小切口摘除术治疗老年性硬核性白内障中眼用凝胶的应用效果

Application effect of ophthalmic gel in small incision enucleation for patients with senile hard nuclear cataract

目的 探讨小切口摘除术联合术后小牛血去蛋白提取物(DCBE)眼用凝胶治疗老年性硬核性白内障的效果。方法 采取前瞻性研究选取老年性硬核性白内障患者94例(108眼),随机数字表法分为观察组和对照组,每组47例。对照组采取小切口摘除术,观察组患者在对照组基础上联合DCBE眼用凝胶治疗,2组均治疗1周。随访3个月,比较2组患者视力、散光程度、术后疗效、泪液分泌、泪膜破裂时间、角膜荧光染色评分、血清β2微球蛋白(β2-MG)、炎症因子水平以及并发症等差异。结果 观察组患者术后4、8、12周的视力量表评分高于对照组,差异有统计学意义(P<0.05)。术前以及术后1、4、8、12周患者的散光情况比较,差异无统计学意义(P>0.05)。2组治疗效果评分均升高,且观察组术后1、4周的治疗效果评分低于对照组,差异有统计学意义(P<0.05)。观察组术后1、4周泪液分泌长度大于对照组,差异有统计学意义(P<0.05)。观察组患者术后1、4周的泪膜破裂时间长于对照组,差异有统计学意义(P<0.05)。观察组患者超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)水平以及β2-MG水平低于对照组,差异有统计学意义(P<0.05)。2组患者角膜水肿、一过性高眼压、瞳孔变形以及房水浑浊比较,差异无统计学意义(P>0.05)。结论 老年性硬核性白内障患者采取小切口摘除术联合术后DCBE眼用凝胶治疗安全、有效,可显著下调血清β2-MG、炎症因子水平。

Objective To investigate the effect of small incision enucleation combined with post⁃operative deproteinized calf blood extract(DCBE)ophthalmic gel in the treatment of patient with se⁃nile hard nuclear cataract.Methods A prospective study was adopted to select 94 patients(108 eyes)with senile hard nuclear cataract,and they were randomly divided into observation group and control group,with 47 cases in each group.The control group was treated with small incision enuclea⁃tion,while the observation was treated with additional DCBE ophthalmic gel on the basis of the control group,and both groups were treated for a week.After 3 months of follow up,the differences in visual acuity,astigmatism degree,postoperative efficacy,tear secretion,rupture time of tear film,score of corneal fluorescence staining,serumβ2⁃microglobulin(β2⁃MG),levels of inflammatory factors and complications were compared between two groups.Results At 4,8 and 12 weeks after operation,the scores of visual acuity scale in the observation group were significantly higher than those in the control group(P<0.05).There were no significant differences in the conditions of astigmatism before opera⁃tion and 1 week,4,8 and 12 weeks after operation in patients(P>0.05).The score of therapeutic effect in both groups increased significantly,and the scores of therapeutic effect at 1 week and 4 weeks after operation in the observation group were significantly lower than those in the control group(P<0.05).The length of lacrimal secretion in the observation group was significantly longer than that in the control group at 1 week and 4 weeks after operation(P<0.05).The rupture time of tear film in the patients of the observation group was significantly longer than that in the control group at 1 weekand 4 weeks after the operation (P < 0. 05). The levels of hypersensitivity C⁃reactive protein(hs⁃CRP), tumor necrosis factor⁃α (TNF⁃α), interleukin⁃6 (IL⁃6) and β2⁃MG in the observationgroup were significantly lower than those in the control group (P <0. 05). There were no significantdifferences in corneal edema, transient high intraocular pressure, pupil deformation and turbid aque⁃ous humor between the two groups (P >0. 05). Conclusion Small incision enucleation combinedwith postoperative DCBE ophthalmic gel is effective and safe in the treatment of patients with senilehard nuclear cataract, which can significantly down⁃regulate the serum levels of β2⁃MG and inflam⁃matory factors.