摘要背景 Nd:YAG激光后囊膜切开术是治疗后发性白内障的重要手段,通常术后常规使用糖皮质激素滴眼液点眼以减轻患者术眼的前房炎症反应,但这存在升高眼压的潜在风险. 目的 比较氯替泼诺混悬滴眼液、妥布霉素地塞米松滴眼液和氟米龙滴眼液在Nd:YAG激光后囊膜切开术后局部应用的抗炎效果及对眼压的影响.方法 采用随机对照研究设计,对接受Nd:YAG激光后囊膜切开术的127例患者171眼按随机数字表法随机分为4个组:氯替泼诺组35例47眼,采用氯替泼诺混悬滴眼液点眼；氟米龙组30例40眼,使用氟米龙滴眼液点眼；妥布霉素地塞米松组29例38眼,给予妥布霉素地塞米松滴眼液点眼；聚乙二醇组33例46眼,使用聚乙二醇滴眼液点眼.4个组均于Nd:YAG激光后囊膜切开术后开始点眼,每日6次,连续使用5d.分别于术前1h及术后1h、1d、3d、1周使用Glodmann眼压计测量眼压,在裂隙灯显微镜下按照Peizeng的标准对术眼的前房炎症反应程度进行评分. 结果 氯替泼诺组术眼术前1h,术后1h、1d、3d及1周的平均眼压分别为(18.2±4.7)、(20.1±5.7)、(18.7±5.5)、(19.0±4.1)和(19.5±3.5) mmHg；氟米龙组分别为(18.7±5.3)、(20.9±5.7)、(21.3±4.5)、(21.0±4.9)、(22.5±6.5) mmHg；妥布霉素地塞米松组分别为(17.9±6.3)、(20.3±6.1)、(23.0±3.7)、(24.7±4.9)、(24.5±6.5)mmHg；聚乙二醇组分别为(18.4±6.3)、(20.7±3.7)、(22.7±6.5)、(19.6±4.8)、(18.5±3.5) mmHg,4个组术眼眼压的总体比较差异有统计学意义(F组别=3.876,P=0.023)；随着时间的延长,氯替泼诺组和聚乙二醇组眼压逐渐下降,而氟米龙组和妥布霉素地塞米松组眼压均高于术前,总体比较差异有统计学意义(F时间 =3.801,P=0.031).各组均未见其他明显眼部和全身药物相关性不良反应.氯替泼诺组和妥布霉素地塞米松组用药后房水细胞分级为1级和2级的百分比明显低于氟米龙组和聚乙二醇组,差异有统计学意义(H=8.276,P=0.012)；氯替泼诺组术眼Ⅰ级房水闪辉的百分比为8％,氟米龙组为22％,妥布霉素地塞米松组为18％,聚乙二醇组为30％,各组房水闪辉严重程度的总体比较差异有统计学意义(H=9.305,P=0.000).结论 Nd:YAG激光后囊膜切开术后局部使用糖皮质激素能有效减轻患者术眼的前房炎症反应,其中氯替泼诺滴眼液抗炎疗效更好,对眼压影响较小,不良反应少,可作为Nd:YAG激光后囊膜切开术后的常规局部用药.

abstractsBackground Nd: YAG laser posterior capsulotomy is an important way for after cataract.Usually the patient will use glucocorticoid eye drops to treat the anterior chamber inflammation after operation,but there is potential risk of elevating intraocular pressure (IOP).Objective This study was to compare the clinical effectiveness and safety of loteprednol etabonate ophthalmic suspension,tobramycin+ dexamethasone eye drops and fluorometholone eye drops following Nd: YAG laser posterior capsulotomy.Methods A randomized-controlled clinical trail was performed.One hundrcd and seventy-onc cycs of 127 paticnts who received Nd: YAG laser posterior capsulotomy for after cataract were randomly divided into four groups.Loteprednol etabonate ophthalmic suspension,fluorometholone eye drops,tobramycin+dexamethasone eye drops and systane eye drops was topically administered respectively in the four groups after laser posterior capsulotomy and 6 times per day for 5 days.IOP was measured with Goldmann tomometer 1 hour before operation and 1 hour,1 day,3 days and 7 days after operation.The ocular anterior segment inflammatory response was examined under the slit lamp and scored based on the Peizeng criteria.Written informed consent was obtained from each patient before any relevant medical procedure.Results The IOP was (18.2 ±4.7),(20.1 ±5.7),(18.7±5.5),(19.0 ±4.1),(19.5 ±3.5) mmHg in various time points in the loteprednol etabonate group; (18.7 ±5.3),(20.9±5.7),(21.3±4.5),(21.0±4.9),(22.5±6.5) mmHg in the fluorometholone eye drops group ; (17.9± 6.3),(20.3 ± 6.1),(23.0 ± 3.7),(24.7 ± 4.9),(24.5 ± 6.5) mmHg in the tobramycin +dexamethasone group and(18.4±6.3),(20.7±3.7),(22.7±6.5),(19.6±4.8),(18.5±3.5) mmHg in the systane group,showing a significant difference among the 4 groups (Fgroup =3.876,P =0.023).With the time lapse,the IOP was gradually reduced in the loteprednol etabonate group and systane group,but that in the fluorometholone group and tobramycin+dexamethasone group was elevated,showing a significant difference among them (Ftime =3.801,P =0.031).No any ocular and systemic adverse effect was found in various groups.The percentage of grade 1 and 2 of aqueous inflammatory cells was lower in the loteprednol etabonate group and tobramycin+dexamethasone group than the fluorometholone group and fluorometholone group and systane group(H =8.276,P =0.012).The percentage of Ⅰgrade of aqueous flare was 8％ in the loteprednol etabonate group,22％ in the fluorometholone group,18％ in the tobramycin+dexamethasone group and 30％ in the systane group,with a significant difference among them (H=9.305,P=0.000).Conclusions The use of corticosteroid eye drops can relieve the inflammatory response of ocular anterior chamber after Nd: YAG laser posterior capsulotomy.Loteprednol etabonate ophthalmic suspension has a better anti-inflammatory effect and less influence on IOP.