玻璃体视网膜手术中绷带镜对糖尿病患者角膜的保护作用

The protective effect of bandage contact lens on the cornea of diabetic patients during vitreoretinai surgery

目的 观察角膜绷带镜在非接触广角镜下玻璃体视网膜手术中对糖尿病患者角膜上皮的影响.方法 前瞻性随机对照研究.增生性糖尿病性视网膜病变玻璃体视网膜手术56例（60只眼）随机分为两组：A组,绷带镜组,29例（29只眼）术中使用角膜绷带镜覆盖于角膜表面,在非接触广角镜下实施手术;B组,黏弹剂组,27例（31只眼）,相同的手术方式使用黏弹剂为角膜保湿.术前及术后角膜荧光素染色、泪液功能及角膜内皮细胞密度检查等数据进行两组间对比.结果 角膜荧光素染色阳性率术前A组和B组分别为41.38%和41.94%（χ2=0.002,P=0.965）.术后1、2、3 d A组为44.83%、41.37%、37.93%,B组为70.97%、70.97%、67.74%,（χ2=4.212、5.342、5.350,均为P〈0.05）;术后7 d,A组为41.37%,B组为61.29%（χ2=2.379,P=0.123）.泪膜破裂时间术前A组和B组分别为（6.69±2.02）s和（7.09±1.98）s（t=-0.913,P=0.327）.术后1、2、3 d A组为（5.77±3.10）s、（5.91±2.64）s、（6.08±2.57）s,B组为（4.49±3.42）s、（4.76±2.55）s、（5.18±2.31）s（t=3.279、3.011、2.259,均为P〈0.05）;术后7 d,A组为（6.28±2.41）s,B组为（5.67±2.51）s（t=1.983,P=0.076）.两组间各时间点泪液分泌试验结果差异无统计学意义.结论 糖尿病患者玻璃体视网膜手术中使用角膜绷带镜者,在术后早期角膜上皮完整性及泪膜稳定性方面均优于使用黏弹剂者.绷带镜可在术中有效保护角膜上皮.

Objective To observe the effect of bandage contact lens on epithelial after vitreoretinal surgery for proliferative diabetic retinopathy .Methods In this prospective, randomized, comparative clinical study , 60 eyes of 56 patients with PDR were randomly divided into two groups .They underwent vitreoretinal surgery.Group A, 29 eyes of 29 cases, the bandage contact lens were covered on corneal surface during surgery under noncontact wide-angle viewing systems .Group B, 31 eyes of 27 cases, the hydroxypropyl methylcellulose were covered on corneal surface during the same surgery . The corneal fluorescein sodium staining , tear function , count of corneal endothelium cells before and after operation were assessed.Results Pre-operation,corneal fluorescein staining positive rate was 41.38% in group A and 41.94%in group B （χ2 =0.002, P=0.965）.At 1, 2 and 3 d after surgery, the positive rate of group A was 44.83%, 41.37% and 37.93%, in group B was 70.97%, 70.97% and 67.74%, （χ2 =4.212, 5.342, 5.350;all P〈0.05）.At 7 d after surgery, the positive rate was 41.37%in group A and 61.29%in group B （χ2 =2.379, P=0.123）.The BUT was （6.69 ±2.02）s in group A and （7.09 ±1.98）s in group B before surgery （t=-0.913, P=0.327）.At 1, 2 and 3 d after surgery, the BUT of group A was （5.77 ±3.10）s, （5.91 ±2.64）s and （6.08 ±2.57）s, in group B was （4.49 ±3.42）s, （4.76 ±2.55）s and （5.18 ±2.31）s （t=3.279, 3.011, 2.259; all P〈0.05）.At 7 d after surgery, BUT was （6.28 ± 2.41）s in group A and （5.67 ±2.51）s in group B （t=1.983, P=0.076）.The difference of SchirmerⅠ test was not significant between two groups .Conclusion Bandage contact lens are used in vitreoretinal surgery for diabetic patients .Bandage contact lens superior to hydroxypropyl methylcellulose in the early postoperative corneal epithelial integrity and tear film stability .The bandage contact lens could protect the corneal epithelium during vitreoretinal surgery .