角膜保护剂对白内障术后干眼的影响

摘要

目的 研究白内障术中应用角膜保护剂对术后干眼的影响.方法 前瞻性病例对照研究.将79例(90眼)入组患者随机分为Croma角膜保护剂组、平衡盐溶液(BSS)组、国产眼用羟丙基甲基纤维素(HPMC)组,术前及术后1、7、30 d检查泪膜客观散射指数(OSI)、泪膜破裂时间(BUT)、角膜荧光染色(CFS)、SchirmerⅠ 试验(SIt)、主观眼表疾病指数(OSDI).采用方差分析或Kruskal-Wallis秩和检验对数据进行分析.结果 3组间OSI、SIt在术后1、7、30 d差异均有统计学意义(P<0.05);两两比较显示,术后1、7、30 d BSS组OSI高于Croma组而SIt低于Croma组(P<0.05);术后7、30 d HPMC组SIt值低于Croma组(P<0.05).3组各指标整体变化趋势相同;3组BUT变化差异均有统计学意义(P<0.05);BSS组术后各时间点SIt一直较术前差异有统计学意义(P<0.05),术后1 d OSI变化幅度(OSI-A)明显增加(P<0.05),术后7 d OSDI较大幅度上升(P<0.05),术后30 d CFS与术前差异有统计学意义(P<0.05);HPMC组术后1 d SIt及OSI-A均有明显变化(P<0.05),而Croma组则始终变化曲线平缓,术后HPMC组与Croma组CFS和OSDI改变差异均无统计学意义.结论Croma角膜保护剂与国产眼用HPMC对于缓解白内障术后干眼有一定效果:术后泪液及角膜上皮的改变、主观不适较少,且Croma角膜保护剂的效果更显著.%Objective To compare the effects of intraoperative corneal wetting by Croma, balanced salt solution (BSS), and hydroxypropyl methylcellulose (HPMC) on xerophthalmia after cataract surgery. Methods This prospective study included 79 patients (90 eyes) who were randomly assigned to a Croma corneal wetting properties group, balanced salt solution (BSS) group, or domestic hydroxypropyl methylcellulose (HPMC) group. Croma is a ophthalmological product to protect corneal epithelium, whose main ingredients is 2%HPMC. The solutions were applied to the ocular surface during the surgery to keep it moist. The following were measure pre-operatively and at 1, 7, and 30 days after cataract surgery, and the effect of each solution was assessed: objective scatter index (OSI) and the amplitude of OSI (OSI-A), tear break-up time (BUT), corneal fluorescein staining (CFS), Schirmer Ⅰ test (SIt), and the ocular surface disease index (OSDI) questionnaire scores. Data were analyzed by repeated ANOVA or Kruskal-Wallis test. Results There were significant differences for OSI and SIt among the three groups (P<0.05). For OSI and SIt, the Croma group had significantly better results than the BSS group at post-operative days 1, 7, and 30 (all P<0.05). The Croma group had significantly higher SIt scores for tear secretion than the HPMC group at 7 and 30 days after surgery (P<0.05). Similar changes in trends were discovered with repeated measures analysis. BUT of the three groups all declined and revealed a significant difference among the pre- and post-operative (P<0.05). For the BSS group, several of the measured parameters were worse than the pre-operative values. On post-surgical day 1, SIt and OSI-A were worse (P<0.05 each), subjective complaints were worse on day 7 (P<0.05), and CFS was worse on day 30 (P<0.001). In the HPMC group, SIt and OSI-A increased significantly on post-operative day 1 (P<0.05). In the Croma group, and there was a slight increase in OSI-A and SIt at the same time. Neither CFS nor OSDI scores increased for either the HPMC or the Croma groups. Conclusion Both Croma corneal wetting properties and domestic HPMC were more beneficial than BSS for alleviating xerophthalmia after cataract surgery. The reduction of tear secretion and the increase in corneal epithelial staining were smaller in the Croma group than in the HPMC and BSS groups, and patients had less discomfort. Therefore, the Croma corneal wetting properties were significantly better than the others.