玻璃酸钠滴眼液对PDR患者玻璃体切除术后眼表的保护作用
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摘要
目的:观察1g/L玻璃酸钠滴眼液对行20G闭合式玻璃体切除手术(PPV)的增殖性糖尿病视网膜病变(proliferation diabetic retinopathy,PDR)患者眼表的保护作用。方法:采用随机单盲病例对照研究。选取因PDR在西安市第四医院眼科住院并由同一术者行20G PPV手术的2型糖尿病患者,随机分为PDR对照组(A组)及玻璃酸钠治疗组(B组),B组在手术后第1d即加用1g/L玻璃酸钠滴眼液持续滴术眼至术后2mo,比较两组在术前、术后1wk,1、3mo OSDI、SⅠt、BUT、角膜荧光素染色(fluorescein cornea staining,FL)及角膜共焦显微镜下泪膜、角膜上皮细胞层情况。结果:共90例90眼参与研究,其中A组45眼,B组45眼。两组术前均有干眼表现,组间比较差异无统计学意义(P>0. 05)。A组眼表损伤在术后进一步加重并且在观察期未能随时间延长恢复; B组术后不同观察时间部分指标较术前好转,术后A、B两组差异显著(P<0. 05)。结论:并发PDR的2型糖尿病患者接受20G PPV手术后联合使用1g/L玻璃酸钠滴眼液能够减轻患眼眼表不适症状,促进泪膜及角膜上皮层修复。
AIM: To observe the clinical therapeutic efficiency of 1 g/L sodium hyaluronate eye drops on ocular surface disorders in patients with proliferative diabetic retinopathy( PDR) after 20 G pars plana vitrectomy( PPV).METHODS: Randomized single blind case control study was used.Patients with type 2 diabetes who were admitted to the department of ophthalmology,Xi'an No. 4 Hospital for PDR and underwent 20 G PPV surgery by the same surgeon were randomly divided into PDR control group( Group A) and sodium hyaluronate treatment group( Group B). Group B received continuous 1 g/L sodium hyaluronate eye drops from 1 d to 2 mo after surgery. Before and 1 wk,1,3 mo after surgery,OSDI,SⅠt,BUT,fluorescein cornea staining( FL)and the tear film and corneal epithelial cell layer under corneal laser scanning confocal microscopy of the two groups were compared.RESULTS: A total of 90 cases and 90 eyes were studied. In preoperative time,the two groups showed obvious dry eye syndrome,and compared with the control subjects,there were no significant difference existed between the two groups( P > 0. 05). In group A,ocular surface injury was further aggravated after surgery and failed to recover with time extension during the observation period. Some indexes of Group B improved at different observation time after surgery compared with those before surgery, and there were significant differences between group A and Group B after surgery( P<0.05).CONCLUSION: Applying 1 g/L sodium hyaluronate eye drops could relief the uncomfortable feeling of ocular surface in patients with PDR after 20 G vitrectomy and accelerate the recovery of ocular surface disorders.
AIM: To observe the clinical therapeutic efficiency of 1 g/L sodium hyaluronate eye drops on ocular surface disorders in patients with proliferative diabetic retinopathy( PDR) after 20 G pars plana vitrectomy( PPV).METHODS: Randomized single blind case control study was used.Patients with type 2 diabetes who were admitted to the department of ophthalmology,Xi'an No. 4 Hospital for PDR and underwent 20 G PPV surgery by the same surgeon were randomly divided into PDR control group( Group A) and sodium hyaluronate treatment group( Group B). Group B received continuous 1 g/L sodium hyaluronate eye drops from 1 d to 2 mo after surgery. Before and 1 wk,1,3 mo after surgery,OSDI,SⅠt,BUT,fluorescein cornea staining( FL)and the tear film and corneal epithelial cell layer under corneal laser scanning confocal microscopy of the two groups were compared.RESULTS: A total of 90 cases and 90 eyes were studied. In preoperative time,the two groups showed obvious dry eye syndrome,and compared with the control subjects,there were no significant difference existed between the two groups( P > 0. 05). In group A,ocular surface injury was further aggravated after surgery and failed to recover with time extension during the observation period. Some indexes of Group B improved at different observation time after surgery compared with those before surgery, and there were significant differences between group A and Group B after surgery( P<0.05).CONCLUSION: Applying 1 g/L sodium hyaluronate eye drops could relief the uncomfortable feeling of ocular surface in patients with PDR after 20 G vitrectomy and accelerate the recovery of ocular surface disorders.
引文
1 Zhang X,Zhao L,Deng S,et al.Dry Eye Syndrome in Patients with Diabetes Mellitus:Prevalence,Etiology,and Clinical Characteristics.JOphthalmol 2016;2016:8201053
2 Manaviat MR,Rashidi M,Afkhami-Ardekani M,et al.Prevalence of dry eye syndrome and diabetic retinopathy in type 2 diabetic patients.BMCOphthalmol 2008;8:10
3 Hom M,De Land P.Self-reported dry eyes and diabetic history.Optometry 2006;77(11):554-558
4 Stevenson W,Chauhan SK,Dana R.Dry eye disease:an immunemediated ocular surface disorder.Arch Ophthalmol 2012;130(1):90
5 Li B,Sheng M,Xie L,et al.Tear proteomic analysis of patients with type 2 diabetes and dry eye syndrome by two-dimensional nano-liquid chromatography coupled with tandem mass spectrometry.Invest Ophthalmol Vis Sci 2014;55(1):177-186
6 Fuerst N,Langelier N,Massarogiordano M,et al.Tear osmolarity and dry eye symptoms in diabetics.Clin Ophthalmol 2014;8(default):507
7 Inoue K,Kato S,Ohara C,et al.Ocular and systemic factors relevant to diabetic keratoepitheliopathy.Cornea 2001;20(8):798-801
8雷春灵,张妍春,宋虎平,等.20G闭合式玻璃体视网膜手术对PDR患者眼表的影响.中国实用眼科杂志2017;35(11):1057-1062
9中华医学会眼科学分会角膜病学组.干眼临床诊疗专家共识(2013年).中华眼科杂志2013;49(1):73-75
10 Murphy RP,Ferris FL,ETDRS Research Group.Photocoagulation for Diabetic Macular EDEMA:Results of the Early Treatment Diabetic Retinopathy Study.Contemporary Ophthalmic Forum 1986;2:25-31
11 Michael A,Lemp GNF.The Definition and Classification of Dry Eye Disease.Ophthalmol Management 2008;12(4):55-56,58-59
12张梅,陈家祺,刘祖国,等.干眼患者115例的临床特点分析.中华眼科杂志2003;39(1):5-9
13 Stonecipher KG,Green PT.Non-contact confocal microscopy of the tear film in unoperated eyes.J Refract Surg 2007;23(4):417-419
14 Heimann H,Coupland SE,Gochman R,et al.Alterations in expression of mucin,tenascin-c and syndecan-1 in the conjunctiva following retinal surgery and plaque radiotherapy.Graefes Arch Clin Exp Ophthalmol 2001;239(7):488-495
15 Yang CQ,Wen S,Yang-Shun GU.A clinical study of the efficacy of topical corticosteroids on dry eye.J Zhejiang Univ Sci B 2006;7(8):675-678
16 Sayin N,Kara N,Pekel GK.Ocular complications of diabetes mellitus.World J Diabetes 2015;6(1):92-108
17 Young AL,Cheng AC,Ng HK,et al.The use of autologous serum tears in persistent corneal epithelial defects.Eye(Lond)2005;18(6):609-614
18 Colligris B,Alkozi HA,Pintor J.Recent developments on dry eye disease treatment compounds.Saudi J Ophthalmol 2014;28(1):19-30
19叶兴桥.干眼的治疗进展.中国实用眼科杂志2011;29(8):761-762
20 Johnson ME,Murphy PJ.Changes in the tear film and ocular surface from dry eye syndrome.Prog Retin Eye Res 2004;23(4):449-474
21 Shimmura S,Ono M,Shinozaki K,et al.Sodium hyaluronate eyedrops in the treatment of dry eyes.Br J Ophthalmol 1995;79(11):1007
22 Lee HS,Ji YS,Yoon KC.Efficacy of hypotonic 0.18%sodium hyaluronate eye drops in patients with dry eye disease.Cornea 2014;33(9):946
23 Aragona P,Di stefano G,Ferreri F,et al.Sodium hyaluronate eye drops of different osmolarity for the treatment of dry eye in Sj9gren's syndrome patients.Br J Ophthalmol 2002;86(8):879-884
24张斌,李威,何伟,等.玻璃酸钠滴眼液治疗青少年近视患者配戴硬性透气性角膜接触镜相关性干眼.国际眼科杂志2016;16(3):511-513
25林惠岳,李小静,林剑鸿,等.玻璃酸钠滴眼液联合普拉洛芬治疗青光眼术后干眼症的临床效果.中国当代医药2016;23(12):104-106
26 Debbasch C,Sb DLS,Brignole F,et al.Cytoprotective effects of hyaluronic acid and Carbomer 934P in ocular surface epithelial cells.Invest Ophthalmol Vis Sci 2002;43(11):3409-3415
27梁冬梅,王强,李国良,等.人工泪液凝胶联合双氯芬酸钠滴眼液治疗干眼症观察.中国实用眼科杂志2013;31(11):1445-1447
28王金铎,曹向荣,付学玲.普拉洛芬联合玻璃酸钠滴眼液对白内障超声乳化术后干眼的干预观察.中国实用眼科杂志2016;34(1):24-26
29 Chen J,Dong F,Chen W,et al.Clinical efficacy of 0.1%pranoprofen in treatment of dry eye patients:a multicenter,randomized,controlled clinical trial.Chin Med J 2014;127(13):2407-2412
2 Manaviat MR,Rashidi M,Afkhami-Ardekani M,et al.Prevalence of dry eye syndrome and diabetic retinopathy in type 2 diabetic patients.BMCOphthalmol 2008;8:10
3 Hom M,De Land P.Self-reported dry eyes and diabetic history.Optometry 2006;77(11):554-558
4 Stevenson W,Chauhan SK,Dana R.Dry eye disease:an immunemediated ocular surface disorder.Arch Ophthalmol 2012;130(1):90
5 Li B,Sheng M,Xie L,et al.Tear proteomic analysis of patients with type 2 diabetes and dry eye syndrome by two-dimensional nano-liquid chromatography coupled with tandem mass spectrometry.Invest Ophthalmol Vis Sci 2014;55(1):177-186
6 Fuerst N,Langelier N,Massarogiordano M,et al.Tear osmolarity and dry eye symptoms in diabetics.Clin Ophthalmol 2014;8(default):507
7 Inoue K,Kato S,Ohara C,et al.Ocular and systemic factors relevant to diabetic keratoepitheliopathy.Cornea 2001;20(8):798-801
8雷春灵,张妍春,宋虎平,等.20G闭合式玻璃体视网膜手术对PDR患者眼表的影响.中国实用眼科杂志2017;35(11):1057-1062
9中华医学会眼科学分会角膜病学组.干眼临床诊疗专家共识(2013年).中华眼科杂志2013;49(1):73-75
10 Murphy RP,Ferris FL,ETDRS Research Group.Photocoagulation for Diabetic Macular EDEMA:Results of the Early Treatment Diabetic Retinopathy Study.Contemporary Ophthalmic Forum 1986;2:25-31
11 Michael A,Lemp GNF.The Definition and Classification of Dry Eye Disease.Ophthalmol Management 2008;12(4):55-56,58-59
12张梅,陈家祺,刘祖国,等.干眼患者115例的临床特点分析.中华眼科杂志2003;39(1):5-9
13 Stonecipher KG,Green PT.Non-contact confocal microscopy of the tear film in unoperated eyes.J Refract Surg 2007;23(4):417-419
14 Heimann H,Coupland SE,Gochman R,et al.Alterations in expression of mucin,tenascin-c and syndecan-1 in the conjunctiva following retinal surgery and plaque radiotherapy.Graefes Arch Clin Exp Ophthalmol 2001;239(7):488-495
15 Yang CQ,Wen S,Yang-Shun GU.A clinical study of the efficacy of topical corticosteroids on dry eye.J Zhejiang Univ Sci B 2006;7(8):675-678
16 Sayin N,Kara N,Pekel GK.Ocular complications of diabetes mellitus.World J Diabetes 2015;6(1):92-108
17 Young AL,Cheng AC,Ng HK,et al.The use of autologous serum tears in persistent corneal epithelial defects.Eye(Lond)2005;18(6):609-614
18 Colligris B,Alkozi HA,Pintor J.Recent developments on dry eye disease treatment compounds.Saudi J Ophthalmol 2014;28(1):19-30
19叶兴桥.干眼的治疗进展.中国实用眼科杂志2011;29(8):761-762
20 Johnson ME,Murphy PJ.Changes in the tear film and ocular surface from dry eye syndrome.Prog Retin Eye Res 2004;23(4):449-474
21 Shimmura S,Ono M,Shinozaki K,et al.Sodium hyaluronate eyedrops in the treatment of dry eyes.Br J Ophthalmol 1995;79(11):1007
22 Lee HS,Ji YS,Yoon KC.Efficacy of hypotonic 0.18%sodium hyaluronate eye drops in patients with dry eye disease.Cornea 2014;33(9):946
23 Aragona P,Di stefano G,Ferreri F,et al.Sodium hyaluronate eye drops of different osmolarity for the treatment of dry eye in Sj9gren's syndrome patients.Br J Ophthalmol 2002;86(8):879-884
24张斌,李威,何伟,等.玻璃酸钠滴眼液治疗青少年近视患者配戴硬性透气性角膜接触镜相关性干眼.国际眼科杂志2016;16(3):511-513
25林惠岳,李小静,林剑鸿,等.玻璃酸钠滴眼液联合普拉洛芬治疗青光眼术后干眼症的临床效果.中国当代医药2016;23(12):104-106
26 Debbasch C,Sb DLS,Brignole F,et al.Cytoprotective effects of hyaluronic acid and Carbomer 934P in ocular surface epithelial cells.Invest Ophthalmol Vis Sci 2002;43(11):3409-3415
27梁冬梅,王强,李国良,等.人工泪液凝胶联合双氯芬酸钠滴眼液治疗干眼症观察.中国实用眼科杂志2013;31(11):1445-1447
28王金铎,曹向荣,付学玲.普拉洛芬联合玻璃酸钠滴眼液对白内障超声乳化术后干眼的干预观察.中国实用眼科杂志2016;34(1):24-26
29 Chen J,Dong F,Chen W,et al.Clinical efficacy of 0.1%pranoprofen in treatment of dry eye patients:a multicenter,randomized,controlled clinical trial.Chin Med J 2014;127(13):2407-2412