普拉洛芬及羟苯磺酸钙在糖尿病患者白内障手术中的应用

Clinical application of pranoprofen and calcium dobesilate on diabetic patients with cataract surgery

目的探讨普拉洛芬联合羟苯磺酸钙对糖尿病(diabetes mellitus,DM)白内障患者超声乳化术后视力、视网膜厚度及黄斑区毛细血管荧光渗漏的影响。方法收集2009年1月至2011年12月在我院治疗的DM白内障患者102例,随机分为4组。A组为羟苯磺酸钙组:24例(33眼),常规治疗基础上术后第1天起口服国产羟苯磺酸钙,每次0.5g,每天3次,连续服用1个月。B组为普拉洛芬组:26例(37眼),常规治疗基础上术前7d及术后1个月加用普拉洛芬眼液每天4次。C组为联合用药组:25例(32眼),常规治疗基础上加用羟苯磺酸钙及普拉洛芬,方法同A组及B组;D组为常规治疗组:27例(38眼),术后常规应用抗生素、激素滴眼液,眼压高者加用降眼压药物。同时,选取非DM白内障患者25例(34眼)为对照组。术后1d、3d、7d、14d、30d和90d进行常规检查,术后30d和术后90d采用光学相干断层扫描观察视网膜厚度,眼底荧光血管造影观察黄斑区荧光素渗漏情况。结果术后30d和90d时,各组视力均得以明显恢复(均为P<0.01)。各组间比较,治疗后30d时,C组和对照组患者的视力恢复明显好于D组(均为P<0.05)。治疗后90d时,A组、B组、C组和对照组患者的视力恢复明显好于同期的D组(均为P<0.05)。术后30d,D组、A组及B组患者,其黄斑中心凹视网膜厚度明显大于C组(均为P<0.05)。术后90d,D组患者黄斑中心凹视网膜厚度明显大于同期其他各组(均为P<0.01)。术后30d,黄斑区荧光渗漏发生率最高的为D组,发生率为21.05%(8/38);其次为A组,发生率为18.18%(6/33);再次为B组,为16.22%(6/37),最低为C组3.13%(1/32)。对照组术后有2眼发病。C组和对照组与其他各组相比,差异均有显著统计学意义(均为P<0.01)。术后90d黄斑区荧光渗漏发生率最高的为D组,发生率为15.79%(6/38);其他各组分别为:A组9.09%(3/33)、B组5.41%(2/37)、C组0%(0/32)、对照组2.94%(1/34)。D组与其他各组相比,差异均有显著统计学意义(均为P<0.01)。结论 DM患者白内障手术前后联合应用普拉洛芬及羟苯磺酸钙,可减轻术后黄斑区视网膜厚度及降低黄斑区毛细血管荧光渗漏,有助于视力的恢复。

Objective To explore the effects of pranoprofen combined with cal- cium dobesilate on visual acuity, retinal thickness and macular capillary leakage after phaeoemulsification in patients with diabetic cataract（DM）. Methods A total of 102 DM patients with cataract was collected in our hospital from January 2009 to December 2011 and were randomly divided into four groups. Group A（ calcium dobesilate group） had 24 cases（33 eyes）. On the basis of routine treatment, group A were treated with calcium dobesilate,0.5g per times,3 timesa day,and continuous administration for one month from the first day after operation. Group B（ pranoprofen group） had 26 cases（37 i eyes）, and were treated with pranoprofen eye drops 4 times a day for 7 days before sur- gery and 1 month after surgery beside conventional treatment. Group C （ drug combina- tion group） had 25 cases^32 eyes） ,treated with conventional treatment combined with , calcium dobesilate and pranoprofen, and the methods were just the same as group A and group B. Group D（ conventional treatment group） had 27 cases（ 38 eyes）, to which normal antibiotics and hormone drops were applied as routine postoperative, and ocular hypotensive drugs were added when high intraocular pressure occured. The non-DMcataract 25 patients（34 eyes） were selected as D group（ control group）. Routine examination was undertaken at 1 day,3 days ,7 days, 14 days,30 days and 90 days after operation. Optical coherence tomography observation of retinal thickness and fundus fluorescein angiography evaluation in the macular area of fluorescein leakage were taken at 30 days and 90 days after operation. Results At postoperative 30 days and 90 days, the vision acuity was impoved significantly in each group （ all P 〈0.01 ）. At postoperative 30 days,visual acuity in group C and control group were better than that in group D（ both P 〈 0. 05 ）, the foveal retinal thickness in group D, group A and group B were significantly greater than that in groups C （ all P 〈 0.05） ,and group D had the highest incidence of the macuiar fluorescein leakage with the occurrence rate of 21.05% （ 8/ 38） ,followed by group A with 18.18% （6/33） ,group B with 16.22% （6/37） and group C with the lowest rate of 3.13% （ l/ 32 ）. At postoperative 90 days, visual acuity in group A, group B, group C and control group were better than that in group D （ all P 〈 0.05 ）, foveal retinal thickness in group D was greater than those in other groups （ all P 〈 0.01 ）, and the incidence of macular fluorescein leakage was the highest in group D with 15.79% （6/38）, the rates in other groups：group A with 9.09% （ 3/33 ）, guoup B with 5.41% （ 2/37 ）, group C with 0% and control group with 2.94% （ 1/34 ）. The difference was statistical- ly significant in group D and other groups （ all P 〈 0.01 ）. Caneluslon Combined application of pranoprofen and calcium dobesilate in diabetic patients before and after cataract operation, can reduce postoperative macular retinal thickness, macu- lar capillary fluorescence leakage, and contribute to the recovery of visual acuity.