圆锥角膜配戴透气性角膜接触镜相关性干眼疗效评价

The therapeutic efficiency on dry eye in keratoconus wearing, rigid gas permeable contact lens

目的观察维生素A棕榈酸酯眼用凝胶对圆锥角膜配戴硬性透气性角膜接触镜（RGP）相关性干眼症的临床疗效。方法将90例透气性角膜接触镜相关性干眼症圆锥角膜患者随机分为3组，每组30例（60眼）：A组使用人工泪液滴眼液，6次／d，1滴／次；B组使用维生素A棕榈酸酯眼用凝胶，3次／d，1滴／次；C组在使用人工泪液滴眼液（6次／d，1滴／次）后15min再用维生素A棕榈酸酯眼用凝胶（3次／d，1滴／次）。观察各组患者用药前1天与用药后第3、7、14天的眼部症状评分、泪膜破裂时间（BUT）、SchirmerI试验（sIT）、角膜荧光染色（F1）评分变化。结果在用药7天后三组患者的干眼症状、BUT和F1染色均较治疗前有明显改善（P〈0．05），三组患者SIT值治疗前后差异均无统计学意义（P〉0．05）。各组患者在治疗14天后和治疗7天时测得的各项指标差异无统计学意义（P〉0．05）。A组与B组对眼部症状、BUT和sIT的改善作用差异无统计学意义（P〉0．05）；B组较A组改善角膜F1染色作用更明显，差异有统计学意义（P〈0．05）。C组对改善干眼症状、BUT和F1染色作用优于A组（P〈0．05）。SIT和F1染色治疗前后比较，C组和B组，差异无统计学意义（P〉0．05），C组对改善干眼症状和BUT作用优于B组（P〈0．05）。结论维生素A棕榈酸酯眼用凝胶能够促进角膜上皮损伤愈合，缓解圆锥角膜患者配戴硬性透气性角膜接触镜所致干眼症状，具有临床应用价值。

Objective To investigate the therapeutic efficiency of vitamin A palmitate eye gel on dry eye in keratoconus wearing rigid gas permeable contact lens （RGP）. Methods Ninety cases of dry eye related to wearing RGP in keratoconus were randomly divided into 3 groups, each group of 30 cases （60 eyes）： group A used artificial tear eye drop, 1 drop each time, 6 times on first; group B used vitamin A palmitate eye gel, 1 drop each time, 3 times on first; group C used artificial tear eye drop first and used vitamin A palmitate eye gel 15 minutes later. All cases had been detected and evaluated by subjective symptoms of dry eye, break-up time （BUT）, Schirmer I test （SIT） and corneal fluorescent staining （F1）,at pre-therapy and 3,7, 14 days of post-therapy. Results The subjec- tive symptoms of dry eye, FI and BUT of three groups had been more improved at 7 days after therapy than pre-therapy （P 〈0.05）. SIT of three groups hadn＇t significant difference after therapy （P 〉0.05）. The each index when measured on day 7 and day 14 had no significant difference in pa- tients of each group （P 〉0.05）. There was no significant difference in subjective symptoms,BUT and SIT between group A and group B （P 〉0.05）, except F1 （P 〈0.05）. Group C in improving the subjec- tive symptoms of dry eye, BUT, and F1 stain was better than group A （P 〈0.05）. SIT and F1 com- pared pre and post therapy had no significant difference between group B and group C （P 〉0.05）.But in improving the subjective symptoms of dry eye and BUT, group C was superior to group B （P 〈0.05）. Conclusions Vitamin A palmitate can promote the repair of corneal epithelial defects and significantly improve dry eye patients＇ symptoms and signs in keratoconus wearing RGP, so it has clinical application value.