维生素A棕榈酸酯眼用凝胶联合羧甲基纤维素钠对白内障术后干眼的预防
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摘要
目的:探讨维生素A棕榈酸酯眼用凝胶联合羧甲基纤维素钠对白内障超声乳化联合人工晶状体植入术后干眼的预防效果。方法:选取2016-03/2017-08在我院行白内障超声乳化联合人工晶状体植入手术的年龄相关性白内障患者90例90眼,随机分为三组:对照组予以妥布霉素地塞米松滴眼液15d;治疗Ⅰ组,在对照组治疗基础上予以羧甲基纤维素钠滴眼液30d;治疗Ⅱ组,在治疗Ⅰ组基础上予以维生素A棕榈酸酯眼用凝胶30d。分别于术前1d和术后15、30d进行干眼主观症状评分、泪膜破裂时间(BUT)检查、角膜荧光素染色(FL)和泪液分泌试验(SⅠt)。结果:术前1d,三组患者干眼主观症状评分、BUT值、FL评分和SⅠt值差异均无统计学意义(P>0.05)。干预后,各组患者干眼主观症状评分、FL评分和SⅠt值随时间延长均呈先升高后降低趋势,BUT值呈先降低后升高趋势。术后15、30d,治疗Ⅰ组和治疗Ⅱ组患者干眼主观症状评分、FL评分和SⅠt值均显著低于对照组,BUT值均明显高于对照组,且治疗Ⅱ组干眼主观症状评分和SⅠt值均明显低于治疗Ⅰ组,BUT值明显高于治疗Ⅰ组,差异均具有统计学意义(P<0.05)。结论:白内障超声乳化联合人工晶状体植入术后初期存在一定程度眼表组织损伤,局部应用维生素A棕榈酸酯眼用凝胶联合羧甲基纤维素钠滴眼液可有效改善患者眼表情况及干眼临床症状。
AIM : To observe the efficacy of vitamin A palmitate eye gel and carboxymethylcellulose sodium eye drops on prevention of dry eye after phacoemulsification.· METHODS: Ninety patients(ninety eyes) with agerelated cataract enrolled in our hospital from March 2016 to August 2017 were performed phacoemulsification with intraocular lens implantation. They were randomly divided into three groups as control group(n = 30),treated group Ⅰ(n = 30) and treated group II(n = 30).The control group was administered with tobramycin and dexamethasone eye drops for 15 d as the basis therapy. In treated group Ⅰ, patients were administered with carboxymethylcellulose sodium eye drops for 30 d based on the treatment of the control group. The treated group II was administered with vitamin A palm itate eye gel for30 d on the basis of the treated groupⅠ. The dry eye symptom score, corneal fluorescence( FL) staining scores, breakup time of tear film(BUT) and Schirmer I test(SIt) without topical anesthesia were examined in1 d before operation and 15 d and 30 d after operation.· RESULTS: There were no statistically significant differences in subjective symptom scores of dry eye, BUT values, FL scores, and S I t values among the three groups before treatment(P>0. 05). After treatment, dry eye symptom scores, FL scores, and S I t values increased at first and then decreased with time. BUT values decreased at first and then increased-Fifteen and thirty days after surgery, dry eye symptom scores, FL scores,and S Ⅰ t values were significantly lower in the treated group Ⅰ and the treated group Ⅱ than in the control group. While BUT values were significantly higher than that in the control group. The dry eye symptom scores and S Ⅰ t value of treated group Ⅱ were significantly lower than the treated group Ⅰ,and the BUT value was significantly higher than that of the treated group Ⅰ(P<0.05).· CONCLUSION: Phacoemulsification combined with intraocular lens implantation has a certain damage of ocular surface tissue on the initial stage. The application of vitamin A palmitate eye gel combined carboxymethylcellulose sodium eye drops can improve the dry eye symptoms.
AIM : To observe the efficacy of vitamin A palmitate eye gel and carboxymethylcellulose sodium eye drops on prevention of dry eye after phacoemulsification.· METHODS: Ninety patients(ninety eyes) with agerelated cataract enrolled in our hospital from March 2016 to August 2017 were performed phacoemulsification with intraocular lens implantation. They were randomly divided into three groups as control group(n = 30),treated group Ⅰ(n = 30) and treated group II(n = 30).The control group was administered with tobramycin and dexamethasone eye drops for 15 d as the basis therapy. In treated group Ⅰ, patients were administered with carboxymethylcellulose sodium eye drops for 30 d based on the treatment of the control group. The treated group II was administered with vitamin A palm itate eye gel for30 d on the basis of the treated groupⅠ. The dry eye symptom score, corneal fluorescence( FL) staining scores, breakup time of tear film(BUT) and Schirmer I test(SIt) without topical anesthesia were examined in1 d before operation and 15 d and 30 d after operation.· RESULTS: There were no statistically significant differences in subjective symptom scores of dry eye, BUT values, FL scores, and S I t values among the three groups before treatment(P>0. 05). After treatment, dry eye symptom scores, FL scores, and S I t values increased at first and then decreased with time. BUT values decreased at first and then increased-Fifteen and thirty days after surgery, dry eye symptom scores, FL scores,and S Ⅰ t values were significantly lower in the treated group Ⅰ and the treated group Ⅱ than in the control group. While BUT values were significantly higher than that in the control group. The dry eye symptom scores and S Ⅰ t value of treated group Ⅱ were significantly lower than the treated group Ⅰ,and the BUT value was significantly higher than that of the treated group Ⅰ(P<0.05).· CONCLUSION: Phacoemulsification combined with intraocular lens implantation has a certain damage of ocular surface tissue on the initial stage. The application of vitamin A palmitate eye gel combined carboxymethylcellulose sodium eye drops can improve the dry eye symptoms.
引文
1 Ianehenko SV,Sakhnov SN,Malvshev AV,et al.Treatment of chronic allergic blepharoconjunetivitis.Vestn Oftalmol 2014;130(5):80-84
2 李佳佳,陈彬川,帖红艳,等.白内障超声乳化吸出联合人工晶状体植入术高危因素临床分析.眼科新进展2014;34(5):448-450
3 Movahedan A,Djalilian AR.Cataract surgery in the face of ocular surface disease.Curr Opin Ophthalmol 2012;23(1):68-72
4 Oh T,Jung Y,Chang D,et al.Changes in the tear film and ocular surface after cataract surgery.Jpn J Ophthalmol 2012;56(2):113-118
5 Khanal S,Tomlinson A,Esakowitz L,et al.Changes in corneal sensitivity and tear physiology after phacoemulsification.Ophthalmic Physiol Opt 2010;28(2):127-134
6 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
7 Macri A,Rolando M,Pflugfelder S.A standardized visual scale for evaluation of tear fluoresecein clearance.Ophthalmology 2000;107(7):1338-1343
8 Ke Y,Bao Y,Jian Y,et al.Efficacy of 1%carboxymethylcellulose sodium for treating dry eye after phacoemulsification:results from a multicenter,open-label,randomized,controlled study.BMC Ophthalmology 2015;15(1):1-10
9 Kasetsuwan N,Satitpitakul V,Changul T,et al.Incidence and pattern of dry eye after cataract surgery.Plo S One 2013;8(11):e78657
10 Sutu C,Fukuoka H,Afshari NA.Mechanisms and management of dry eye in cataract surgery patients.Curr Opin Ophthalmol 2016;27(1):24-30
11 Cho YK,Kim MS.Dry eye after cataract surgery and associated intraoperative risk factors.Korean J Ophtalmol 2009;23(2):65-73
12 Lemp MA.The definition and classification of dry eye disease:report of the Definition and Classification Subcommittee of the International Dry Eye Work Shop(2007).Ocul Surf 2007;5(2):75-92
13 Belmonte C,Acosta MC,Gallar J.Neural basis of sensation in intact and injured corneas.Exp Eye Res 2004;78(3):513-525
14 Cetinkaya S,Mestan E,Acir NO,et al.The course of dry eye after phacoemulsification surgery.BMC Ophthalmol 2015;15(1):68-72
15 Han KE,Yoon SC,Ahn JM,et al.Evaluation of dry eye and meibomian gland dysfunction after cataract surgery.Am J Ophthalmol2014;157(6):1144-1150
16 Foulks GN.Challenges and pitfalls in clinical trials of treatments for dry eye.Ocul Surf 2003;1(1):20-30
17 Lee JH,Ahn HS,Kim EK,et al.Efficacy of sodium hyaluronate and carboxymethylcellulose in treating mild to moderate dry eye disease.Cornea 2011;30(2):175-179
18 Simmons PA,Vehige JG.Clinical performance of a mid-viscosity artificial tear for dry eye treatment.Cornea 2007;26(3):294-302
19 Garrett Q,Simmons PA,Xu S,et al.Carboxymethylcellulose binds to human corneal epithelial cells and is a modulator of corneal epithelial wound healing.Invest Ophthalmol Vis Sci 2007;48(4):1559-1567
20 Baudouln C,de Lunardo C.Short-term comparative study of topica12 %carteolol with and without benzalkonium chloride in healthy volunteers.Br J Ophthalmol 1998;82(1):39-42
21 Kim EC,Choi JS,Joo CK.A comparison of vitamin a and cyclosporine a 0.05%eye drops for treatment of dry eye syndrome.Am J Ophthalmol2009;147(2):206-213
22 Toshida H,Tabuchi N,Koike D,et al.The effects of vitamin A compounds on hyaluronic acid released from cultured rabbit corneal epithelial cells and keratocytes.J Nutr Sci Vitaminol 2012;58(4):223-229
23 Tabuchi N,Toshida H,Koike D,et al.Effect of retinol palmitate on corneal and conjunctival mucin gene expression in a rat dry eye model after injury.J Ocul Pharmacol Ther 2017;33(1):24-33
24 Kubo Y,Arimura A,Nakayasu K,et al.Effect of vitamin A palmitate on the synthesis of mucins in cultured conjunctiva.Nippon Ganka Gakkai Zasshi 1999;103(8):580-583
25 Toshida H,Funaki T,Ono K,et al.Efficacy and safety of retinol palmitate ophthalmic solution in the treatment of dry eye:a Japanese Phase II clinical trial.Drug Des Devel Ther 2017;11:1871-1879
26 Baudouin C,LabbéA,Liang H,et al.Preservatives in eyedrops:the good,the bad and the ugly.Prog Retin Eye Res 2010;29(4):312-334
2 李佳佳,陈彬川,帖红艳,等.白内障超声乳化吸出联合人工晶状体植入术高危因素临床分析.眼科新进展2014;34(5):448-450
3 Movahedan A,Djalilian AR.Cataract surgery in the face of ocular surface disease.Curr Opin Ophthalmol 2012;23(1):68-72
4 Oh T,Jung Y,Chang D,et al.Changes in the tear film and ocular surface after cataract surgery.Jpn J Ophthalmol 2012;56(2):113-118
5 Khanal S,Tomlinson A,Esakowitz L,et al.Changes in corneal sensitivity and tear physiology after phacoemulsification.Ophthalmic Physiol Opt 2010;28(2):127-134
6 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
7 Macri A,Rolando M,Pflugfelder S.A standardized visual scale for evaluation of tear fluoresecein clearance.Ophthalmology 2000;107(7):1338-1343
8 Ke Y,Bao Y,Jian Y,et al.Efficacy of 1%carboxymethylcellulose sodium for treating dry eye after phacoemulsification:results from a multicenter,open-label,randomized,controlled study.BMC Ophthalmology 2015;15(1):1-10
9 Kasetsuwan N,Satitpitakul V,Changul T,et al.Incidence and pattern of dry eye after cataract surgery.Plo S One 2013;8(11):e78657
10 Sutu C,Fukuoka H,Afshari NA.Mechanisms and management of dry eye in cataract surgery patients.Curr Opin Ophthalmol 2016;27(1):24-30
11 Cho YK,Kim MS.Dry eye after cataract surgery and associated intraoperative risk factors.Korean J Ophtalmol 2009;23(2):65-73
12 Lemp MA.The definition and classification of dry eye disease:report of the Definition and Classification Subcommittee of the International Dry Eye Work Shop(2007).Ocul Surf 2007;5(2):75-92
13 Belmonte C,Acosta MC,Gallar J.Neural basis of sensation in intact and injured corneas.Exp Eye Res 2004;78(3):513-525
14 Cetinkaya S,Mestan E,Acir NO,et al.The course of dry eye after phacoemulsification surgery.BMC Ophthalmol 2015;15(1):68-72
15 Han KE,Yoon SC,Ahn JM,et al.Evaluation of dry eye and meibomian gland dysfunction after cataract surgery.Am J Ophthalmol2014;157(6):1144-1150
16 Foulks GN.Challenges and pitfalls in clinical trials of treatments for dry eye.Ocul Surf 2003;1(1):20-30
17 Lee JH,Ahn HS,Kim EK,et al.Efficacy of sodium hyaluronate and carboxymethylcellulose in treating mild to moderate dry eye disease.Cornea 2011;30(2):175-179
18 Simmons PA,Vehige JG.Clinical performance of a mid-viscosity artificial tear for dry eye treatment.Cornea 2007;26(3):294-302
19 Garrett Q,Simmons PA,Xu S,et al.Carboxymethylcellulose binds to human corneal epithelial cells and is a modulator of corneal epithelial wound healing.Invest Ophthalmol Vis Sci 2007;48(4):1559-1567
20 Baudouln C,de Lunardo C.Short-term comparative study of topica12 %carteolol with and without benzalkonium chloride in healthy volunteers.Br J Ophthalmol 1998;82(1):39-42
21 Kim EC,Choi JS,Joo CK.A comparison of vitamin a and cyclosporine a 0.05%eye drops for treatment of dry eye syndrome.Am J Ophthalmol2009;147(2):206-213
22 Toshida H,Tabuchi N,Koike D,et al.The effects of vitamin A compounds on hyaluronic acid released from cultured rabbit corneal epithelial cells and keratocytes.J Nutr Sci Vitaminol 2012;58(4):223-229
23 Tabuchi N,Toshida H,Koike D,et al.Effect of retinol palmitate on corneal and conjunctival mucin gene expression in a rat dry eye model after injury.J Ocul Pharmacol Ther 2017;33(1):24-33
24 Kubo Y,Arimura A,Nakayasu K,et al.Effect of vitamin A palmitate on the synthesis of mucins in cultured conjunctiva.Nippon Ganka Gakkai Zasshi 1999;103(8):580-583
25 Toshida H,Funaki T,Ono K,et al.Efficacy and safety of retinol palmitate ophthalmic solution in the treatment of dry eye:a Japanese Phase II clinical trial.Drug Des Devel Ther 2017;11:1871-1879
26 Baudouin C,LabbéA,Liang H,et al.Preservatives in eyedrops:the good,the bad and the ugly.Prog Retin Eye Res 2010;29(4):312-334