白内障手术后对眼表的影响及局部应用地夸磷索对术后干眼的作用：一项多中心前瞻性随机研究。
Influence on ocular surface after cataract surgery and effect of topical diquafosol on postoperative dry eye: a multicenter prospective randomized study.
作者信息
Miyake Kensaku, Yokoi Norihiko
机构信息
Miyake Eye Hospital, Nagoya.
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
出版信息
Clin Ophthalmol. 2017 Mar 17;11:529-540. doi: 10.2147/OPTH.S129178. eCollection 2017.
PURPOSE
To investigate influences of 3% diquafosol sodium ophthalmic solution (DQS) on ocular surface after cataract surgery and effects on postoperative dry eye.
DESIGN
This study had two consecutive prospective study phases. The former was an observational study from before cataract surgery to 4 weeks after surgery and the latter was a randomized open-label study from 4 to 8 weeks after surgery.
METHODS
Subjects were 433 eyes of 433 patients undergoing cataract surgery with intraocular lens implantation. Dry eye examination of tear breakup time (BUT), corneal and conjunctival fluorescein staining scores, total subjective symptom score (12 symptoms), and Schirmer I test were conducted before surgery and 4 weeks after surgery. Patient demographics and these examination results were used to analyze risk factors to predict postoperative dry eye. In a randomized study, 154 eyes diagnosed with dry eye postoperatively were applied either DQS or artificial tears (AT) six times daily for 4 weeks. The data of the examinations were compared.
RESULTS
At 4 weeks after surgery, BUT was shortened significantly (=0.036), fluorescein staining score increased significantly (=0.012), but total subjective symptom score was significantly improved (<0.001). The majority of postoperative dry eye was shortened BUT type (53.1%). The dry eye prevalence after surgery decreased (55.7%) compared with before surgery (69.7%). Females and the patient with dry eye symptoms before surgery had significant risk factors for postoperative dry eye. In a randomized study, BUT was significantly prolonged in the DQS group (=0.015), but not in the AT group. Fluorescein staining score was significantly improved in both groups (<0.001). Total subjective symptom score was significantly decreased in the AT group (<0.001), but not in the DQS group.
CONCLUSION
Our study suggests that cataract surgery has harmful effects on tear film stability and ocular surface, and DQS has a capability to improve them.
目的
探讨3%双醋瑞因钠滴眼液（DQS）对白内障手术后眼表的影响以及对术后干眼的作用。
设计
本研究有两个连续的前瞻性研究阶段。前者是从白内障手术前至手术后4周的观察性研究，后者是从手术后4至8周的随机开放标签研究。
方法
研究对象为433例行白内障超声乳化人工晶状体植入术患者的433只眼。术前及术后4周进行干眼检查，包括泪膜破裂时间（BUT）、角膜和结膜荧光素染色评分、总主观症状评分（12项症状）及Schirmer I试验。利用患者人口统计学资料和这些检查结果分析预测术后干眼的危险因素。在随机研究中，154只术后诊断为干眼的眼睛，每天使用DQS或人工泪液（AT）6次，持续4周。比较检查数据。
结果
术后4周，BUT显著缩短（=0.036），荧光素染色评分显著增加（=0.012），但总主观症状评分显著改善（<0.001）。术后干眼类型以BUT缩短型为主（53.1%）。术后干眼患病率较术前（69.7%）有所下降（55.7%）。女性及术前有干眼症状的患者是术后干眼的显著危险因素。在随机研究中，DQS组BUT显著延长（=0.015），而AT组无显著变化。两组荧光素染色评分均显著改善（<0.001）。AT组总主观症状评分显著降低（<0.001），而DQS组无显著变化。
结论
我们的研究表明，白内障手术对泪膜稳定性和眼表有不良影响，而DQS有改善作用。
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