| 张玉生,冯有为.典必殊对LASIK术后角膜修复及泪液中3种细胞因子
的影响[J].中国烧伤创疡杂志,2014,(5):357~363. |
| DOI： |
| 中文关键词: LASIK 细胞因子 典必殊 糖皮质激素 激素性高眼压 |
| 英文关键词:LASIK Cytokine Tobradex Glucocorticoid Corticosteroid Induced Ocular Hypertension |
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| 中文摘要: |
| 目的 通过检测近视患者准分子激光角膜原位磨镶术（Laser in situ keratomileusis，LASIK）前后，不同时间泪液中某些细胞因子的表达，观察其附加典必殊治疗后的变化规律，分析其与典必殊不同日用药量及疗程的关系，探讨该疗法对角膜愈合、视力及眼压的影响，以期指导术后合理用药。方法 选取接受LASIK治疗的近视患者96例（189只眼），根据术后典必殊眼液疗程随机分为3个实验组，各组均自术后24 h开始接受典必殊眼液治疗，其中实验1组点眼治疗1周；实验2组点眼治疗2周；实验3组点眼治疗4周。各组患者分别于术前及术后24 h（未用典必殊治疗前），治疗后1周、2周及4周采集泪液标本，测定其中IL-1α、IL-2和TNF-α 3种细胞因子的浓度，分析典必殊不同日用药次数及疗程对疗效的干预，及对患者角膜愈合、视力及眼压的影响。所有资料均运用SAS 6.12统计软件包进行统计学处理。结果 术后24 h3组患者泪液中IL-1α、IL-2和TNF-α的含量均显著升高，与术前相比有显著性差异（P<0.01）；典必殊治疗1周后，3组患者泪液中IL-1α、IL-2和TNF-α的含量均降至术前水平（P>0.05）。3组患者术后24 h检查，角膜创面全部被上皮细胞覆盖，角膜瓣复位良好，术后1周创面愈合；术后2周与4周各组患者视力恢复良好，无显著性差异（P>0.05）。术后激素性高眼压发生率：术后2周，3组发生率对比，差异具有统计学意义（P<0.05）；术后4周，实验1组及实验2组患者的高眼压消失，但实验3组的激素性高眼压发生率仍高达13.16%，差异具有统计学意义（P<0.005）。结论 LASIK术后应用典必殊治疗1周～2周，每日4次，可有效控制角膜局部创伤性炎症反应，日用药次数的增加和疗程的延长，具有诱发激素性高眼压的危险。 |
| 英文摘要: |
| Objective By testing the expression of some cytokines in tears at different time before and after receiving Laser in situ keratomileusis (LASIK), to observe the rules of their change after receiving additional Tobradex treatment and analyze the relations between cytokines and daily dosage and treatment course. Also, to discuss the influence of this treatment on the healing of cornea, eyesight and eye pressure for guiding reasonable postoperative drug administration. Method All 96 patients with myopia (189 eyes) who received LASIK treatment, were randomly divided into three test groups of different postoperative Tobradex treatment course. All groups began to receive Tobradex treatment 24h after surgery, the first group was treated for one week the second two weeks and the third four weeks. The tear samples of each group were collected before and 24h after surgery, one week, two weeks and four weeks after treatment to determine the concentration of 3 cytokines IL-1a, IL-2 and TNF-α and analyze the influence of different daily dosage and treatment course on the efficacy, healing of cornea, eyesight and eye pressure. All data were processed statistically with SAS 6.12 statistic software package. Results The content of IL-1a, IL-2 and TNF-α in tears of patients in three groups 24 hours after surgery increased substantially and had significant difference ( P<0.01) comparing with that before surgery. After being treated with Tobradex for one week, the content of IL-1a, IL-2 and TNF-α in tears of patients of three groups decreased to the level before surgery (P>0.05). In examination for 3 groups 24h after surgery, the wounds of cornea had all been covered by epithelial cells, the restoration of corneal flap was good and the wounds healed one week after surgery. Two weeks and four weeks after surgery, their eyesight improved and restored, without obvious difference (P>0.05). The occurrence rate of corticosteroid induced ocular hypertension was different in three groups two weeks after surgery, which was of statistical significance (P<0.05). Four weeks after surgery, ocular hypertension disappeared in test groups one and two, however the occurrence rate of corticosteroid induced ocular hypertension in test group three was still as high as 13.16%, the difference between groups was of statistical significance (P<0.005). Conclusion After LASIK surgery, treatment with Tobradex for one to two weeks, 4 times a day, can effectively control local inflammation of cornea. The incremental usage of daily dosage and prolonging of treatment course risk corticosteroid induced ocular hypertension. |
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