角膜屈光术前奥布卡因滴眼液对角膜及角膜上皮厚度的影响

摘要

目的 探讨角膜屈光术前表面麻醉剂奥布卡因应用前后患者角膜、角膜上皮厚度及其均匀性的变化.方法 前瞻性自身对照研究.选择2016年3月1-30日在本院眼视光中心拟行SMILE术的连续病例30例(59眼),在滴表面麻醉剂奥布卡因前后用眼前节光学相干断层成像仪(AS-OCT)对中央6mm直径范围内角膜及角膜上皮的厚度进行测量,测量区域分为中央区(直径2 mm)、旁中央区(直径2～5 mm)、中央周围区(直径5～6 mm),后2个区域再分别分为8个象限,通过比较上-下侧、鼻-颞侧的差值以及极差、标准差来评估角膜、角膜上皮厚度变化.通过Pentacam眼前节分析系统测量用药前后角膜散光度、瞳孔中央角膜厚度、偏心值e、角膜最薄点厚度及其位置差异.通过自身配对t检验和轮廓分析比较表面麻醉剂对角膜、角膜上皮厚度的影响.结果 30例(59眼)患者中共发现2例(3眼)患者在表面麻醉后角膜上皮厚度显著增厚.各象限角膜上皮厚度变化差异均无统计学意义.瞳孔中心角膜厚度表面麻醉前后分别为(535.6±25.1)μm、(537.7±25.1)μm,差异有统计学意义(t=2.74,P＜0.01);颞下方(2～5 nun)角膜在表面麻醉前后差异有统计学意义(t=2.05,P＜0.05);角膜和角膜上皮鼻-颞侧差值、上-下侧差值、极差、标准差在表面麻醉前后差异均无统计学意义.表面麻醉前后散光度差异无统计学,偏心值e值在表面麻醉前后分别为(0.56±0.10)D、(0.57±0.10)D,差异无统计学意义(t=-2.60,P＞0.05);角膜最薄点厚度及位置分布(距角膜中心距离)差异无统计学意义.结论 奥布卡因滴眼液对角膜、角膜上皮厚度及其均匀性分布影响较小,但不能完全排除其对角膜形态的影响,在屈光手术术前检查中应引起重视.%Objective To investigate the influence of the topical anesthetic oxybuprocaine on corneal thickness (CT),corneal epithelial thickness (CET),and corneal uniformity among patients scheduled for corneal refractory surgery.Methods In this prospective self-controlled study,a total of 59 eyes of 30 consecutive patients presenting for SMILE in the Refractive Surgery Center during March 2016 were enrolled.The central (2 mm diameter),para-central (2-5 mm diameter),and peripheral (5-6 mm diameter) CT and CET were assessed by anterior segment optical coherence tomography before and after 30 minutes after the instillation of 0.4％ oxybuprocaine prior to SMILE.Each area was divided into 8 regions.Values of the superior-inferior,nasal-temporal,range,and the standard deviation of the CET and CT were used to assess the uniformity of the cornea.Keratometry,astigmatism,eccentricity,central pupil thickness,and the thinnest point of the cornea were recorded by Pentacam.Paired t-test and contour analysis were used to detect anesthetic effects.Results While the CET of 3 eyes of 2 patients was significantly increased after oxybuprocaine,there was no significant effect overall on the CET of the entire study group.Central pupil thickness was 535.6.±.25.1 μm and 537.7± 25.1 μm before and after the use of the topical anesthetic (t=-2.74,P＜0.01).There was a significant increase in CT in the infero-temporal area of the para-central region after oxybuprocaine.The distributions of CT and CET did not change significantly.Eccentricity values before and after oxybuprocaine were 0.56±0.10 diopter (D) and 0.57±0.10 D (t=-2.60,P＞0.05),respectively.There was no significant difference in astigmatism or thickness at the thinnest point before and after the use of the topical anesthetic.Conclusion The topical anesthetic oxybuprocaine had little influence on the thickness and shape of the cornea or corneal epithelium However,some individuals can have a significant increase in CET after anesthetic eye drops are instilled.This requires a close observation by the surgeons.