General Ng Glucocorticoid Compare Efficacy In LASIK / LASEK Surgery

ObjectiveTo compare the effects of0.1%bromfenac sodium hydrate ophthalmic solution (Bronuck) with topical glucocorticoid following LASIK/LASEK from the aspects of subjective visual perception, ophthalmic signs, intraocular pressure and corneal topography, in order to provide the basis of postoperative NSAIDs-combined or NSAIDs alternative treatment.Methods1One hundred forty-nine patients (298eyes) undergoing LASIK/LASEK in PUMCH from January2011to May2012were randomized into3groups according to spherical equivalent (SE) and operative procedures. Each group was divided into a control group and a NSAIDs group in accordance with medication. Group1:LASIK, SE<-6.0D,48patients to receive steroid and48patients to receive NSAIDs. Group2: LASIK, SE≥-6.0D,12patients to receive steroid and11patients to receive NSAIDs. Group3:LASEK, SE<-6.0D,15patients to receive steroid and15patients to receive NSAIDs2Medications after operation. Group1and Group2:control group,0.1%dexamethasone (DEX) Qid×10days; NSAIDs group,0.1%bromfenac Bid×10days. Group3:control group,0.1%DEX Qid for1st week,0.1%fluorometholone (FML) Tid from the2nd to the4th week,0.1%FML Bid from the5th to8th week,0.1%FML Qd from the9th to12th week; NASIDs group,0.1%DEX Qid for1st week,0.1%bromfenac Bid for next3months.3Results of the routine examination were recorded including UCVA, BCVA, refractive status, fundus examination, corneal topography, corneal thickness, IOP, visual symptoms and signs.4Compared UCVA, IOP, corneal topography (K1, K2, SAI, SRI, CY), subjective visual symptoms and signs.ResultsGroup1:There is no statistically significant difference in visual acuity, corneal topography (K1, K2, SAI, SRI and CY) postoperatively and IOP on day30,90,180. Both the control group and the NSAIDs group have1eye (1%) below preoperative BCVA on day180, but all eyes (100%) reach the expected corrected visual acuity postoperatively. The control group on day10:IOP16.62±4.74mmHg. The NSAIDs group on day10:IOP13.31±2.44mmHg. And the P value is0.00<0.05. In detail,4eyes (4.2%)>23mmHg in the control group on day10;0eye>21or23mmHg in the NSAIDs group on day10. There are2patients (4eyes) complaining of foreign body sensation,1(2eyes) of burning,4(8eyes) of visual fatigue and4(8eyes) of dry eye in the control group. There are2patients (4eyes) complaining of foreign body sensation in the NSAIDs group. No HAZE and DLK appear in both groups. There are3patients applied with antiglaucoma medications in the control group because of increased IOP.Group2:There is no statistically significant difference in visual acuity, corneal topography (K1, K2, SAI, SRI and CY) postoperatively. Day30,4eyes (16.7%) in the control group and1eye (4.5%) in the NSAIDs group fail to reach preoperative BCVA, but all can reach the expected corrected visual acuity postoperatively. The control group on day10:IOP17.32±4.74mmHg. The NSAIDs group on day10:IOP12.36±1.30mmHg. And the P value on day10is0.00<0.05. The control group on day30:IOP14.81±2.26mmHg. The NSAIDs group on day30:IOP12.10±2.12mmHg. The P value of IOP on day30is0.04<0.05. In detail,1eye (4.2%)>21mmHg and3eyes (12.5%)>23mmHg in the control group on day10;0eye>18mmHg in the NSAIDs group on day10. There are2patients (4eyes) complaining of foreign body sensation in the control group. There are2patients (4eyes) complaining of foreign body sensation,2(4eyes) complaining of dry eye in the NSAIDs group. No HAZE and DLK appear in both groups. There are3patients applied with antiglaucoma medications in the control group because of increased IOP.Group3:The visual acuity of control group on day30is0.99±0.25and1.27±0.24of NSAIDs group. The P value is0.03<0.05. Day180,3eyes (10%) in the control group fail to reach preoperative BCVA, but all can reach the expected corrected visual acuity postoperatively. Postoperative IOP is lower than preoperative IOP. In detail,1eye (3.3%)>21mmHg,1eye (3.3%)>23mmHg on Day10in both groups. And2eyes (6.7%)>23mmHg in the control group on Day30;1eye (3.3%)>21mmHg in the NSAIDs group on Day30.No statistically significant difference exists in corneal topography. There are2patients (4eyes) complaining of visual fatigue and2(4eyes) of dry eye in the NSAIDs group. No DLK appears in both groups. However, one case (HAZE0.5, bilateral) appear on day30for each group and one new case (HAZE0.5, bilateral) on day 60in the NSAIDs group. There are4patients in the control group and one patient in the NSAIDs group applied with antiglaucoma medications because of increased IOP.Conclusions1Bronuck is beneficial to IOP control. Furthermore, it is probably that Bronuck is superior to dexamethasone in keeping the stability of IOP after LASIK and LASEK (SE<-6.0D).2Bronuck is as effective as dexamethasone in recovery of visual acuity, visual quality and keeping the stability of refractive status following LASIK/LASEK with a good compliance. No DLK is reported in all groups. However, HAZE0.5is reported in both the NSAIDs group and the control group in LASEK group on early stage and disappears after intensive treatment.3Bronuck could substitute for glucocorticoid in some part after LASIK/LASEK. High-myopia patients require long-term clinical observation and a large sample.