羟丙基甲基纤维素在超声乳化术中角膜的保护作用

Protective effect of hydroxypropyl methyl cellulose on corneal epithelium during phacoemulsification

目的评价角膜保护剂2％羟丙基甲基纤维素（HPMC）在超声乳化术中及术后早期角膜上皮的保护作用。方法回顾性分析2017年3月至2017年8月行超声乳化人工晶状体植入术328例（328眼）的临床资料。患者曾随机分为HPMC组（164眼）和对照组（164眼）。HPMC组在超声乳化术中在角膜表面滴用角膜保护剂HPMC，而对照组应用平衡盐水湿润角膜。观察术后1d和1周泪膜破裂时间（TBUT）、荧光素染色、丽丝胺绿染色和SchirmerⅠ试验。结果术后1d，两组患者的TBUT均比基线减少，两组间比较差异有统计学意义（P=0．012）。术后1周，两组间比较差异有统计学意义（P=0．009）。术后1d两组患者的荧光素染色、丽丝胺绿染色和表麻下SchirmerⅠ试验的结果组间比较，差异均有统计学意义（P=0．029，0．041，0．032），术后1周各项差异均有统计学意义（P=0．032，0．039，0．047）。结论角膜保护剂对超声乳化术中角膜上皮有明显保护作用。可以明显改善术后泪膜功能。有效预防角膜上皮功能障碍的发生。

Objective To evaluate the protective effect of corneal protective agent （2% hydroxypropyl methyl cellulose, HPMC ） on corneal epithelium intraoperative and early postoperative phacoemulsification. Methods The data of 328 eyes of 328 cases with cataract from Mar. 2017 to Aug. 2017 were analyzed retrospectively. All cases underwent phacoemulsification and intraocular lens implantation. They were randomly divided into HPMC group of 164 eyes and control group of 164 eyes. The HPMC group received corneal surface drops HPMC during operation. The control group only used balanced salt solution to wet cornea during operation. The tear break up time （TBUT）, fluorescein staining, conjunctival lissamine green staining and Schirmer I test were observed at 1 day and 1 week after operation. Results One day after operation, the TBUT of two groups was less than that before surgery, the difference was statistically significant （P =0.012）. The difference of TBUT at 1 week postoperatively was statistically significant between the two groups （P = 0. 009 ）. The differences in the results of fluorescein staining, conjunctival lissamine green staining and Schirmer I test value were significant between the two groups （ 1 day postoperatively P = 0. 029, P = 0. 041, P = 0.032 ; 1 week postoperatively ： P = 0. 032, P = 0. 039, P = 0.047）. Conclusion Corneal protector has obvious protective effect on corneal epithelium during phacoemulsification. It will obviously improve the function of tear film after cataract surgery. It can effectively prevent the occurrence of corneal epithelial dysfunction.