中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2012年
6期
553-556
,共4页
张珍珍%张辉%吴星伟%唐于荣
張珍珍%張輝%吳星偉%唐于榮
장진진%장휘%오성위%당우영
重组人表皮生长因子%白内障%超声乳化%玻璃酸钠%干眼
重組人錶皮生長因子%白內障%超聲乳化%玻璃痠鈉%榦眼
중조인표피생장인자%백내장%초성유화%파리산납%간안
Recombinant human epithelial growth factor%Cataract%Phacomulsification%Sodium hyaluronate%Dry eye
背景 随着白内障超声乳化联合后房型人工晶状体(IOL)植入术治疗年龄相关性白内障的广泛应用,部分患者术后感到明显的烧灼感、异物感,该手术对患者眼表的损伤及影响多有报道. 目的 观察重组人表皮生长因子(rhEGF)对年龄相关性白内障患者行白内障超声乳化联合IOL植入术后眼表损伤的修复作用.方法 采用前瞻性研究方法.选择确诊为年龄相关性白内障并行白内障超声乳化联合IOL植入术的患者89例120眼,依据术后第1天给予滴眼液的不同分为rhEGF组、玻璃酸钠组和空白对照组,每组40眼.各组间术前角膜荧光素染色、泪膜破裂时间(BUT)及泪液分泌(Schirmer Ⅰ)试验结果差异均无统计学意义(均P＞0.05).各组基础用药为质量分数0.3％氧氟沙星眼膏和妥布霉素地塞米松滴眼液,持续2周.术后第1天rhEGF组和玻璃酸钠组分别给予rhEGF滴眼液、玻璃酸钠滴眼液点眼,每日4次,持续4周.患者分别于术前1d及术后1d、1周、2周和1个月时行角膜荧光素染色、BUT及Schirmer Ⅰ试验检测,并进行比较分析.结果 3个组间人口基线特征差异均无统计学意义(F年龄=3.740,x2性别=0.615,P＞0.05),术前1d眼表检查差异亦无统计学意义(角膜荧光素染色评分:F=0.247,P＞0.05:BUT:F=0.579,P＞0.05；Schirmer Ⅰ试验:F=0.475,P＞0.05).随着术后时间的延长,各组内角膜荧光素染色评分、Schirmer Ⅰ试验结果均出现先升高后下降的趋势,BUT出现先缩短后延长的趋势,3个组术前1d,术后1d、1周、2周、1个月时角膜荧光素染色评分值、BUT、Schirmer Ⅰ试验结果各时间点间差异均有统计学意义(F时间=6.754、6.233、6.079,P＜0.01)；3个组间差异亦有统计学意义( F分组=4.953、4.071、4.511,P＜0.05).rhEGF组术后2周和术后1个月角膜荧光素染色评分明显低于玻璃酸钠组(P=0.039、0.014),1个月时恢复至术前水平(P=0.137).rhEGF组术后1周和2周时BUT均明显高于玻璃酸钠组(P=0.019、0.007),于2周时恢复至术前水平(P=1.009).rhEGF组在术后1周、2周、1个月时Schirmer Ⅰ试验值均明显低于玻璃酸钠组(P=0.022、0.003、0.019),于2周时恢复至术前水平(P=0.052).结论 rhEGF可明显促进白内障超声乳化术后眼表损伤的修复.
揹景 隨著白內障超聲乳化聯閤後房型人工晶狀體(IOL)植入術治療年齡相關性白內障的廣汎應用,部分患者術後感到明顯的燒灼感、異物感,該手術對患者眼錶的損傷及影響多有報道. 目的 觀察重組人錶皮生長因子(rhEGF)對年齡相關性白內障患者行白內障超聲乳化聯閤IOL植入術後眼錶損傷的脩複作用.方法 採用前瞻性研究方法.選擇確診為年齡相關性白內障併行白內障超聲乳化聯閤IOL植入術的患者89例120眼,依據術後第1天給予滴眼液的不同分為rhEGF組、玻璃痠鈉組和空白對照組,每組40眼.各組間術前角膜熒光素染色、淚膜破裂時間(BUT)及淚液分泌(Schirmer Ⅰ)試驗結果差異均無統計學意義(均P＞0.05).各組基礎用藥為質量分數0.3％氧氟沙星眼膏和妥佈黴素地塞米鬆滴眼液,持續2週.術後第1天rhEGF組和玻璃痠鈉組分彆給予rhEGF滴眼液、玻璃痠鈉滴眼液點眼,每日4次,持續4週.患者分彆于術前1d及術後1d、1週、2週和1箇月時行角膜熒光素染色、BUT及Schirmer Ⅰ試驗檢測,併進行比較分析.結果 3箇組間人口基線特徵差異均無統計學意義(F年齡=3.740,x2性彆=0.615,P＞0.05),術前1d眼錶檢查差異亦無統計學意義(角膜熒光素染色評分:F=0.247,P＞0.05:BUT:F=0.579,P＞0.05；Schirmer Ⅰ試驗:F=0.475,P＞0.05).隨著術後時間的延長,各組內角膜熒光素染色評分、Schirmer Ⅰ試驗結果均齣現先升高後下降的趨勢,BUT齣現先縮短後延長的趨勢,3箇組術前1d,術後1d、1週、2週、1箇月時角膜熒光素染色評分值、BUT、Schirmer Ⅰ試驗結果各時間點間差異均有統計學意義(F時間=6.754、6.233、6.079,P＜0.01)；3箇組間差異亦有統計學意義( F分組=4.953、4.071、4.511,P＜0.05).rhEGF組術後2週和術後1箇月角膜熒光素染色評分明顯低于玻璃痠鈉組(P=0.039、0.014),1箇月時恢複至術前水平(P=0.137).rhEGF組術後1週和2週時BUT均明顯高于玻璃痠鈉組(P=0.019、0.007),于2週時恢複至術前水平(P=1.009).rhEGF組在術後1週、2週、1箇月時Schirmer Ⅰ試驗值均明顯低于玻璃痠鈉組(P=0.022、0.003、0.019),于2週時恢複至術前水平(P=0.052).結論 rhEGF可明顯促進白內障超聲乳化術後眼錶損傷的脩複.
배경 수착백내장초성유화연합후방형인공정상체(IOL)식입술치료년령상관성백내장적엄범응용,부분환자술후감도명현적소작감、이물감,해수술대환자안표적손상급영향다유보도. 목적 관찰중조인표피생장인자(rhEGF)대년령상관성백내장환자행백내장초성유화연합IOL식입술후안표손상적수복작용.방법 채용전첨성연구방법.선택학진위년령상관성백내장병행백내장초성유화연합IOL식입술적환자89례120안,의거술후제1천급여적안액적불동분위rhEGF조、파리산납조화공백대조조,매조40안.각조간술전각막형광소염색、루막파렬시간(BUT)급루액분비(Schirmer Ⅰ)시험결과차이균무통계학의의(균P＞0.05).각조기출용약위질량분수0.3％양불사성안고화타포매소지새미송적안액,지속2주.술후제1천rhEGF조화파리산납조분별급여rhEGF적안액、파리산납적안액점안,매일4차,지속4주.환자분별우술전1d급술후1d、1주、2주화1개월시행각막형광소염색、BUT급Schirmer Ⅰ시험검측,병진행비교분석.결과 3개조간인구기선특정차이균무통계학의의(F년령=3.740,x2성별=0.615,P＞0.05),술전1d안표검사차이역무통계학의의(각막형광소염색평분:F=0.247,P＞0.05:BUT:F=0.579,P＞0.05；Schirmer Ⅰ시험:F=0.475,P＞0.05).수착술후시간적연장,각조내각막형광소염색평분、Schirmer Ⅰ시험결과균출현선승고후하강적추세,BUT출현선축단후연장적추세,3개조술전1d,술후1d、1주、2주、1개월시각막형광소염색평분치、BUT、Schirmer Ⅰ시험결과각시간점간차이균유통계학의의(F시간=6.754、6.233、6.079,P＜0.01)；3개조간차이역유통계학의의( F분조=4.953、4.071、4.511,P＜0.05).rhEGF조술후2주화술후1개월각막형광소염색평분명현저우파리산납조(P=0.039、0.014),1개월시회복지술전수평(P=0.137).rhEGF조술후1주화2주시BUT균명현고우파리산납조(P=0.019、0.007),우2주시회복지술전수평(P=1.009).rhEGF조재술후1주、2주、1개월시Schirmer Ⅰ시험치균명현저우파리산납조(P=0.022、0.003、0.019),우2주시회복지술전수평(P=0.052).결론 rhEGF가명현촉진백내장초성유화술후안표손상적수복.
Background With the widely application of phacoemulsication for cataract,dry eye-associated symptoms,such as foreign body sensation and burning frequently occur after cataract surgery in some patients.Objective This study was to evaluate the repair effects of recombinant human epithelial growth factor (rhEGF) on ocular surface injuriy after phacomulsification. Methods This was a prospective study,and informed consent was obtained from each subject before the experiment.One hundreds and twenty eyes of 89 consecutive patients after phacomulsification for age-related cataract were collected and randomized into rhEGF group,hyaluronic acid group and control group and 40 eyes for each.RhEGF drops and hyaluronic acid drops were topically administered 4 times per day for consecutive 4 weeks after surgery in corresponding group,and no drops mentioned above was used in the control group.The 0.3％ ofloxacin eye ointment and tobramycin+dexamethasone drops were used as the element drops in all patients of each group.Corneal fluorescein staining score,tear film break-up time ( BUT),Schrimer Ⅰ test without topical anesthesia were performed 1 day before surgery and 1 day,1 week,2 weeks and 1 month after surgery.Results The demography and the relevant surface examinational outcomes were no significantly different among the rhEGF group,hyaluronic acid group and control group in preoperation (age:F =3.74; gender:x2 =0.615; corneal fluorescein staining:F =0.247 ; BUT:F =0.579 ; Schrimer Ⅰ test:F =0.475 ; all P＞ 0.05 ).With the prolong of the time,the corneal fluorescein staining scores and Schrimer Ⅰ test values appeared a early ascent and latterly decline,and the BUT value showed a early shorten and latterly restore,with a statistically significant differences among various time points( F时间 =6.754,6.079,6.233,P＜0.01 ).Meanwhile,statistically significant differences were found in the corneal fluorescein staining scores,Schrimer Ⅰ test values and BUT among these 3 groups (F分组 =4.953,4.511,4.071,P＜0.05 ).The corneal fluorescein staining scores in the rhEGF group were significantly lower than those in the hyaluronic acid group at 2 weeks and 1 month after operation(P=0.039,0.014),and the BUT values in the rhEGF group were significantly longer than ones in the hyaluronic acid group at 1 week and 2 weeks after operation (P =0.019,0.007).The Schrimer I test values were significantly reduced in the rhEGF group compared with hyaluronic acid group at 1 week,2 weeks and 1 month after operation (P=0.022,0.003,0.019). Conclusions RhEGF promotes the repair of the ocular surface injury in the patients with age-related cataract after phacomulsification.
