非甾体类药物预防飞秒激光辅助白内障术中瞳孔缩小的观察与分析

Observation and analysis of nonsteroidal drugs in preventing intraoperative miosis of femtosecond assist cataract surgery

目的探讨飞秒激光术后眼内前列腺素E2(prostaglandin E2)浓度的变化与瞳孔缩小的关系,同时比较术前应用两种非甾体类药物(nonsteroidal drugs,NSAIDs)预防飞秒激光辅助白内障术中瞳孔缩小的效果。方法前瞻性队列研究。研究对象为2014年6月至2015年3月于天津医科大学眼科医院白内障科行白内障手术的老年性白内障患者120例(120眼),根据手术方式及用药分为4组,其中拟行传统超声乳化手术30例(30眼)为A组;拟行飞秒激光辅助白内障手术90例(90眼)随机分为3组,其中空白对照组为B组,术前应用1 g·L^(-1)普拉洛芬滴眼液为C组,术前应用1 g·L^(-1)双氯芬酸钠滴眼液为D组。收集包括患者年龄、性别、晶状体核分级、术前充分散瞳后以及完成飞秒激光或手工透明角膜切口后瞳孔直径等临床资料,测量所有样本中PGE2浓度。结果 A、B、C、D四组中PGE2浓度分别为(48.25±10.52)pg·m L^(-1)、(124.14±8.97)pg·m L^(-1)、(18.28±3.49)pg·m L^(-1)、(19.05±3.13)pg·m L^(-1);B组与A、C、D组差异均有统计学意义(均为P<0.000 1),C组与D组差异无统计学意义(P>0.05)。A、B、C、D四组术中瞳孔缩小的发生率分别为6.67%(2/30)、20.00%(6/30)、3.33%(1/30)、3.33%(1/30);B组与A、C、D组差异均有统计学意义(均为P<0.05),C组与D组差异无统计学意义(χ2=0.001,P>0.05)。瞳孔缩小与年龄、性别及晶状体核分级均无相关性(均为P>0.05)。发生瞳孔缩小者与未发生瞳孔缩小者PGE2浓度分别为(130.74±8.76)pg·m L^(-1)、(120.86±7.27)pg·m L^(-1),差异有统计学意义(P<0.05),瞳孔缩小程度与PGE2浓度无相关性(P>0.05)。结论飞秒激光术后瞳孔缩小可能与房水中PGE2浓度升高有关,术前局部应用NSAIDs能降低眼内PGE2浓度,减少飞秒激光术后瞳孔缩小的发生。

Objective To investigate the potential relationship between the miosis after femtosecond laser treatment and the concentration of intraocular prostaglandin E2（ PGE2）,meanwhile evaluate and compare the effect of the two different nonsteroidal drugs（ NSAIDs） in preventing intraoperative miosis. Methods Prospective cohort study. The subjects were 1 2 0 patients with cataract surgery（ 1 2 0 eyes） raging from 5 0 years to 9 0 years old in the Tianjin Medical University Eye Hospital,Cataract Branch Line from June 2 0 1 4 to March 2 0 1 5,according to the surgical methods and drugs the patients were divided into four groups,which scheduled for traditional phacoemulsification in 3 0 cases（ 30 eyes） for group A,scheduled for femtosecond laser-assisted cataract surgery 90 cases（ 90 eyes） were randomly divided into three groups,including group B which was the control group,group C which topically use 1 g· L^-1pranoprofen eye drops（ pranoprofen） before surgery,group D which topically use 1 g· L^-1diclofenac sodium eye drops（ diclofenac sodium） before surgery. Clinical data were collected including age,gender,lens stage,pupil size after fully dilated before the surgery and after the laser treatment,total PGE2 levels were measured using enzyme-linked immunoassay. R esults The concentrations of PGE2 in group A,B,C,D were（ 4 8.2 5 ± 1 0. 5 2） pg· m L^-1,（ 124. 14 ± 8. 97） pg· m L^-1,（ 18. 28 ± 3. 49） pg· m L^-1,（ 19. 05 ± 3. 13） pg· m L^-1,respectively,there were statistical differences between group B and group A,C,D（ all P 〈0. 0 0 0 1）,and there was no statistical difference between group C and group D（ P 〈0. 0 5）. The incidence of intraoperative miosis were 6. 6 7 %（ 2 /3 0）,2 0. 0 0 %（ 6 /30）,3. 33%（ 1 /30）,3. 33%（ 1 /30） in group A,B,C,D,the differences between group B and group A,C,D were statistically significant（ all P 〈0. 0 5）,there was no statistical difference between group C and group D（ χ^2= 0. 0 0 1,P 〈0.0 0 1）,and there was no correlation between miosis and age,gender and nucleus stage（ all P 〈0. 0 5）. The concentration of PGE2 in patients with miosis and no miosis were（ 1 3 0. 7 4 ± 8. 7 6） pg · m L^-1,（ 120. 86 ± 7. 27） pg· m L^-1,respectively,there was statistical difference between them（ P 〈0. 0 5）,the degree of miosis and concentration of PGE2 was not correlated（ P 〈0. 05）. Conclusion The miosis after femtosecond laser treatment may be associated with elevated concentrations of PGE2 in the aqueous humor,using topical NSAIDs preoperatively can decrease the intraocular concentrations of PGE2,and reduce the occurrence of miosis after femtosecond laser treatment.