目的 比较医用透明质酸钠(medical sodium hyaluronate,HA)和平衡盐溶液(balance salt solution,BSS)在增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)微创玻璃体手术(minimally invasive vitreorentinal surgery,MIVS)中对眼表保护的效果及对泪膜稳定性的影响.方法 临床随机对照试验:选取PDR患者40例40眼,采用抗血管内皮生长因子(vascular endothelial growth factor,VEGF)药物辅助的MIVS治疗.按照随机数字表法将患者分为HA组(20例20眼)、BSS组(20例20眼).每组术中分别应用HA和BSS保持眼表湿润.分别于术前、术后l、7、30d行眼表疾病指数量表(ocular sur-face disease index,OSDI)、非侵入性泪膜破裂时间(non-invasive tear break-up time,NITBUT)、基础泪液分泌试验(SchirmerⅠ test,SⅠt)、角膜荧光染色(corneal fluorescein staining,CFS)及术中角膜透明度的检测和评估.结果 OSDI组间比较,术后各个时间点HA组优于BSS组(P1d=0.001、P7d＜0.001、P30=0.001);组内比较,HA组术后1 d较术前受损(PHA1d＜0.001),术后30 d优于术前(PHA30d=0.002),BSS组术后1 d、7 d较术前受损(PBSS1d＜0.001、PBSS7d＜0.001).S Ⅰt2组组内比较,HA组、BSS 组术后 1、7d较术前受损(PHA1d＜0.001、PHA7d＜0.001、PBSS1d＜0.001、PBSS7d＜0.001),HA 组术后 30 d 优于术前(PHA30d＜0.001).NITBUT组间比较,术后7dHA组优于BSS组(P7d＜0.001);组内比较,HA组、BSS组术后7 d、30 d较术前均受损(PHA7d＜0.001、PHA30d=0.027、PBSS7d＜0.001,PBSS30d=＜0.001).CFS 组间比较,术后 1 d HA 组优于 BSS 组(P1d＜0.001);组内比较,HA 组、BSS 组术后 1、7 d 较术前受损(PHA1d＜0.001、PHA7d＜0.001、PBSS1d＜0.001、PBSS7d＜0.001),BSS 组术后 30 d 较术前仍受损(PBSS30d=0.024).术中角膜透明度HA组优于BSS组(P=0.038).结论 在增殖性糖尿病视网膜病变微创玻璃体手术中应用医用透明质酸钠保护眼表,可减轻围手术期眼表损伤,增加术中的可视性,缩短术后泪膜恢复时间.
Effect of sodium hyaluronate and balanced salt solution on ocular surface protection during minimally inva-sive vitreorentinal surgery
Objective To evaluate the protective effect of the ocular surface of medical sodium hyaluronate(HA)and balanced salt solution(BSS)in patients with proliferative diabetic retinopathy(PDR)performing minimally invasive vitreorentinal surgery(MIVS).Methods A retrospective case-controlled study was designed.Forty patients(40 eyes)with PDR performed with anti-vascular endothelial growth factor-assisted MIVS surgery were enrolled in this study,randomly divided into the HA group[20 cases(20 eyes)]and the BSS group[20 cases(20 eyes)].During surgery,HA and BSS were applied to keep the ocular surface moist according to grouping.Ocular surface disease index(OSDI),Schirmer Ⅰ test(S Ⅰt),non-invasive tear film break-up time(NIT-BUT),corneal fluorescein staining(CFS)and corneal transparency during the surgery were performed preoperatively and at 1,7 and 30 days postoperatively.Results The OSDI of the HA group was superior to that of the BSS group at all postoperative time points(P1d=0.001、P7d＜0.001、P30d=0.001).Intragroup comparison showed that the HA group was more damaged 1 day after sur-gery than preoperative(PHA1d＜0.001),and 30 days after surgery was better than preoperative(PHA30d=0.002),and the BSS group was more damaged 1 day and 7 days after surgery than preoperative(PBSS1d＜0.001,PBSS7d＜0.001).Intragroup comparison in the S Ⅰt 2 group showed that the damage in the HA group and the BSS group was worse than preoperative(PHA1d＜0.001,PHA7d＜0.001,PBSS1d＜0.001,PBSS7d＜0.001),and damage in the HA group was better than preoperative(PHA30d＜0.001).Compared to the NITBUT group,the 7 d HA group was better than the BSS group(P7d＜0.001).Intragroup comparison showed that the damage to the HA group and the BSS group was greater at 7 and 30 days postoperatively than preoperatively(PHA7d＜0.001,PHA30d=0.027,PBSS7d＜0.001,PBSS30d=＜0.001).Among the CFS groups,the HA group was better than the BSS group on 1d postoperatively(P1d＜0.001).Intragroup comparison showed that the damage in the HA group and the BSS group was greater than before the operation(PHA1d＜0.001,PHA7d＜0.001,PBSS1d＜0.001,PBSS7d＜0.001),and the damage in the BSS group was still greater than before the operation and 30 days after the operation(PBSS30d=0.024).Intraoperative corneal transparency in the HA group was better than that in the BSS group(P=0.038).Conclusion Compared to BSS,HA has better protection of the ocular surface during MIVS in patients with PDR,remains the corneal transparency during surgery and shortens the repair time of the ocular surface tissue after surgery.
Vitreorentinal surgeryMinimally invasiveProliferative diabetic retinopathySodium hyaluronateBalance salt solu-tionTear film
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