角膜表层切削术后皮质类固醇性高眼压患者临床分析

摘要

Objective:To investigate the treatment protocol for patients with corticosteroid induced ocular hypertension following corneal surface ablation . Methods:The clinical data were retrospectively analyzed in 306 patients(612 eyes) with corticosteroid induced ocular hypertension following corneal sur-face ablation between Jan.2012 and Dec.2013.The patients with corticosteroid induced ocular hypertension were managed by withdrawal of the corticoste-roid,and the intraocular pressure was controlled with appropriate drugs.Lotemax drops was interimly applied to inhibit corneal inflammation when the in-traocular pressure was stably maintained for one week .Results:Corticosteroid induced ocular hypertension occurred in 23 of the 612 eyes following excimer laser surgery,in whom 9 were managed with 2% Carteolol drop,and 3 with oral Methazolamide plus intravenous drip of 20% mannitol.Elevated intraocular pressure,high haze response or refractive regression did not occur in the 23 eyes.Conclusion:Intraocular pressure should be closely monitored in patients with corticosteroid induced ocular hypertension following corneal surface eximer laser ablation ,and interim administration of Lotemax drops can safely and effectively control the incidence.%目的：回顾性分析角膜表层切削术后激素性高眼压患者降眼压及治疗角膜反应的临床资料，探索安全、高效的治疗方法。方法：对角膜表层准分子激光手术后常规滴用皮质类固醇滴眼液（0．1％氟米龙）出现高眼压患者，停用皮质类固醇滴眼液，酌情给予药物控制眼压，眼压稳定后间歇给予氯替泼诺滴眼液抑制角膜反应。结果：612眼中有23眼发生皮质类固醇性高眼压，9例给予2％卡替洛尔滴眼液滴眼，3例加服醋甲唑胺和静脉滴注20％甘露醇，经治疗后眼压恢复基础水平。眼压稳定1周后开始间歇给予氯替泼诺滴眼液抑制角膜反应，23眼均未再出现眼压升高、2级以上haze反应或屈光回退。结论：角膜表层切削术后应密切监测眼压。间歇应用氯替泼诺滴眼液对糖皮质激素高眼压患者是一种安全有效的治疗方法。