group and the predicted IOP values.IOP began to increase at 2 months after operation.The IOP measurements at 2 months,3 months and 4 months after operation had significant difference compared with the predicted IOP values after operation.There was no significant difference at 6 months,1 year and 5 years.There was no significant difference in IOP measurements at each time after operation between the experimental group and the predicted IOP values.,and there was no upward trend.There was significant difference in the incidence of intraocular hypertension > 3 mmHg between the two groups.Comparing the intraocular pressure(IOP)of the two groups after operation,15 eyes in the control group are the new cases whose IOP exceeded the estimated IOP of 3 mmHg after operation,accounting for 12%;3 eyes(2.4%)in 3 weeks after operation,6 eyes(4.8%)in 2 months after operation,5 eyes(4.0%)in 3 months after operation and 1 eye(0.8%)in 4 months after operation.In the experimental group,only 2 eyes had intraocular pressure(IOP)which exceeded the predicted IOP of 3 mmHg after operation,accounting for 2.5%;2 eyes(2.5%)in 3 weeks after operation,and no new cases with intraocular pressure(IOP)exceeding the estimated IOP of 3 mmHg were found in 2,3 and 4 months after operation.No intraocular pressure exceeded the normal value of 21 mmHg in both groups.4 Coneal haze:The incidence of haze in the control group and the experimental group was 8% and 11.25%,respectively.The incidence of haze in the experimental group was higher than that in the control group,but there was no significant difference.In the control group,there were 10 eyes(8%)with grade 0.5-1 haze in 125 eyes of 63 patients.One eye(0.8%)saw grade 0.5 haze in the second month after operation,three eyes(2.4%)saw grade 1 haze in the third month after operation,four eyes(3.2%)saw grade 0.5 haze in the third month after operation,and two eyes(1.6%)saw grade 0.5 haze in the fourth month after operation.In the experimental group,grade 1 haze was found in 9 eyes(11.25%)of 40 patients(80 eyes),including 4 eyes(5%)in the second month after operation,3 eyes(3.8%)in the third month after operation,and 2 eyes(2.5%)in the fourth month after operation.Haze was not found in 6 months,1 year and 5 years follow-up.Conclusions:1 The short course of fluorometholone combined with pranoprofen eye drops has the same effect as the long course of fluorometholone eye drops in maintaining the stability of postoperative uncorrected visual acuity and diopter.2 The short course of fluorometholone combined with pranoprofen eye drops is more effective in preventing the increase of intraocular pressure,and the incidence of fluorometholone is lower than that of long course of treatment.3 Although there was no difference between fluorometholone combined with pranoprofen in the prevention and reduction of haze incidence in the short course group and in the long course group,the data showed that haze incidence was slightly higher in the short course group and the classification was heavier,possibly related to the sample size,and the inhibition of haze was not as good as that in the long course group.In the furture,in clinical work,we may consider increasing the use of glucocorticoids or prolonging the use of glucocorticoids appropriately to reduce haze and reduce the severity of haze while ensuring that intraocular pressure is controlled within the normal range.4 There was no difference in safety,efficacy and stability between short-term use and long-term use of fluorometholone combined with pranoprofen.However,the short course of fluorometholone improves patient compliance,reduces the financial burden of patients,and is more conducive to the loss of respondents after refractive surgery and the high-risk population prone to glaucoma,which is worthy of promotion and application in clinical practice.Because the sample size of this experiment is small,a larger sample size is needed to follow up. |
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