Hwang Jin Sun, Lee Yoon Pyo, Shin Young Joo
Department of Ophthalmology, Hallym University College of Medicine, Seoul, Korea.
Cornea. 2019 Mar;38(3):304-310. doi: 10.1097/ICO.0000000000001822.
To investigate the efficacy of topical carbomer-based lipid-containing artificial tears (CLAT) and hyaluronate (HU) in patients with dry eye disease (DED) based on serum 25-hydroxyvitamin D (25HD) levels and cholecalciferol (vitamin D) supplementation.
A total of 116 patients with DED from June 2015 to June 2016 were included. The participants were divided into the vitamin D deficiency (VDD) group and the non-VDD group according to their serum 25HD levels. The patients determined the ways of cholecalciferol supplementation. Ocular Surface Disease Index (OSDI) score, visual analog pain scale score, lid hyperemia, tear breakup time (TBUT), corneal fluorescein staining score, and Schirmer test were compared between baseline and 2 weeks posttreatment after topical applications and between before and after cholecalciferol supplementation.
The OSDI and visual analog pain scale scores of both VDD and non-VDD groups decreased after application of topical CLAT and HU compared with baseline values (P < 0.05 for all, paired t test). TBUT, corneal fluorescein staining score, and lid hyperemia in the VDD group remained unaffected by topical CLAT and HU, whereas those in the non-VDD group were improved (3.2 ± 1.7 vs. 4.1 ± 2.2, 0.5 ± 0.7 vs. 0.4 ± 0.6, and 2.2 ± 0.8 vs. 1.9 ± 0.7 in the non-VDD group, P = 0.001, 0.030, and 0.012, respectively). OSDI score, TBUT, and lid margin hyperemia were improved in the intramuscular group after cholecalciferol supplementation compared with pretreatment (33.2 ± 23.2 vs. 28.5 ± 21.9, 3.5 ± 1.9 vs. 6.0 ± 2.5, and 2.2 ± 0.7 vs. 1.2 ± 0.8, P < 0.05, Wilcoxon rank test).
The effect of topical CLAT and HU was dependent on serum 25HD levels. Cholecalciferol supplementation enhanced the efficacy of topical treatment and may be a useful adjuvant therapy for patients with DED refractory to topical lubricants.
基于血清25-羟基维生素D（25HD）水平和补充胆钙化醇（维生素D），研究局部应用含卡波姆的脂质人工泪液（CLAT）和透明质酸盐（HU）对干眼症（DED）患者的疗效。
纳入2015年6月至2016年6月期间的116例DED患者。根据血清25HD水平将参与者分为维生素D缺乏（VDD）组和非VDD组。患者自行决定补充胆钙化醇的方式。比较局部应用前后基线和治疗后2周的眼表疾病指数（OSDI）评分、视觉模拟疼痛量表评分、睑结膜充血、泪膜破裂时间（TBUT）、角膜荧光素染色评分和泪液分泌试验，以及补充胆钙化醇前后的上述指标。
与基线值相比，局部应用CLAT和HU后，VDD组和非VDD组的OSDI和视觉模拟疼痛量表评分均降低（均P<0.05，配对t检验）。VDD组的TBUT、角膜荧光素染色评分和睑结膜充血不受局部CLAT和HU的影响，而非VDD组的上述指标得到改善（非VDD组分别为3.2±1.7对4.1±2.2、0.5±0.7对0.4±0.6、2.2±0.8对1.9±0.7，P分别为0.001、0.030和0.012）。补充胆钙化醇后，肌肉注射组的OSDI评分、TBUT和睑缘充血较治疗前改善（33.2±23.2对28.5±2（此处原文有误，应为21.9）、3.5±1.9对6.0±2.5、2.2±0.7对1.2±0.8，P<0.05，Wilcoxon秩和检验）。
局部应用CLAT和HU的效果取决于血清25HD水平。补充胆钙化醇可增强局部治疗的疗效，可能是对局部润滑剂治疗无效的DED患者有用的辅助治疗方法。
