重组牛碱性成纤维细胞生长因子对角膜内皮细胞密度低下患者白内障术后角膜内皮的保护作用

Protective effect of recombinant bovine basic fibroblast growth factor on corneal endothelium in cataract patients with low corneal endothelial cell density after phacoemulsification

目的研究角膜内皮细胞密度(ECD)低下患者行超声乳化白内障吸除术后应用重组牛碱性成纤维细胞生长因子(re-bFGF)对角膜内皮的保护作用。方法前瞻性队列研究。选取2019年9月至2022年4月在北京大学第三医院眼科就诊、拟行超声乳化白内障吸除且合并ECD低下的患者80例(90眼)为研究对象,随机分为两组,试验组41例(45眼),对照组39例(45眼)。术后除常规抗炎治疗外,试验组患眼应用re-bFGF滴眼液每日4次滴眼,对照组患眼应用1 g•L-1玻璃酸钠滴眼液每日4次滴眼,均使用至术后6个月。对比分析两组患眼术前和术后1个月、3个月、6个月的ECD和中央角膜厚度(CCT)等。结果术后1个月、3个月、6个月,试验组患眼的ECD和CCT均较术前变化不明显(均为P>0.05),而对照组患眼的ECD均较术前下降,CCT均较术前增加(均为P<0.05)。术前,试验组和对照组患眼ECD分别为(1120.6±306.1)个·mm^(-2)、(1040.5±317.3)个·mm^(-2),CCT分别为(543.1±51.6)μm、(546.8±35.6)μm,两组相比差异均无统计学意义(均为P>0.05);术后6个月,试验组和对照组患眼ECD分别为(1271.3±288.6)个·mm^(-2)、(746.5±193.5)个·mm^(-2),CCT分别为(542.0±55.3)μm、(583.5±45.3)μm,两组相比差异均有统计学意义(均为P<0.05)。术后2眼发生了角膜内皮失代偿,且均发生在对照组。结论re-bFGF对ECD低下患者行超声乳化白内障吸除术后的角膜内皮有保护作用,可减轻超声乳化手术造成的ECD下降,减少角膜水肿及术后短期角膜内皮失代偿的严重并发症的发生率。

Objective To investigate the protective effect of the recombinant bovine basic fibroblast growth factor(re-bFGF)on corneal endothelium in cataract patients with low corneal endothelial cell density(ECD)after phacoemulsification.Methods In this prospective cohort study,80 patients(90 eyes)admitted to the Ophthalmology Department of Peking University Third Hospital for phacoemulsification from September 2019 to April 2022 and with low corneal ECD before surgery were selected and randomly divided into two groups:41 patients(45 eyes)in the experimental group and 39 patients(45 eyes)in the control group.In addition to routine postoperative anti-inflammatory therapy,patients in the experimental group received re-bFGF eye drops 4 times a day after surgery,while patients in the control group received 1 g•L-1 sodium hyaluronate eye drops 4 times a day after surgery.The medication duration of both groups was 6 months.The ECD and central corneal thickness(CCT)were measured before and 1,3,and 6 months after surgery.Results No statistically significant difference was found in ECD or CCT in the experimental group before or at 1,3 and 6 months after surgery(all P>0.05).However,ECD decreased and CCT increased in the control group at 1,3 and 6 months after surgery(all P<0.05).Before surgery,ECD and CCT were(1120.6±306.1)cells·mm^(-2) and(543.1±51.6)μm respectively in the experimental group,(1040.5±317.3)cells·mm^(-2) and(546.8±35.6)μm respectively in the control group,and there were no statistically significant differences between the two groups(both P>0.05).Six months after surgery,ECD and CCT were(1271.3±288.6)cells·mm^(-2) and(542.0±55.3)μm respectively in the experimental group,(746.5±193.5)cells·mm^(-2) and(583.5±45.3)μm respectively in the control group,and there were statistically significant differences between the two groups(both P<0.05).Moreover,corneal endothelial decompensation happened in two eyes within 6 months after surgery in the control group.Conclusion re-bFGF has a protective effect on corneal endothelial cells in cataract patients with low corneal ECD after phacoemulsification.It can slow down the ECD decrease and reduce the incidence of corneal edema and corneal endothelial decompensation as a severe side effect after phacoemulsification.