玻璃体切除术中应用透明质酸钠对泪膜保护作用的研究

Protective effect of sodium hyaluronate on tear film during vitrectomy

目的评价透明质酸钠在玻璃体切除术中对泪膜的保护作用。方法采用前瞻性随机对照研究。纳入济南市第二人民医院2019年10月至2021年5月黄斑前膜67例(67眼),所有患者均行单眼玻璃体切除术,依随机数字表法分为两组。透明质酸钠组(HA组,33眼),术中使用透明质酸钠保持角膜湿润透明。平衡盐溶液组(BSS组,34眼),术中使用BSS保持角膜湿润透明。术后随访60 d。比较术后两组泪液分泌试验(SIt)、泪膜破裂时间(BUT)、角膜荧光素染色(CFS)、泪河高度(TMH)及主观眼表疾病指数评分。结果两组SIt术后不同时间点比较差异有统计学意义(F_(组间)=32.87,P_(组间)<0.001;F_(时间)=134.53,P_(时间)<0.001;F_(交互)=59.81,P_(交互)<0.001)。两组BUT术后不同时间点比较差异有统计学意义(F_(组间)=8.69,P_(组间)=0.004;F_(时间)=836.52,P_(时间)<0.001;F_(交互)=35.46,P_(交互)<0.001)。两组荧光素角膜染色术后1d均较术前增高,HA组低于BSS组(Z=-5.83,P<0.001),术后7、30 d及60 d两组间比较差异无统计学意义(P=0.723,0.758,0.575)。两组术后泪河高度较术前均增高,BSS组高于HA组(F_(组间)=4.61,P_(组间)=0.035;F_(时间)=399.54,P_(时间)<0.001;F_(交互)=25.48,P_(交互)<0.001)。两组术后主观眼表疾病指数不同时间点比较差异有统计学意义(F_(组间)=56.11,P_(组间)<0.001;F_(时间)=3207.15,P_(时间)<0.001;F_(交互)=116.63,P_(交互)<0.001)。结论透明质酸钠在玻璃体切除术中应用对眼表泪膜具有保护作用,可减轻术后主观不适。

Objective To evaluate the protective effect of sodium hyaluronate on tear film during vitrectomy.Methods A prospective randomized controlled trial was conducted.Total of 67 eyes of 67 patients with macular epiretinal membrane from Oct.2019 to May 2021 in Jinan Second People’s Hospital were clollected.Allcases received monocular vitrectomy.All cases were divided into two groups based on random number table methods.The sodium hyaluronate group(HA group),33 eyes used sodium hyaluronate to keep the cornea moist and transparent during vitrectomy.The balanced salt solution group(BSS group),34 eyes used BSS to keep the cornea moist and transparent during vitrectomy.The follow-up time was 60 days after surgery.The postoperative parameters included SchirmerⅠtest(SIt),fluorescein break up time(BUT),corneal fluorescein staining(CFS),tear meniscus height(TMH)and ocular surface disease index(OSDI)between the two groups were compared.Results The difference of SIt at each time point after surgery were statistically significant between the two groups(Fbetween groups=32.87,P_(between groups)<0.001;F_(time)=134.53,P_(time)<0.001;F_(interactive)=59.81,P_(interactive)<0.001).The difference of SIt at each time point after surgery were statistically significant between the two groups(Fbetween groups=8.69,P_(between groups)=0.004;F_(time)=836.52,P_(time)<0.001;F_(interactive)=35.46,P_(interactive)<0.001).CFS in the two groups increased at 1 day after operation compared with that before operation,and that in the HA group was lower than that in the BSS group(Z=-5.83,P<0.001).There was no significant difference between the two groups at 7,30 and 60 days after operation(P=0.723,0.758,0.575).The postoperative TMH in two groups were higher than that of preoperative,and that in BSS group was higher than that in HA group(Fbetween groups=4.61,P_(between groups)=0.035;F_(time)=399.54,P_(time)<0.001;F_(interactive)=25.48,P_(interactive)<0.001).The difference of SIt at each time point after surgery were statistically significant between the two groups(Fbetween groups=56.11,P_(between groups)<0.001;F_(time)=3207.15,P_(time)<0.001;F_(interactive)=116.63,P_(interactive)<0.001).Conclusion Application of sodium hyaluronate can protect the tear film during vitrectomy,and can relieve subjective discomfort after operation.