羧甲基纤维素钠眼液治疗糖尿病合并白内障术后干眼的疗效分析
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摘要
目的:分析糖尿病白内障超声乳化摘除术后羧甲基纤维素钠眼液治疗干眼症的临床效果。方法:选取2015年6月至2016年6月于我院行白内障超声乳化摘除术的糖尿病合并白内障患者117例(151眼),随机分为对照组(61例,84眼)和治疗组(56例,67眼),对照组予以常规白内障术后用药,治疗组在对照组基础上加用羧甲基纤维素钠眼液。对患者分别行术前及术后1 d、1周、1个月、2个月泪膜破裂时间(tear breakup time,BUT)、角膜荧光染色(cornea fluorescein staining,FL)、基础泪液分泌试验(Schimer I test,SⅠt)检查和自觉症状评分。结果:所有糖尿病合并白内障术后患者干眼主观症状增加、BUT缩短、SⅠt延长、FL增多(P<0.05)。至白内障术后2个月,对照组干眼主观症状仍较术前严重、BUT较术前缩短(P<0.05)。治疗组术后1个月干眼主观症状、BUT和FL已接近术前水平(P>0.05),且术后各时间点较对照组干眼主观症状更轻、BUT更长、FL更少(P<0.05)。结论:糖尿病合并白内障超声乳化手术后使用羧甲基纤维素钠眼液可有效改善干眼症状、恢复泪膜稳定、缩短眼表功能修复时间。
Objective:To investigate the effect of carboxymethylcellulose sodium eye drops on the diabetic cataract patients with dry eye after phacoemulsification. Methods:A total of 117 patients underwent operation(151 eyes)with diabetic cataract referred to our hospital from June 2015 to June 2016 were enrolled in the study. Patients were randomly divided the control group(61 patients,84 eyes)and treatment group(56 patients,67 eyes). The routine antibiotic and anti-inflammatory eye drops were used in control group,while treatment group was received carboxymethylcellulose sodium eye drops therapy except the routine treatment. Tear break-up time,Schimer I test,cornea fluorescein staining were measured,as well as subjective symptoms were graded before and on 1 day,at 1 week,1 month and 2 months after phacoemulsification and intraocular lens implantation. Results:All the subjective symptoms were worse,tear break-up time was shorter,S I t was prolonged and cornea fluorescein staining on epithelium was more common ly seen post-operation as compare to pre-operation(P<0.05). The subjective symptoms grade and tear break-up time were still worse than the conditions that before operation in the control group 2 months post-operation(P<0.05). However,the subjective symptoms grade,tear break-up time and cornea fluorescein staining on epithelium 1 month post-operation was similar to that pre-operation conditions(P>0.05),and all the post-opertation index were better in the treatment group than that in control group(P<0.05). Conclusion:The car boxymethylcellulose sodium eye drops could efficiently relieve the symptoms of dry eye and maintain the tear film stable for the diabetic cataract patients underwent phacoemulsification.
Objective:To investigate the effect of carboxymethylcellulose sodium eye drops on the diabetic cataract patients with dry eye after phacoemulsification. Methods:A total of 117 patients underwent operation(151 eyes)with diabetic cataract referred to our hospital from June 2015 to June 2016 were enrolled in the study. Patients were randomly divided the control group(61 patients,84 eyes)and treatment group(56 patients,67 eyes). The routine antibiotic and anti-inflammatory eye drops were used in control group,while treatment group was received carboxymethylcellulose sodium eye drops therapy except the routine treatment. Tear break-up time,Schimer I test,cornea fluorescein staining were measured,as well as subjective symptoms were graded before and on 1 day,at 1 week,1 month and 2 months after phacoemulsification and intraocular lens implantation. Results:All the subjective symptoms were worse,tear break-up time was shorter,S I t was prolonged and cornea fluorescein staining on epithelium was more common ly seen post-operation as compare to pre-operation(P<0.05). The subjective symptoms grade and tear break-up time were still worse than the conditions that before operation in the control group 2 months post-operation(P<0.05). However,the subjective symptoms grade,tear break-up time and cornea fluorescein staining on epithelium 1 month post-operation was similar to that pre-operation conditions(P>0.05),and all the post-opertation index were better in the treatment group than that in control group(P<0.05). Conclusion:The car boxymethylcellulose sodium eye drops could efficiently relieve the symptoms of dry eye and maintain the tear film stable for the diabetic cataract patients underwent phacoemulsification.
引文
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[13]Tseng SC,Hirst LW,Maumenee AE,et al.Possible mechanisms for the loss of goblet cells in mucin-deficient disorders[J].Ophthalmology,1984,91(6):545-552.
[14]王文玲.白内障术后干眼的原因分析及处理[J].临床眼科杂志,2007,15(5):456-457.
[15]赵家良.眼科疾病临床诊疗规范教程[M].北京:北京大学医学出版社,2007:51.
[16]宋颖,张琳,周绍荣.干眼对白内障术后角膜散光的影响[J].眼科新进展,2005,25(6):553-555.
[17]苗晓晴,黄祖烽,杨筱曦.糖尿病患者超声乳化白内障吸除术后干眼症相关指标变化的临床观察[J].中华眼科医学杂志(电子版),2015,5(6):297-302.
[18]何章彪,冯传博,王翠侠,等.超声乳化术对伴有糖尿病的白内障患者眼表及角膜内皮细胞的影响[J].国际眼科杂志,2017,17(12):2229-2233.
[19]刘祖国,罗丽辉,张振平,等.超声乳化白内障吸除术后泪膜变化[J].中华眼科杂志,2002,38(5):274-277.
[20]薛敏,董健鸿,朱茂丽.合并糖尿病的白内障患者超声乳化术后干眼分析[J].中国眼耳鼻喉科杂志,2010,10(3):168-170,后插4.
[21]Baudouln C,de Lunardo C.Short-term comparative study of topica1 2%carteolol with and without benzalkonnium chloride in healthy volunteers[J].Br J Ophthahnol,1998,82(1):39-42.
[22]王尧.羧甲基纤维素钠眼液在白内障患者术后干眼症治疗中的应用价值[J].中国药物经济学,2016,11(3):91-92,180.
[2]Ram J,Gupta A,Brar G,et al.Outcomes of phacoemulsification inpatients with dry eye[J].J Cataract Refract Surg,2002,28(8):1386-1389.
[3]徐建江,孙兴怀,陈宇虹,等.白内障超声乳化手术对眼表的影响[J].中国实用眼科杂志,2005,23(8):801-803.
[4]Najafi L,Malek M,Valojerdi AE,et al.Dry eye and its correlation to diabetes microvascular compilcation in people with type 2 diabetes mellitus[J].J Diabetes Complications,2013,27(5):459-462.
[5]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)[J].中华眼科杂志,2013,49(1):73-75.
[6]刘祖国,彭娟.干眼的诊断与治疗规范[J].眼科研究,2008,26(3):161-164.
[7]Macri A,Rolando M,Pflugfelder S.A standardized visual scale for evaluation of tear fluoresecein clearance[J].Ophthalmology,2000,107(7):1338-1343.
[8]吴先萍,杨晓妍,张宁梅,等.我国人群2型糖尿病流行病学研究现状[J].预防医学情报杂志,2002,18(5):413-416.
[9]陈灏珠.实用内科学[M].北京:人民卫生出版社,1998:838.
[10]朱姝,贾卉.糖尿病角膜上皮和泪膜改变的研究进展[J].眼科新进展,2007,27(4):318-320.
[11]Beckman KA.Characterization of dry eye disease in diabetic patients versus nondiabetic patients[J].Cornea,2014,33(8):851-854.
[12]Imam S,Elagin RB,Jaume JC.Diabetes-associated dry eye syndrome in a new humanized transgenic model of type 1 diabetes[J].Mol Vis,2013,8(19):1259-1267.
[13]Tseng SC,Hirst LW,Maumenee AE,et al.Possible mechanisms for the loss of goblet cells in mucin-deficient disorders[J].Ophthalmology,1984,91(6):545-552.
[14]王文玲.白内障术后干眼的原因分析及处理[J].临床眼科杂志,2007,15(5):456-457.
[15]赵家良.眼科疾病临床诊疗规范教程[M].北京:北京大学医学出版社,2007:51.
[16]宋颖,张琳,周绍荣.干眼对白内障术后角膜散光的影响[J].眼科新进展,2005,25(6):553-555.
[17]苗晓晴,黄祖烽,杨筱曦.糖尿病患者超声乳化白内障吸除术后干眼症相关指标变化的临床观察[J].中华眼科医学杂志(电子版),2015,5(6):297-302.
[18]何章彪,冯传博,王翠侠,等.超声乳化术对伴有糖尿病的白内障患者眼表及角膜内皮细胞的影响[J].国际眼科杂志,2017,17(12):2229-2233.
[19]刘祖国,罗丽辉,张振平,等.超声乳化白内障吸除术后泪膜变化[J].中华眼科杂志,2002,38(5):274-277.
[20]薛敏,董健鸿,朱茂丽.合并糖尿病的白内障患者超声乳化术后干眼分析[J].中国眼耳鼻喉科杂志,2010,10(3):168-170,后插4.
[21]Baudouln C,de Lunardo C.Short-term comparative study of topica1 2%carteolol with and without benzalkonnium chloride in healthy volunteers[J].Br J Ophthahnol,1998,82(1):39-42.
[22]王尧.羧甲基纤维素钠眼液在白内障患者术后干眼症治疗中的应用价值[J].中国药物经济学,2016,11(3):91-92,180.