两种滴眼液防治白内障超声乳化术后角膜水肿的效果及作用机制

Curative effect and mechanism of two kinds of eye drops in prevention and treatment of corneal edema after phacoemulsification

目的探讨两种滴眼液防治白内障超声乳化术后角膜水肿的效果及作用机制。方法选择2012年3月至2016年1月我院择期行白内障超声乳化术联合人工晶体植入术的88例(120眼)白内障患者,按随机数字表法分为A、B组各44例(60眼),A组术后单用妥布霉素地塞米松滴眼液预防角膜水肿,B组加用重组人表皮生长因子滴眼液,比较两组术前及术后1、3个月眼压、黄斑中心亚区域厚度(CSMT)、中央角膜厚度(CCT)的变化,评定两组症状、体征积分的改善情况,统计角膜水肿及不良反应发生率,并采用干眼自觉症状评分表与眼表疾病指数(OSDI)问卷评定患者眼表功能恢复情况。结果术后1个月,A、B组眼压降低,B组术后1、3个月眼压均低于A组(P<0.05)。术后1、3个月,A组CSMT上升,CCT降低,B组CCT降低(P<0.05),CSMT与术前比较差异无统计学意义(P>0.05),B组CSMT及CCT均低于A组(P<0.05)。术后1、3个月两组症状体征积分均降低,B组低于A组(P<0.05)。B组术后角膜水肿、黄斑水肿发生率低于A组(P<0.05)。术后1、3个月,两组干眼自觉症状评分、OSDI评分均降低(P<0.05)。结论应用重组表皮生长因子滴眼液可降低白内障患者超声乳化术后角膜水肿发生率,主要机制为重组表皮生长因子可快速修复受损角膜内皮细胞,促进角膜内皮细胞增生。

To investigate the effect and mechanism of two kinds of eye drops in prevention and treatment of corneal edema after phacoemulsification.A prospective study was carried out in 88 patients(120 eyes)with cataract who underwent elective phacoemulsification and intraocular lens implantation in our hospital from March 2012 to January 2016.By using the random number table method,the patients were divided into group A and B with 44 cases(60 eyes)in each group.The group A used tobramycin and dexamethasone eye drops to prevent corneal edema,while the group B used recombinant human epidermal growth factor eye drops.The changes of intraocular pressure(IOP),central subfield mean thickness(CSMT)and central corneal thickness(CCT)before surgery,1 month and 3 months after surgery were compared between the two groups.The improvement scores of symptoms and signs in two groups was evaluated,and the incidence rates of corneal edema and adverse reactions were statistically analyzed.The ocular function recovery was evaluated with the scoring scale of dry eye self-conscious symptom and ocular surface disease index(OSDI).After one month of surgery,the IOP of the two group was all decreased(P<0.05)and the IOP of the group B was lower than that of group A after 1 month and 3 months of surgery(P<0.05).CSMT was increased but CCT was decreased in the group A after 1 month and 3 months of surgery(P<0.05).CCT was decreased(P<0.05)but there was no significant difference in CSMT before and after surgery in the group B(P>0.05)after 1 month and 3 months after surgery.CSMT and CCT of the group B were lower than those of the group A(P<0.05).The scores of symptoms and signs of the both groups were decreased after 1 months and 3 months of surgery(P<0.05),and the scores of the group B were lower than those of the group A(P<0.05).The incidence rates of corneal edema and macular edema were lower in the group B than that of the group A after surgery(P<0.05).The scores of dry eye symptoms and OSDI score were decreased in two groups after 1 month and 3 months of surgery(P<0.05).The application of recombinant human epidermal growth factor eye drops can reduce the incidence of corneal edema in cataract patients after phacoemulsification.The main mechanism may be that recombinant human epidermal growth factor can quickly repair damaged corneal endothelial cells,and promote the proliferation of corneal endothelial cells.