不同人工泪液治疗白内障超声乳化术后干眼症

Efficacy of different kinds of artificial tears treatment in patients with xerophthalmia after phacoemulsification combined with intraocular lens implantation

目的:探究不同种类人工泪液治疗白内障超声乳化联合人工晶状体植入术后发生干眼症患者的疗效。方法:选取2015-01/2016-06期间我院收治的行白内障超声乳化联合人工晶状体植入术后具有干眼症症状患者280例280眼为研究对象。根据使用的人工泪液种类的不同,分为四组:(1)对照组:术后连续使用妥布霉素地塞米松眼膏涂术眼1wk,3次/d;使用左氧氟沙星滴眼液滴术眼1wk,3次/d;使用普拉洛芬滴眼液1mo,4次/d。(2)聚丙烯酸组:在对照组基础上连续使用聚丙烯酸点术眼1mo,4次/d;(3)聚乙二醇组:在对照组基础上连续使用聚乙二醇点术眼1mo,4次/d;(4)玻璃酸钠组:在对照组基础上连续使用玻璃酸钠点术眼1mo,4次/d。观察并比较四组患者治疗后1、2、3wk及1mo时的泪膜破裂时间(BUT)、泪液分泌试验(SⅠt)、干眼症状评分、角膜染色评分等。结果:(1)BUT:四组患者治疗后BUT均呈上升趋势,显著高于治疗前,差异有统计学意义(P<0.05),且聚丙烯酸组、聚乙二醇组及玻璃酸钠组治疗后BUT与对照组比较差异有统计学意义(P<0.05),玻璃酸钠组术后2wk的BUT显著高于其他组,差异有统计学意义(P<0.05);(2)SⅠt:四组患者治疗后SⅠt均呈上升趋势,显著高于治疗前,差异有统计学意义(P<0.05),且聚丙烯酸组、聚乙二醇组及玻璃酸钠组治疗后的SⅠt与对照组比较差异有统计学意义(P<0.05),其中玻璃酸钠组治疗后SⅠt显著高于其他组,差异有统计学意义(P<0.05);(3)干眼症状评分:四组患者治疗后干眼症状评分均呈下降趋势,与治疗前比较具有统计学差异(P<0.05),且聚丙烯酸组、聚乙二醇组及玻璃酸钠组治疗后评分与对照组比较差异均有统计学意义(P<0.05),玻璃酸钠组治疗后3wk评分显著低于其他组,差异有统计学意义(P<0.05);(4)角膜染色评分:治疗后各组与治疗前比较显著降低,差异有统计学意义(P<0.05),其中1、2wk各组角膜染色评分均无统计学差异(P>0.05),治疗后3wk,1 mo玻璃酸钠组角膜染色评分显著低于其他组,差异有统计学意义(P<0.05)。结论:人工泪液治疗白内障超声乳化联合人工晶状体植入治疗后干眼症具有较好的临床疗效,含有玻璃酸钠成份的泪液效果最佳。

AIM： To explore efficacy of the different kinds of artificial tears treatment in patients with xerophthalmia after phacoemulsification combined with intraocular lens implantation. METHODS： Totally 280 patients （280 eyes） with xerophthalmia after operation in our hospital from January 2015 to June 2016 were selected. According to the different treatment methods, they were divided into control group （n = 70; treated with tobramycin and dexamethasone eye ointment 3 times per day for lwk, levofloxacin eye drops 3 times per day for lwk, pranoprofen eye drops 4 times per day for l mo ）, polyacrylic acid group （ n = 70; besides the treatment of control group, polyacrylic acid was used 4 times per for lmo）, polyethylene glycol group （ n = 70; besides the treatment of control group, polyethylene glycol was used 4 times per for lmo） and sodium hyaluronate group （ n= 70; besides the treatment of control group, sodium hyaluronate was used 4 times per for 1too）. The tear film break up time （BUT）, Schirmer I test （S I t）, symptoms of dry eye and corneal staining in four groups were observed. RESULTS. （1） BUT： The BUT of the four groups significantly increased after treatment （ P〈 0.05） ; that of polyacrylic acid group, polyethylene glycol group, andsodium hyaluronate group was different compared with control group（P〈0.05）; the BUT in sodium hyaluronate group was significantly higher than the other groups after 2wk of treatment （ P〈 0. 05 ） . （2） S I t： S I t of the four groups significant increased after treatment（P〈0.05） ; that of polyacrylic acid group, polyethylene glycol group, and sodium hyaluronate group was different compared with control group （P〈 0. 05）; and the S I t in sodium hyaluronate group was significantly higher than other groups （P〈0.05）. （3） Xeroma score： the scores of dry eye significantly decreased after treatment in the four groups （P〈 0. 05）; that of polyacrylic acid group, polyethylene glycol group, and sodium hyaluronate group was different compared with control group（ P〈0.05）; and the scores of the sodium hyaluronate group after 3wk was significantly lower compared with other groups（P〈0.05）. （4） Corneal staining score： the scores significantly decreased after treatment in the four groups（P〈0.05） ; at 1 and 2wk after treatment the corneal staining score had not statistically different among the four groups （P〉 0.05）; sodium hyaluronate group was significant lower than other groups in corneal staining score at 3wk and 1 mo after treatment（P〈0.05）. CONCLUSION： Artificial tears in the treatment of xerophthalmia after cataract phacoemulsification combined with intraocular lens implantation has better clinical efficacy, which contains sodium hyaluronate may be the better than others.