玻璃酸钠滴眼液对干眼患者生物测量参数及人工晶状体度数的影响

Effect of Sodium Hyaluronate Eye Drops on Measurement Parameters and Intraocular Lens Power in Dry Eye Patients

目的:研究玻璃酸钠滴眼液对干眼患者及无干眼者生物测量参数及人工晶状体度数的影响。方法:前瞻性非随机对照研究。纳入2018年8月1日至2019年3月1日于解放军总医院第一医学中心眼科门诊就诊患者140例(140眼),根据干眼检测指标分为中重度干眼组、轻度干眼组和无干眼组,其中中重度干眼组40例,轻度干眼组50例,无干眼组50例,均取其右眼数据。所有患者行IOLMaster 700生物测量后,滴入1滴0.1%的玻璃酸钠滴眼液,分别于5 min、10 min及15 min后再次行IOLMaster 700生物测量,比较3组滴入玻璃酸钠滴眼液前后不同时间点中央角膜厚度(CCT)、角膜曲率(K)、散光度数(K2-K1)及散光轴位的差异,并分别计算人工晶状体(IOL)度数,采用方差分析或t检验进行数据分析。结果:点药前,与无干眼组相比较,中重度干眼组CCT较小(P=0.030),K1、K2较大(P=0.048、0.041),IOL度数较小(P=0.018);轻度干眼组K1、K2较大(P=0.022、0.011),IOL度数无明显差异。中重度干眼组在滴入1滴玻璃酸钠滴眼液后5 min,CCT及IOL度数有增大的趋势(t=28.244,P<0.001;t=2.623,P=0.012),K1、K2有减小的趋势(t=-0.621,P=0.538;t=-2.462,P=0.018),IOL度数增加0.5 D的眼数占总眼数的18%;10 min后,与点药前比,CCT及IOL度数有增大的趋势(t=7.334,P<0.001;t=4.425,P<0.001),K1、K2有减小的趋势(t=-4.876,P<0.001;t=-4.179,P<0.001),22.5%的IOL度数增大0.5 D或1.0 D。15 min后,IOLMaster测量参数均回到干预前水平。轻度干眼组在滴药后5 min及10 min,与点药前比较除CCT增大(t=9.286,P<0.001;t=7.516,P<0.001),余生物测量参数差异均无统计学意义;点药后15 min,所有生物测量参数较点药前差异均无统计学意义。无干眼组在滴后5 min及10 min,CCT有增大趋势(t=11.618,P<0.001;t=16.785,P<0.001),IOL度数有减小的趋势(t=-2.641,P=0.011;t=-1.429,P=0.159),IOL度数最大减小0.5 D;15 min后,所有生物测量参数较点药前差异均无统计学意义。各时间点中重度干眼组角膜前表面散光轴位变化较其他2组大,滴后5 min,3组差异有统计学意义(F=3.220,P=0.043)。结论:玻璃酸钠滴眼液的使用可能改变生物测量的数据,尤其对于合并有中重度干眼的患者。滴入玻璃酸钠滴眼液后短时间内,角膜曲率及散光轴位发生变化,中重度干眼患者IOL预测值增大、无干眼患者IOL预测值减小。

Objective:To assess the changes in measurement parameters and intraocular lens power after instillation of sodium hyaluronate eye drops in dry eye patients and non-dry eye patients.Methods:Non-randomized controlled clinical research was performed.Patients with moderate to severe dry eye(40 eyes),mild dry eye(50 eyes)and non-dry eye(50 eyes)were included in this study.All patients underwent IOL Master 700 bioassay before and 5 min,10 min and 15 min after instilling 0.1%sodium hyaluronate eye drops.Differences in central corneal thickness(CCT),corneal curvature(K),astigmatism(K2-K1),axis position and intraocular lens(IOL)power were compared before and after instillation of a drop of sodium hyaluronate.Results:Before instilling sodium hyaluronate eye drops,compare with non-dry eye group,CCT was thicker(P=0.30),K1 and K2 was higher(P=0.048,0.041),IOL was smaller in moderate to severe dry eye group(P=0.018);and K1 and K2 was higher in mild dry eye group(P=0.022,0.011).For the moderate to severe dry eye group,CCT and IOL power increased at 5 min and 10 min after instilling sodium hyaluronate eye drops(CCT:t=28.244,P<0.001;t=7.334,P<0.001;IOL:t=2.623,P=0.012;t=4.425,P<0.001),and K showed a decreasing trend(K1:t=-0.621,P=0.538;t=-4.876,P<0.001;K2:t=-2.462,P=0.018;t=-4.179,P<0.001).Five minutes after instilling sodium hyaluronate eye drops,IOL power in 17.5%of the cases increased by 0.5 D.Further,IOL power in 22.5%of the cases increased by 0.5 D or 1.0 D in 10 minutes.After 15 minutes,the IOLMaster parameters returned to the level of pre-intervention.For the non-dry eye group,CCT increased 5 and 10 minutes after instilling sodium hyaluronate eye drops(t=11.618,P<0.001;t=16.785,P<0.001),and the IOL power decreased by a maximum of 0.5 D(t=-2.641,P=0.011;t=-1.429,P=0.159).After 15 min,there was no significant difference for any parameters.The axial position of astigmatism on the anterior corneal surface of the moderate to severe dry eye group changed significantly in 5 min(F=3.220,P=0.043).Conclusions:For patients with moderate to severe dry eyes or non-dry eyes,sodium hyaluronate eye drops may alter biometric measurements,leading to changes in IOL predicted values.