不同药物治疗白内障术后干眼的效果比较

Comparison of the effects of different drugs in treating dry eyes after cataract surgery

目的研究氯替泼诺与环孢素分别联合玻璃酸钠滴眼液治疗白内障术后中重度干眼的效果。方法前瞻性随机对照研究。以濮阳市安阳地区医院2021年5月至2022年2月白内障术后中重度干眼123例(123眼)为研究对象,采用随机数字表法分为对照组41例(41眼)、环孢素组41例(41眼)、氯替泼诺组41例(41眼)。对照组采用单纯玻璃酸钠滴眼液治疗,环孢素组采用环孢素联合玻璃酸钠滴眼液治疗,氯替泼诺组采用氯替泼诺联合玻璃酸钠滴眼液治疗。治疗后随访1个月,比较三组治疗前及治疗后1个月干眼症状评分、眼表疾病指数(OSDI)评分及最佳矫正视力(logMAR)、眼表功能指标即泪液分泌试验(SIt)、泪膜破裂时间(BUT)、角膜荧光素染色(FL)评分、泪液中氧化应激因子即丙二醛(MDA)、超氧化物歧化酶(SOD)、脂质过氧化物(LPO)、总抗氧化能力(TAC)水平及不良反应发生率。结果治疗后1个月,氯替泼诺组、环孢素组临床总有效率分别为97.56%(40/41)、92.68%(38/41),均高于对照组73.17%(30/41)(均P<0.05);氯替泼诺组干眼症状评分[(0.74±0.25)分]、OSDI评分[(20.11±3.47)分]低于环孢素组[(0.97±0.24)分、(24.43±3.69)分]及对照组[(1.76±0.33)分、(29.67±3.15)分],最佳矫正视力(0.15±0.03)高于环孢素组(0.17±0.10)及对照组(0.22±0.05)(P<0.05);氯替泼诺组SIt、BUT[(15.22±3.11)mm/5min、(13.04±2.47)s]高于环孢素组[(12.14±2.73)mm/5min、(11.12±2.36)s]及对照组[(9.05±2.34)mm/5min、(8.13±2.14)s](均P>0.05);氯替泼诺组FL(2.06±0.38)分低于环孢素组(2.44±0.32)分(P<0.05);氯替泼诺组泪液中MDA、LPO水平[(2.39±0.35)U/L、(1.03±0.12)μmol/L]低于环孢素组[(3.67±0.32)U/L、(1.19±0.14)μmol/L]及对照组[(4.25±0.41)U/L、(1.76±0.15)μmol/L],泪液中SOD、TAC水平[(0.21±0.04)mmol/L、(15.74±3.08)kU/L]高于环孢素组[(0.18±0.03)mmol/L、(13.12±3.11)kU/L]及对照组[(0.14±0.02)mmol/L、(9.63±2.61)kU/L](均P<0.05);氯替泼诺组、环孢素组、对照组不良反应发生率分别为7.32%(3/41)、9.76%(4/41)、4.88%(2/41),三组间比较差异无统计学意义(P>0.05)。结论采用氯替泼诺与环孢素分别联合玻璃酸钠治疗白内障术后中重度干眼均具有一定效果,而氯替泼诺与玻璃酸钠联合治疗方案效果更好。

Objective To study the effects of combination therapy with sodium hyaluronate eye drops for moderate to severe dry eyes after cataract surgery.Methods This was a prospective random control study.A total of 123 eyes of 123 patients with moderate to severe dry eyes after cataract surgery admitted to Anyang District Hospital in Puyang City from May 2021 to Feb.2022 were included.The patients were divided into the control group with 41 cases(41 eyes),the cyclosporin group with 41 cases(41 eyes),and the loteprednol group with 41 cases(41 eyes)based on random number table method.The control group was treated with sodium hyaluronate eye drops only,the cyclosporin group was treated with cyclosporin combined with sodium hyaluronate eye drops,and the loteprednol group was treated with loteprednol combined with sodium hyaluronate eye drops.They were followed up for 1 month after treatment.Dry eye symptom scores,ocular surface disease index(OSDI)scores,best corrected visual acuity(logMAR),eye surface function indicators[schirmerⅠtest(SIt),break-up time of tear film(BUT),fluorescence staining(FL)score],and levels of oxidative stress factors in tears[malondialdehyde(MDA),superoxide dismutase(SOD),lipid peroxide(LPO),and total antioxidant capacity(TAC)]among the three groups were compared before and at 1 month after treatment,along with the incidence of adverse reactions(elevated intraocular pressure,foreign body sensation,and eyelid congestion).Results At 1 month after treatment,the total clinical effective rates of the loteprednol group and the cyclosporine group were 97.56%(40/41)and 92.68%(38/41),respectively,which were higher than the 73.17%(30/41)of the control group(all P<0.05);the dry eye symptom score and OSDI score[(0.74±0.25)scores,(20.11±3.47)scores]of the loteprednol group were lower than those of the cyclosporine group[(0.97±0.24)scores,(24.43±3.69)scores]and the control group[(1.76±0.33)scores,(29.67±3.15)scores],and the best corrected visual acuity(0.15±0.03)was higher than that of the cyclosporine group(0.17±0.10)and the control group(0.22±0.05)(P<0.05);The SIt and BUT of the loteprednol group[(15.22±3.11)mm/5 min,(13.04±2.47)s]were higher than those of the cyclosporine group[(12.14±2.73)mm/5 min,(11.12±2.36)s]and the control group[(9.05±2.34)mm/5 min,(8.13±2.14)s](all P>0.05).The FL score of the loteprednol group[(2.06±0.38)scores]were lower than that of the cyclosporine group[(2.44±0.32)scores].The levels of MDA and LPO in tear fluid of the cyclosporin group[(2.39±0.35)U/L,(1.03±0.12)μmol/L]were lower than those of the cyclosporine group[(3.67±0.32)U/L,(1.19±0.14)μmol/L]and the control group[(4.25±0.41)U/L,(1.76±0.15)μmol/L],and the levels of SOD and TAC in tears[(0.21±0.04)mmol/L,(15.74±3.08)kU/L]were higher than those of the cyclosporine group[(0.18±0.03)mmol/L,(13.12±3.11)kU/L]and the control group[(0.14±0.02)mmol/L,(9.63±2.61)kU/L](all P<0.05).The incidence rates of adverse reactions in the loteprednol group,the cyclosporin group,and the control group were 7.32%(3/41),9.76%(4/41),and 4.88%(2/41),respectively.There was no statistically significant difference among the groups(P>0.05).Conclusion The combination of clopidogrel and cyclosporine,combined with sodium hyaluronate,has a certain effect on the treatment of moderate to severe dry eyes after cataract surgery,while the combination of clopidogrel and sodium hyaluronate has a better effect.