普拉洛芬对糖尿病患者白内障术后视力和黄斑厚度的影响
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摘要
目的探讨普拉洛芬对合并糖尿病的白内障超声乳化术后视力及黄斑厚度的影响。方法前瞻性单中心随机临床观察研究。收集行白内障超声乳化摘出联合人工晶状体植入术的不伴有视网膜病变的糖尿病患者44例(66眼)随机分为两组。对照组术前3 d常规应用左氧氟沙星滴眼液,试验组在对照组的基础上加用普拉洛芬滴眼液。对比手术前后两组最佳矫正视力、黄斑厚度、黄斑水肿情况。必要时对患眼行光学相干断层扫描血管成像(optical coherence tomography angiography,OC-TA)检查。结果两组患者术前基本情况及术中有效超声乳化时间差异均无统计学意义(均为P> 0. 05)。术后1周,试验组最佳矫正视力为(0. 10±0. 23) log MAR,对照组为(0. 31±0. 35) log MAR,两组相比差异有统计学意义(P=0. 005),试验组视力优于对照组。术后1个月,试验组黄斑厚度为(249. 09±22. 89)μm,与术前(241. 39±17. 42)μm相比差异无统计学意义(P=0. 150);对照组黄斑厚度为(256. 70±40. 84)μm,与术前(232. 80±20. 10)μm相比显著增厚,差异有统计学意义(P=0. 003)。术后1个月时对照组5眼行OCTA检查,其中3眼可观察到黄斑区微血管瘤和无灌注区,1眼存在明显的黄斑囊样水肿;试验组2眼行OCTA检查,均未见明显微血管瘤及无灌注区。结论术前应用普拉洛芬可减少术后1个月黄斑区视网膜增厚,有助于术后早期视功能的尽快恢复。
Objective To investigate the effect of pranoprofen on visual acuity and macular thickness in patients with diabetes mellitus after phacoemulsification. Methods A prospective,single-center,randomized clinical study. Forty-four diabetic patients(66 eyes) without retinopathy undergoing phacoemulsification combined with intraocular lens implantation were randomly divided into two groups : control group and experimental group. Medication in the control group was routine levofloxacin eye drops 3 days before operation. Medication in the experimental group was administration of levofloxacin eye drops and pranoprofen. Best corrected visual acuity (BCVA), macular thickness, occurrence of macular edema were compared before and after operation between the two groups. Optical coherence tomography angiography (OCTA) was performed on affected eyes if necessary. Results There was no statistically significant difference in preoperative baseline and intraoperative effective phacoemulsification time between the two groups (both P > 0. 05). One week after operation, BCVA in the experimental group was(0. 10 ±0.23) logMAR while BCVA in control group was(0.31 ±0.35)logMAR. The difference between the two groups was statistically significant (P=0. 005). Visual acuity in the experimental group was better than that in the control group. One month after operation,macular thickness in experimental group was(249. 09 ± 22. 89) μm,there was no statistically significant differencecompared to preoperative macular thickness(24 1. 39 ±17.42) μm (P = 0. 150). Macular thickness in the control group was(256. 70 ± 40. 84) μm,which was thicker than preoperative macular thickness(232. 80 ± 20. 10) μm and the difference was statistically significant(P =0. 003). One month after operation, OCTA were performed on 5 eyes in the control group. Among them, macular microaneurysms and retinal non-perfusion area were observed in 3 eyes, and obvious cystoid macular edema was observed in one eye.OCTA were performed on 2 eyes in the experimental group and there was no obvious microaneurysms and non-perfusion area. Conclusion Preoperative application of pranoprofen can reduce the macular thickening 1 month after operation and is helpful in rapid recovery of visual function in early postoperative time.
Objective To investigate the effect of pranoprofen on visual acuity and macular thickness in patients with diabetes mellitus after phacoemulsification. Methods A prospective,single-center,randomized clinical study. Forty-four diabetic patients(66 eyes) without retinopathy undergoing phacoemulsification combined with intraocular lens implantation were randomly divided into two groups : control group and experimental group. Medication in the control group was routine levofloxacin eye drops 3 days before operation. Medication in the experimental group was administration of levofloxacin eye drops and pranoprofen. Best corrected visual acuity (BCVA), macular thickness, occurrence of macular edema were compared before and after operation between the two groups. Optical coherence tomography angiography (OCTA) was performed on affected eyes if necessary. Results There was no statistically significant difference in preoperative baseline and intraoperative effective phacoemulsification time between the two groups (both P > 0. 05). One week after operation, BCVA in the experimental group was(0. 10 ±0.23) logMAR while BCVA in control group was(0.31 ±0.35)logMAR. The difference between the two groups was statistically significant (P=0. 005). Visual acuity in the experimental group was better than that in the control group. One month after operation,macular thickness in experimental group was(249. 09 ± 22. 89) μm,there was no statistically significant differencecompared to preoperative macular thickness(24 1. 39 ±17.42) μm (P = 0. 150). Macular thickness in the control group was(256. 70 ± 40. 84) μm,which was thicker than preoperative macular thickness(232. 80 ± 20. 10) μm and the difference was statistically significant(P =0. 003). One month after operation, OCTA were performed on 5 eyes in the control group. Among them, macular microaneurysms and retinal non-perfusion area were observed in 3 eyes, and obvious cystoid macular edema was observed in one eye.OCTA were performed on 2 eyes in the experimental group and there was no obvious microaneurysms and non-perfusion area. Conclusion Preoperative application of pranoprofen can reduce the macular thickening 1 month after operation and is helpful in rapid recovery of visual function in early postoperative time.
引文
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[6]OZGUR O R,OZKURT Y,KULEKCI Z,EVCIMAN T.The combination of phacoemulsification surgery and intravitreal triamcinolone injection in patients with cataract and diabetic macular edema[J].Saudi J Ophthalmol,2016,30(1):33-38.
[7]KESSEL L,TENDAL B,JRGENSEN K J,ERNGAARD D,FLESNER P,ANDRESEN J L,et al.Post-cataract prevention of inflammation and macular edema by steroid and nonsteroidal anti-inflammatory eye drops:a systematic review[J].Ophthalmology,2014,121(10):1915-1924.
[8]KIM S J,EQUI R,BRESSLER N M.Analysis of macular edema after cataract surgery in patients with diabetes using optical coherence tomography[J].Ophthalmology,2007,114(5):881-889.
[9]NEUBAUER A S,PRIGLINGER S,ULLRICH S,BECHMANN M,THIEL M J,ULBIG M W,et al.Comparison of foveal thickness measured with the retinal thickness analyzer and optical coherence tomography[J].Retina,2001,21(6):596-601.
[10]KIM S J,SCHOENBERGER S D,THORNE J E,EHLERS J P,YEH S,BAKRI S J.Topical nonsteroidal anti-inflammatory drugs and cataract surgery:a report by the American academy of ophthalmology[J].Ophthalmology,2015,122(11):2159-2168.
[11]CHEN W,LIN H T,WU C R,XIE C F,HUANG X K,CHEN WR.Clinical research of anterior chamber inflammation after phacoemulsification surgery in patients with complicated cataract secondary to uveitis[J].Chin J Ophthalmol,2013,49(3):212-216.
[12]HONG T,MITCHELL P,DE LORYN T,ROCHTCHINA E,CU-GATI S,WANG J J.Development and progression of diabetic retinopathy 12 months after phacoemulsification cataract surgery[J].Ophthalmology,2009,116(8):1510-1514.
[13]SUZUKI N,HIRANO Y,YOSHIDA M,TOMIYASU T,UEMURAA,YASUKAWA T,et al.Microvascular abnormalities on optical coherence tomography angiography in macular edema associated with branch retinal vein occlusion[J].Am J Ophthalmol,2016,161(2):126-132.
[2]EARLY TREATMENT DIABETIC RETINOPATHY STUDY RE-SEARCH GROUP.Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema.Early treatment diabetic retinopathy study report number 2[J].Ophthalmology,1987,94(7):761-774.
[3]PIRES I,SANTOS A R,NUNES S,LOBO C,CUNHA-VAZ J.Subclinical macular edema as a predictor of progression to clinically significant macular edema in type 2 diabetes[J].Ophthalmologica,2013,230(4):201-206.
[4]BROWNING D J,MCOWEN M D,BOWEN R M,O’MARAH T L.Comparison of the clinical diagnosis of diabetic macular edema with diagnosis by optical coherence tomography[J].Ophthalmology,2004,111(4):712-715.
[5]ISHIBAZAWA A,NAGAOKA T,TAKAHASHI A,OMAE T,TANI T,SOGAWA K,et al.Optical coherence tomography angiography in diabetic retinopathy:A prospective pilot study[J].Am J Ophthalmol,2015,160(1):35-44.
[6]OZGUR O R,OZKURT Y,KULEKCI Z,EVCIMAN T.The combination of phacoemulsification surgery and intravitreal triamcinolone injection in patients with cataract and diabetic macular edema[J].Saudi J Ophthalmol,2016,30(1):33-38.
[7]KESSEL L,TENDAL B,JRGENSEN K J,ERNGAARD D,FLESNER P,ANDRESEN J L,et al.Post-cataract prevention of inflammation and macular edema by steroid and nonsteroidal anti-inflammatory eye drops:a systematic review[J].Ophthalmology,2014,121(10):1915-1924.
[8]KIM S J,EQUI R,BRESSLER N M.Analysis of macular edema after cataract surgery in patients with diabetes using optical coherence tomography[J].Ophthalmology,2007,114(5):881-889.
[9]NEUBAUER A S,PRIGLINGER S,ULLRICH S,BECHMANN M,THIEL M J,ULBIG M W,et al.Comparison of foveal thickness measured with the retinal thickness analyzer and optical coherence tomography[J].Retina,2001,21(6):596-601.
[10]KIM S J,SCHOENBERGER S D,THORNE J E,EHLERS J P,YEH S,BAKRI S J.Topical nonsteroidal anti-inflammatory drugs and cataract surgery:a report by the American academy of ophthalmology[J].Ophthalmology,2015,122(11):2159-2168.
[11]CHEN W,LIN H T,WU C R,XIE C F,HUANG X K,CHEN WR.Clinical research of anterior chamber inflammation after phacoemulsification surgery in patients with complicated cataract secondary to uveitis[J].Chin J Ophthalmol,2013,49(3):212-216.
[12]HONG T,MITCHELL P,DE LORYN T,ROCHTCHINA E,CU-GATI S,WANG J J.Development and progression of diabetic retinopathy 12 months after phacoemulsification cataract surgery[J].Ophthalmology,2009,116(8):1510-1514.
[13]SUZUKI N,HIRANO Y,YOSHIDA M,TOMIYASU T,UEMURAA,YASUKAWA T,et al.Microvascular abnormalities on optical coherence tomography angiography in macular edema associated with branch retinal vein occlusion[J].Am J Ophthalmol,2016,161(2):126-132.