环孢霉素A离子导入治疗干眼症的临床研究

Clinical study of cyclosporine A iontophoresis for the treatment of dry eyes

目的探讨环孢霉素A离子导入治疗干眼症的临床疗效。方法选取深圳市南山区西丽人民医院2010年1月-2013年1月门诊收治的按照国际干眼症研究组(DEWS)标准分级为2、3级干眼病患者100例(200只眼),按级分层后随机分为两组:对照组100只眼予以0.22%卡波姆眼用凝胶治疗,4~6次/d;观察组100只眼在对照组治疗基础上给予环孢霉素A离子导入治疗。观察治疗前及治疗2、4、6、8周后患者的自觉症状、角膜荧光素染色(FL)、眼表炎症体征、泪膜破裂时间(BUT)、Sehirmer I试验(SIt)及眼压,并在治疗前及治疗后第8周行结膜印迹细胞检测。结果治疗后2周两组患者不适主诉较治疗前均明显好转,症状总分平均值明显降低,两组治疗4、6、8周后分别与其治疗前及治疗2周后总分平均值之间比较,差异有统计学意义(P<0.05);治疗2、4、6周后观察组较对照组症状总分平均值低,差异有统计学意义(P<0.05)。观察组治疗8周后、对照组治疗6周后较治疗前平均BUT延长,差异有统计学意义(P<0.05)。观察组和对照组治疗8周后,平均杯状细胞密度分别为(348.6±22.5)和(360.4±27.8)个/mm2,与治疗前比较差异有统计学意义(P<0.05)。结论环孢霉素A离子导入治疗能够明显减轻干眼结膜炎症,降低了滴眼剂的眼表毒性反应。

Objective To evaluate the clinical efficacy of cyclosporine A iontophoresis treatment of dry eye.Methods According to international dry eye Study Group(DEWS) standard rating,patients(200eyes) with 2,3-grade dry eyes were selected from Xili People's Hospital of Shenzhen Nanshan District from January 2010 to January 2013,and they were randomly divided into two groups.The control group of 100 eyes were treated with 0.22% carbomer eye gel,4 to 6 times per day; the observation group of 100 eyes were treated wth cyclosporin A iontophoresis on the basis of the control group.Symptoms,corneal fluorescein staining(FL),ocular inflammation signs,tear film break-up time(BUT),Sehirmer I test(SIt) and intraocular pressure,conjunctival impression cytology were observed and measured before and after treatment.Results After 2 weeks of treatment,complains of discomfort in two group were significantly improved compared with before treatment,and the average symptom scores decreased significantly.The average scores of the two groups after 4,6,8 weeks treatment were statistically lower than before treatment and after 2 weeks treatment(P<0.05).There were differences between the observation group and the control group after 2,4,6 weeks treatment(P<0.05).Compared with before treatment,BUT extended significantly in the observation group after 8 weeks treatment and in the control group after 6 weeks treatment(P<0.05).After 8 weeks treatment,the average goblet cell density in the observation group and control group was(348.6 ± 22.5) and(360.4 ±27.8) cells/mm2,both them were statistically significant with those before treatment(P<0.05).Conclu-sions Cyclosporine A iontophoresis therapy can significantly reduce the symptoms of dry eye conjunctivitis and ocular toxicity of eye drops.