溴芬酸钠滴眼液在先天性白内障围手术期中的应用研究

Application of Bromfenac Sodium Eye Drops in Perioperative Period of Congenital Cataracts

目的评估在先天性白内障围手术期使用溴芬酸钠滴眼液对减少术后短期炎症和高眼压的作用。方法前瞻性随机对照研究。选取2016年4月～2017年4月就诊于中山大学中山眼科中心拟行白内障手术并符合入选标准的先天性白内障患儿分为研究组25例(34眼)及对照组29例(35眼)。对照组术后使用妥布霉素地塞米松滴眼液及眼膏,研究组术前术后联合使用溴芬酸钠滴眼液,同时减少妥布霉素地塞米松用量。通过观察两组术前、术后1周、术后1个月的炎症反应、角膜水肿、眼压和后发性白内障等并发症的组间对比(独立样本t检验),比较两组用药方案的疗效。结果本研究共纳入54例患儿,其中研究组25例,对照组29例。研究组和对照组患儿的眼压(13.44±2.84及14.54±3.01 mm Hg,P=0.123)和中央角膜厚度(554.88±49.42及576.91±49.08μm,P=0.068)在术前差异无统计学意义。术后1周时,两组患儿眼压和中央角膜厚度均较术前明显上升,在术后1月下降。术后中央角膜厚度的变化差异无统计学意义。术后1周时,研究组眼压低于对照组(15.11±5.18及18.70±8.92 mm Hg,P=0.045)。研究组和对照组在术后1周的高眼压患者(> 21 mm Hg)比例分别为8.82%(3/34)和20.0%(7/35);术后1月的高眼压患者比例分别为2.94%(1/34)和5.71%(2/35)。研究组在术后的炎症反应和后发性白内障总分均低于对照组。结论先天性白内障围手术期使用溴芬酸钠滴眼液可以有效降低术后炎症和并发症,是一种合理有效的用药方案。

OBJECTIVE To evaluate the effect of bromfenac sodium eye drops on postoperative short-term inflammation and ocular hypertension in patients with congenital cataract. METHODS A prospective randomized controlled study. From April 2016 to April 2017,54 children with congenital cataract from the Zhongshan Ophthalmic Center for cataract surgery were randomly divide into study group( 24 cases with 34 eyes) and control group( 29 cases with 35 eyes). In the control group,Tobramycin,Dexamethasone Ophthalmic Suspension and eye ointment were used after operation. The study group combined with bromfenac sodium eye drops before and after operation,and reduced the amount of tobramycin dexamethasone. The effects were compared between the two groups of complications such as inflammation,corneal edema,intraocular pressure,and posterior onset cataract( independent sample t test) before and after the operation,one week after operation,and one month after the operation. RESULTS There was no significant difference in intraocular pressure( 13.44± 2. 84 VS. 14. 54 ± 3. 01 mmHg,P = 0. 123) and central corneal thickness( 554. 88 ± 49. 42 VS. 576. 91 ±49.08 μm,P = 0. 068) between the study group and the control group before operation. At one week after operation,the intraocular pressure and central corneal thickness of the two groups increased significantly compared with those before operation,and decreased in one month after operation. There was no difference in central corneal thickness after surgery. One week after surgery,the intraocular pressure of the study group was lower than that of the control group( 15.11±5.18 VS. 18.70±8.92 mm Hg,P = 0.045). The proportion of patients with high intraocular pressure( >21 mm Hg) in the study group and the control group was 8.82%( 3/34) vs. 20%( 7/35),respectively,and 2.94%( 1/34) vs. 5. 71%( 2/35) after one month after operation,respectively. The total scores of inflammatory reaction and posterior capsule cataract in the study group were lower than those in the control group. CONCLUSION Bromfenac sodium eye drops during perioperative period of congenital cataract can effectively reduce postoperative inflammation and complications.It is a rational and effective medication regimen.