透明质酸钠滴眼液治疗准分子激光角膜原位磨镶术术后干眼症的临床观察

Effectiveness of sodium hyaluronate on dry eye following laser in situ keratomileiusis

目的评价质量分数0.1%透明质酸钠对准分子激光角膜原位磨镶术(LASIK)后干眼症患者的治疗作用。方法选取LASIK术后1个月诊断为干眼症的患者21例42眼,应用0.1%透明质酸钠滴眼液局部点眼法连续治疗30d。0.1%透明质酸钠滴眼液的治疗效果评价指标包括患者主觉症状的临床评分变化和客观指标的改善情况,如泪膜破裂时间(BUT)、角膜荧光素着色评分、SchirmerⅠ试验。对0.1%透明质酸钠滴眼液治疗前和治疗后1、2、4周上述指标的变化进行比较。结果所有患者均按要求完成治疗和随访。0.1%透明质酸钠治疗4周,患者主觉症状评分较用药前明显下降,差异有统计学意义(10.71±12.99vs25.09±18.30,Z=-3.326,P=0.001),角膜荧光素着色评分较用药前明显降低,差异有统计学意义(2.24±2.36vs8.26±2.69,Z=-6.909,P<0.01)。0.1%透明质酸钠治疗4周患者的BUT(4.64±1.44)s比治疗前(2.69±1.58)s明显延长,差异有统计学意义(t=-5.899,P<0.01),而SchirmerⅠ试验值(7.60±3.35)mm明显高于治疗前(5.81±3.57)mm,差异有统计学意义(t=-2.359,P=0.021)。随访过程中未发现任何不良反应。结论 0.1%透明质酸钠可通过促进LASIK术后角膜上皮的修复和改善泪液分泌量缓解LASIK术后干眼症患者的主觉症状。

Background Laser in situ keratomileiusis （LASIK） was extensively used for the correction of reh＇action error. But,dry eye is frequently occurred after LASIK. Objective This study was to evaluate the effectiveness and safety of 0. 1% sodium hyaluronate eye drops in the treatment of dry eye after LASIK. Methods A ease-observation study was designed. Twenty-one patients with dry eye at one month after LASIK were enrolled in this study. The dry eye was diagnosed upon the subjective symptoms of patients such as eye fatigue, foreign body sensation, dryness, burning sensation, itchiness, eye pain, photophohia, eye congestive after reading, etc. and objective results such as tear break-up time（BUT） , Schirmer I test and corneal fluorescine staining. 0. 1% sodium hyaluronate eye drops was topically administered 4 times a day for 30 days. The changes of clinical symptom was scored and analyzed. The improvement of BUT,Schirmer I test and corneal fluorescine staining in 1 week, 2,4 weeks after use of drug were observed. The effectiveness of 0. 1% sodium hyaluronate eye drops on dry eye following LASIK was evaluated in I ,2 and 4 weeks. Written informed consent was obtained from each individual before this study. Results All patients finished tbe trial at the end of follow-up duration. In 4 weeks after treatment with 0. 1% sodium hyaluronate eye drops,the symptom score was obviously declined and showed a statistically significant difference in comparison with before treatment （ 10. 71 ± 12.99 versus 25.09 ± 18.30,Z = - 3. 326,P = 0. 001 ）. The scores of corneal fluorescine staining in 4 weeks after treatment was significantly lower than that of before treatment （2.24 ±2.36 versus 8.26 ±2.69,Z = -6. 909,P =0. 001 ）. BUT value in 4 weeks after use of drug was significantly longer than that before use of drug （4.64 ± 1.44 seconds versus 2.69 ± 1.58 seconds） （t = -5. 899,P 〈0.01 ） ,and the Schirmer I test value was significantly ascent in 4 weeks after use of drug in comparison with before use of drug （7.60±3.35 mm versus 5.81 ±3.57 mm） （t= -2.359,P=0.021）.No evidently adverse effect was found during the follow-up period. Conclusion 0. 1% sodium hyaluronate eye drops is effective on the dry eye after LASIK by promoting the repair of corneal epithelium and improving tear secretion.