玻璃酸钠对翼状胬肉术后眼表创伤修复的研究

Investigation on the effects of eye drops of O. 3 % hyaluronate sodium on ocular surface of after pterygium surgery

目的评价0．3％玻璃酸钠滴眼液对翼状胬肉术后眼表创伤修复的作用。方法前瞻性双盲随机对照临床研究。选取原发翼状胬肉60例（60眼），随机分为治疗组及对照组各30眼。由同一医生以相同方式行翼状胬肉切除联合白体角膜缘结膜移植术。术后两组均给与抗生素及糖皮质激素滴眼，治疗组加用0．3％玻璃酸钠滴眼液滴眼，4次／d，共1个月。术后不同时间点行眼部症状评分、角膜上皮修复评估、角膜知觉、非侵入式泪膜破裂时间、非侵入式泪河高度及激光共焦角膜显微镜检查。结果症状评分：术后2、3、7d治疗组均低于对照组（P〈0．05）。角膜上皮修复：治疗组术后1、2、3d角膜上皮面修复率均高于对照组（P〉0．05）；术后2d角膜上皮完全修复的眼数比较，治疗组17眼（56．67％），对照组9眼（30．00％）（P=0．037）。术后14、28d治疗组泪河高度均高于对照组（P〈0．05）；术后7、14、28d治疗组泪膜破裂时间均长于对照组（P〉0．05）。角膜知觉：两组各时间点比较差异均无统计学意义（P〉0．05）。激光共焦角膜显微镜检查：治疗组7d胬肉切除区角膜上皮细胞排列紧密，无水肿，无明显炎性细胞浸润；对照组该区角膜上皮细胞部分肿胀，并见炎性细胞浸润。治疗组角膜上皮细胞密度高于对照组（P=0．000）。结论0．3％玻璃酸钠滴眼液可加速胬肉术后早期角膜上皮修复，改善上皮细胞规整性，显著减轻围手术期不适症状，持续使用可增加泪河高度。

Objective To evaluate the the effects of 0.3% hyaluronate sodium eye drops on ocular surface of pterygium patients after limbal eonjunetival autograft transplantation. Methods Prospective, double-blind, randomized, eontrolled clinical trial. Sixty eyes of 60 patients diagnosed as primary pterygium were randomly divided into two groups with 30 eyes in each group. All received pterygium resection combined with limhal eonjunctival autograft transplantation by the same doctor. After operation, patients in the control group were given 0.5 % levofloxaein, 0.1% fluorometholone eye drops 4 times a day. For that in treatment group, O. 3% sodium hyaluronate eye drops were added 1 day postoperatively, four times a day for 1 month. The follow-up time was 1 month. The healing of epithelium, the scores of clinical symptoms, corneal sensation, non-invasive breakup time of tear film （BUT）, non-invasive tear meniscus height （TMH）, and eonfocal mieroseopy examination were done and recorded. Results The scores of clinical symptoms at the 2, 3, 7 days after the surgery were lower in the treatment group than that in the control group（P 〈 0.05 ）. the rates of epithelium healing area in treatment group was higher than that in control group at 1, 2, 3 days after the surgery（P 〉 0.05 ）. At day 2, the eyes with intact epithelium in treatment group was 17（57% ） , compared with control group only 9（30% ）（x^2 =4.344,P =0. 037）. TMH ＆ BUT：at 14 and 28 days postoperatively, the TMH in the treatment group were higher than that in the control group （P 〈 0.05 ） ;at 7, 14, and 28 days after surgery, the BUT in the treatment group were higher than that in the control group（P 〉 0.05 ）. Corneal sensation： at each time point, there was no statistically significant difference between two groups （ P 〉 0.05 ）. Confocal microscopy ： at 7 days postoperatively, the epithelia of the pterygium resection area were assembled tightly without edema or inflammation cells infiltration in the treatment group; however, in the control group, some of the epithelial ceils were swollen with inflammation cells infiltration. The corneal epithelial cells density was higher in the treatment group compared with the control group （P 〈 0.05 ）. Conclusion 0.3 % hyaluronate sodium eye drops promote the healing of corneal epithelium, and significantly reduce the perioperative pain. Continual using 0. 3% hyaluronate sodium eye drops could increase the TMH.