增生性糖尿病视网膜病变微创玻璃体手术中角膜保护剂与平衡盐溶液对眼表保护效果对比

Comparison of the Effect of Corneal Protectant and Balanced Salt Solution on Ocular Surface Protection in Minimally Invasive Vitreous Surgery for Proliferative Diabetic Retinopathy

目的研究增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)微创玻璃体手术中角膜保护剂与平衡盐溶液对眼表的保护效果。方法方便选择2020年1月—2021年11月于大庆油田总医院接受微创玻璃体手术治疗的92例PDR患者作为观察对象,采用随机数表法将其分为2组,各46例。对照组微创玻璃体术中滴加平衡盐溶液,研究组术中滴加角膜保护剂。对比两组术前和术后7 d泪膜功能、眼部不适症状及术毕角膜上皮水肿分级。结果与术前相比,术后7 d两组泪膜破裂时间、泪液浸湿长度均更短,术后7 d两组角膜荧光素钠染色评分均更高,差异有统计学意义(P<0.05);术后7 d研究组泪膜破裂时间(5.62±1.60)s、泪液浸湿长度(11.25±2.19)mm/5 min均长于对照组(4.83±1.52)s、(9.87±1.2)mm/5 min,角膜荧光素钠染色评分(5.38±1.06)分低于对照组(6.16±1.23)分,差异有统计学意义(t=2.428、3.436、3.258,P<0.05);与术前相比,术后7 d两组患者OSDI评分均更高,差异有统计学意义(P<0.05);但术后7 d研究组OSDI评分(51.61±7.23)分低于对照组(54.89±7.56)分,差异有统计学意义(t=2.127,P<0.05);研究组患者术毕角膜上皮水肿分级优于对照组,差异有统计学意义(P<0.05)。结论相比于平衡盐溶液,PDR微创玻璃体手术中应用角膜保护剂能有效保护眼表,促进术后眼表组织及泪膜功能恢复,减轻眼部不适症状。

Objective To study the effect of corneal protectant and balanced salt solution on ocular surface protection during minimally invasive vitreous surgery for proliferative diabetic retinopathy(PDR).Methods Ninety-two patients with PDR who underwent minimally invasive vitreous surgery in Daqing Oilfield General Hospital from January 2020 to November 2021 were conveniently selected as observation subjects.They were divided into two groups using a ran⁃dom number table method,with 46 patients in each group.Balanced salt solution was added to drops in the control group during minimally invasive vitrectomy,and corneal protector was added to drops in the study group during sur⁃gery.The tear film function,ocular discomfort symptoms and postoperative corneal epithelial edema grading were com⁃pared between the two groups before and 7 d after surgery.Results Compared with the preoperative period,the tear film rupture time and tear wetting length were shorter in both groups at 7 d postoperatively,and the corneal sodium fluorescein staining score was higher in both groups at 7 d postoperatively,the difference was statistically significant(P<0.05).The tear film rupture time(5.62±1.60)s and tear wetting length(11.25±2.19)mm/5 min were longer in the study group than in the control group(4.83±1.52)s and(9.87±1.2)mm/5 min,and the corneal fluorescein sodium staining score(5.38±1.06)points was lower than that of the control group(6.16±1.23)points at 7 d postoperatively,the difference was statistically significant(t=2.428,3.436,3.258,P<0.05).The OSDI scores were higher in both groups at 7 d postoperatively compared with preoperatively,the difference was statistically significant(P<0.05).However,the OSDI score was lower in the study group(51.61±7.23)points than in the control group(54.89±7.56)points at 7 d post⁃operatively,the difference was statistically significant(t=2.127,P<0.05).Patients in the study group had better grading of corneal epithelial edema after surgery than the control group,the difference was statistically significant(P<0.05).Conclusion Compared with balanced salt solution,the application of corneal protectant during PDR minimally inva⁃sive vitreous surgery can effectively protect the ocular surface,promote the recovery of ocular surface tissues and tear film function after surgery,and reduce ocular discomfort symptoms.