四种常见人工泪液对白内障术后干眼患者泪液动力学变化影响的差异

摘要

目的 利用眼前节光学相干断层扫描仪(optical coherence tomography,OCT)探讨四种常见人工泪液对白内障超声乳化术后干眼患者泪液动力学变化影响的差异.方法 将白内障术后有干眼症状40人(40眼)随机分为A、B、C、D四组,A组(10眼)使用羟糖甘滴眼液,B组(10眼)使用聚乙二醇滴眼液,C组(10眼)使用羧甲基纤维素钠滴眼液,D组(10眼)使用玻璃酸钠滴眼液.使用眼前节OCT动态比较四组患者使用滴眼液前和使用后不同时间总泪新月的变化,并比较四组组内及组间的差异.结果 白内障术后有干眼症状患者平均下泪新月面积约为11358±4026 μm,较正常老年人有减少.组内比较:A组和B组在使用滴眼液后0 min、10 min、20 min、30 min、45 min总泪新月面积均大于使用前,且差异均有统计学意义(P＜ 0.05);C组和D组在使用滴眼液后0 min、10 min总泪新月面积大于使用前,且差异均有统计学意义(P＜0.05).组间比较:使用滴眼液后10 min,B组总泪新月面积大于C组和D组,差异均有统计学意义(P＜0.05);使用滴眼液后20 min,A组和B组总泪新月面积均大于C组及D组,且差异均有统计学意义(P＜0.05);使用滴眼液后30 min,A组泪新月面积大于D组,差异有统计学意义(P =0.026),B组泪新月面积大于C组及D组,差异均有统计学意义(P＜0.005);使用滴眼液后45 min,B组泪新月面积大于C组及D组,差异均有统计学意义(P ＜0.005);到60 min四组间已无统计学差异.结论 聚乙二醇滴眼液和羟糖甘滴眼液在治疗白内障术后干眼方面优于羧甲基纤维素钠滴眼液及玻璃酸钠滴眼液,推荐使用频率为l小时一次.%Objective To study the difference of the tear film changes of four types artificial tear in treatment of dry eye after phacoemulsification by spectral-domain OCT (SD-OCT).Methods This clinical study included 40 patients (40 eyes) having dry eye after phacoemulsification,10 patients used Tears Naturale Forte Eye Drops (group A),10 patients used Polyethylene Glycol Eye Drops (group B),l0 patients used Sodium Hyaluronate Eye Drops (group C),l0 patients used Carboxxymethylcellulose Sodium Eye Drop (group D).Total tear meniscus area (TTMA) was measured before and at differeat times after treatment.Results In the group A and B,TTMA was statistically significantly (P ＜0.05) better than preoperatively at 0 minute,l0 minute,20 minute,30 minute and 45 minute.In the group C and D,TTMA was statistically significantly (P ＜0.05) better than preoperatively at 0 minute and 10 minute.Comparison among groups,at 10 minute,TTMA of group B was statistically significantly (P =0.020,P =0.011) better than group C and group D.At 20 minute TTMA of group A and group B was statistically significantly (P =0.006,P =0.005,P =0.004,P =0.003) better than group C and group D.Even at 45minute,TTMA of group B was statistically significantly (P =0.040,P =0.016) better than group C and group D.Conclusions Polyethylene Glycol Eye Drops and Tears Naturale Forte Eye Drops are better in treatment of dry eye after phacoemulsification,and qlh is recommended.