氟比洛芬对糖尿病白内障患者超声乳化术后黄斑囊样水肿预防作用的研究

Studies on the preventive effect of pranoprofen on cystoid macular edema after phacoemulsification in diabetic cataract patients

目的探讨氟比洛芬对糖尿病(DM)白内障患者超声乳化术后黄斑囊样水肿(CME)的预防作用。方法选择2008年9月至2009年3月就诊并行超声乳化手术、临床资料完整的DM白内障患者(DM组)100例。同时,选取非DM白内障患者25例为研究的对照。将DM白内障患者随机分入四组。A组23例(27只眼),典必殊滴眼液术后第1周6次/d,后3周4次/d;B组24例(30只眼),0.03%氟比洛芬滴眼液和典必殊滴眼液术后第1周各4次/d,后3周各3次/d;C组27例(34只眼),术前1d开始滴用0.03%氟比洛芬滴眼液,3次/d,术后用药及方法同B组;D组26例(36只眼),术前7d开始滴用0.03%氟比洛芬滴眼液,3次/d,术后用药及方法同B组。非DM白内障患者采用A组的治疗方法,25例(32只眼)。所有患者于术后第1、3、7、14、30天和90天接受术眼症状或体征的综合评分。术前和术后的第30天、第90天,对患者进行视力和眼压的测定。患者分别于术前和术后第90天进行眼底的相干光断层成像(OCT)和荧光素眼底血管造影(FFA)检查。结果 DM白内障A组和B组术后CME发生率高于其它各组(P<0.01)。术眼症状和体征综合评分,各组间差异主要集中在术后的第3天和第7天,C、D两组综合评分分别为7.97±0.51、7.21±0.46和5.96±0.36、5.48±0.33,均明显低于同期其他各组(P<0.05,或P<0.01)。各组间,第30天时,D组和对照组患者的视力恢复明显好于同期其它各组(P<0.05)。第90天时,C组、D组和对照组患者的视力恢复明显好于同期的A组和B组(P<0.05)。术后第90天,A组和B组患者,其黄斑中心凹视网膜厚度分别为(188.92±43.37)μm和(167.23±34.19)μm,明显高于同期其它各组(P<0.01)。A组和B组的术后黄斑区团块状或血管拱环荧光渗漏病例的发生率分别达18.52%和13.33%,明显高于C组、D组和对照组(P<0.01)。结论 DM白内障超声乳化手术前后,患者应用氟比洛芬滴眼液能有效预防CME的发生。

Objective To explore the preventive effect of pranoprofen on cystoid macular edema after phacoemulsification in diabetic cataract patients.Methods One hundred cases of diabetes mellitus with cystoid macular edema after phacoemulsification（DM group） were selected from September 2008 to March 2009 in our hospital with complete clinical data.At the same time,twenty five cases of non-DM cataract patients were selected as the control.The DM cataract patients were randomly divided into four groups.A group had 23 cases of 27 eyes,tobradex eye drops 6 times daily in the first 1 week after surgery,4 times daily in the last 3 weeks;B group had 24 cases of 30 eyes,0.03% pranoprofen and tobradex eye drops 4 times daily in the first 1 week after surgery,3 times daily in the last 3 weeks;C group had 27 cases of 34 eyes,0.03% pranoprofen eye drops 3 times daily starting from 1 day preoperatively,and the medication and method after surgery were identical to B group;D group had 26 cases of 36 eyes,0.03% pranoprofen eye drops 3 times daily starting from 3 day preoperatively,and the medication and method after surgery were identical to B group.The medication and method of nonDM cataract patients were identical to B group,including 25 cases of 32 eyes.All patients received a comprehensive scores testing on symptoms or signs 1d,3d,7d,14d,30d and 90d postoperatively.The vision and intraocular pressure of all patients were determined preoperatively and 30d,90d postoperatively.The optical coherence tomography and fundus fluorescein angiography were tested in the preoperative and 90d postoperative patients.Results The incidence of postoperative cystoid macular edema in A group and B group of DM cataract patients were higher than any other groups（P 0.01）.The differences of comprehensive scores on symptoms or signs between the groups were focused on the first 3d and 7d after surgery.The comprehensive scores of C group and D group were 7.97 ± 0.51,7.21 ± 0.46 and 5.96 ± 0.36,5.48 ± 0.33,respectively.All scores were significantly lower than other groups in the same period（P 0.05 or P 0.01）.After the first 30d postoperatively,the vision restoration of D group and control group were significantly better than other groups in the same period（P 0.05）.After the first 90d postoperatively,the vision restoration of C group,D group and control group were significantly better than A group and B group in the same period（P 0.05）.After 90 days,the macular retinal foveal thickness of A group and B group（188.92 ± 43.37 μm,167.23 ± 34.19 μm） were significantly higher than other groups in the same period（P 0.05）.The incidence of after macular mass or vascular leakage arch ring fluorescence of A group and B group was 18.52% and 13.33%,which were significantly higher than C group,D group and control group（P 0.01）.Conclusion The occurrence of cystoid macular edema in diabetes mellitus can be effectively prevented with eye drops pranoprofen performed before and after phacoemulsification surgery.