透明質(zhì)酸鈉和堿性成纖維細(xì)胞生長(zhǎng)因子治療術(shù)后干眼癥臨床觀察

1、    透明質(zhì)酸鈉和堿性成纖維細(xì)胞生長(zhǎng)因子治療術(shù)后干眼癥臨床觀察作者：王猛，趙桂秋，潘紹新，張麗麗，劉奎香 作者單位：266003中國(guó)山東省青島市，青島大學(xué)醫(yī)學(xué)院附屬醫(yī)院眼科【摘要】目的：探討干眼癥患者手術(shù)后使用不含防腐劑的透明質(zhì)酸鈉和堿性成纖維細(xì)胞生長(zhǎng)因子滴眼液的療效。方法：對(duì)行眼部手術(shù)的干眼癥患者132例(149眼),所行手術(shù)，眼局部用藥情況、手術(shù)前、手術(shù)后藥物治療2,4wk基礎(chǔ)淚液分泌實(shí)驗(yàn)和淚膜破裂時(shí)間實(shí)驗(yàn)的變化情況進(jìn)行分析：根據(jù)病情停用抗生素激素滴眼液,術(shù)后第4wk停用透明質(zhì)酸鈉和堿性成纖維細(xì)胞生長(zhǎng)因子，術(shù)后第5wk行基礎(chǔ)淚液分泌實(shí)驗(yàn)和淚膜破裂時(shí)

2、間實(shí)驗(yàn)。結(jié)果：對(duì)眼科手術(shù)前、術(shù)后藥物治療2,4wk基礎(chǔ)淚液分泌、淚膜破裂時(shí)間進(jìn)行比較,差異有統(tǒng)計(jì)學(xué)意義(P<0.01)。結(jié)論：干眼癥患者術(shù)后使用不含防腐劑的透明質(zhì)酸鈉和堿性成纖維細(xì)胞生長(zhǎng)因子滴眼液治療，有較好療效。【關(guān)鍵詞】 干眼癥 淚膜破裂時(shí)間 透明質(zhì)酸鈉 堿性成纖維細(xì)胞生長(zhǎng)因子 基礎(chǔ)淚液分泌實(shí)驗(yàn)INTRODUCTIONDry eye is a kind of disease that the quantity or quality of tears are abnormal and the patients present with symptoms of burning, blur

3、ring vision, foreign body sensation and tired eyes1. In these years, tens of thousands of eye surgeries are performed in every country, and dry eye cases after eye surgery have been reported in the literature following surgery. (references to be written from the published data) In this article, we a

4、nlyse the results of Shirmer test I and BUT to evaluate the curative effect of sodium hyaluronate and basic fibrblast growth factor in the treatment of dry eyes after eye operation.MATERIALS AND METHODSOne hundred and thirty two patients who underwent eye surgery, from May 2004 to April 2007, in the

5、 department of Ophthalmology, the Affiliated Hospital of Medical College of Qingdao University were subjected to Schirmer test I and BUT. Post operatively, the patients were given Oflaxacin eye drops (4 times daily) and Tobramycindexamethasone eye drops (4 times daily) and preservative free artifici

6、al tear drops and bFGF eye drops were both given 4 times daily to patients for 2 4 weeks depending the type of eye surgery performed. The Scirmer test I and BUT were done before eye surgery, and were repeated after 2 weeks and 4 weeks of post operative eye drops. The antibiotic/corticosteroid eye dr

7、ops were stopped after 2 weeks or 4 weeks; and preservative free sodium hyaluronate and bFGF eye drops were stopped after 4 weeks. Then Schirmer test I and BUT were repeated after 5 weeks. The symptoms of dry eye (burning/foreign body sensation,tired eyes, blurring of vision etc) were noted during f

8、ollow up of patients. The data were analyzed using SPSS 11.5 version. The results of Schirmer test I and BUT before operation and during post operative period (after 2 weeks and 4 weeks) and after 5 weeks were compared using analysis of Variance test.RESULTSOne hundred and forty nine (149) eye surge

9、ries were performed in 132 patients (54 males and 78 females aged between 28 and 78 years). The different surgeries performed are shown in Table 1.The Schirmer test I results before eye surgery are diagnostic of dry eye. The difference between (t1) group and (t2) group is significant (F=2575.34, P&l

10、t;0.01). The difference between t (t1) group and (t3) is significant (F=1725.11, P<0.01). The difference between (t3) group and (t2) group is also significant (F=371.45, P<0.01, Table 2).The BUT results before eye surgery are less than normal; the difference between (t1) group and (t2) group i

11、s significant (F=1356.04, P<0.01). The difference between (t1)group and (t3) group is significant (F=1013.77, P<0.01). The difference between (t3) group and (t2) group is significant (F=234.32,P<0.01,Table 3).During the follow up, some patients defaulted. Only 105 eyes could be subjected fo

12、r Schirmer test I and BUT. The sensation of discomfort disappeared and the result of the Schirmer test I was >8mm, and the BUT test was >8seconds. Then test again a week after drug withdrawal. The Schirmer test I between (t3) group and (t4) group had no statistical significance (F=43.63, P>

13、0.05,Table 4). And the BUT tests between (t3) group and (t4) group had no statistical significance (F=38.58, P>0.05,Table 5).DISCUSSIONAs the knowledge about dry eye are developing and long time follow up after surgery, dry eye after eye surgery are more and more diagnosed. But not every oculist

14、keep their eyes on the ball2,3, so dry eye often be misdiagnosed and not be treated in time, so the disease went worse. In our research, many patients had the symptoms of burning, foreign body sensation and tired eye. We can make sure the dry eye because of the patients chief complaint and the resul

15、t of experiment tests. The mechanism of dry eye after eye surgery is not clear, but earlier studies suggested the following contributory factors to it.Firstly, the structure and function of eye surface may be destroyed by the eye surgery, so the quantity and/or quality of tear may be changed, and th

16、en dry eye occurred. For example, when trabeculectomy be operated, although the concentration and time of mitomycin be controlled strictly, and rinsed carefully, the conjunctiva may be injured4. When we did excision of pterygium, if much conjunctiva be excised, the number of goblet cells and the muc

17、oprotein which secreted by conjunctiva reduced, the quality of tear be changed, then dry eye occurred5.Secondly, Ofloxacin and Tobramycindexamethasone had been used by patients in our experiment, they are used as the Firstline drugs for treatment, have good curative effect. But the side effects can

18、not be ignored1, it has been reported that antibiotic can reduce the lysozyme in the tear6, long time use of tobramycin can reduce the regeneration capacity of cell7. Dexamethasone can cause the dry eye if used continuously for a long time.Thirdly, preservative can also cause the dry eye, Benzalkoni

19、um Chloride is a kind of antiseptic which is generally used now, it can destroy the tight junction and the microvilli of the cornea epithelium, cause the cells apoptosis and necrosis, inhibit cell mitosis and destroy the stabilization of lachrymal film8.Liu7 pointed out that etiological treatment is

20、 the key point of dry eye treatment. Relief the symptoms is prerequisite thing. In this study, we stopped using the eye drops of Ofloxacin and Tobramycindexamethasone after the required period in order to prevent further damage. And use the artificial tears which not containing antiseptic, we used s

21、odium hyaluronate, it was reported9 that sodium hyaluronate can relieve pain and reduce the oxygenderived free radicals, so it can inhibit the inflammatory of ocular surface. It can also accelerate the cell mobility and proliferation, promote wound healing and keep the eye moist. The bFGF is a kind

22、of growth factor which can promote cell regeneration and prevent the corneal neovascularization10. Xu had used sodium hyaluronate and bFGF for the treatment of druginduced dry eye, and the result was very good11.Table 1 Eye surgeries performed in 149 eyes(略)PCIOL = posterior chamber intraocular lens

23、 implantationTable 2Schirmer test I (mm) at different times(n=149 eyes) (略)A:Before eye surgery(t1);B:After 2 weeks of eye surgery(t2);C:After 4 weeks of eye surgery (t3)Table 3 BUT test (seconds) at different times (n=149 eyes)(略)A：Before eye surgery(t1);B：After 2 weeks of eye surgery(t2);C：After 4

24、 weeks of eye surgery(t3)Table 4 Schirmer test I (mm) before and after drug withdrawal (n=105 eyes) (略)A：After 4 weeks of eye surgery(t3);B：After 5 weeks of eye surgery(t4)Table 5 BUT test (seconds) before and after drug withdrawal (n=105 eyes)(略)A：After 4 weeks of eye surgery(t3);B：After 5 weeks of

25、 eye surgery(t4)The cases in our study are all after eye surgery, maybe the change of ocular surface and tear are temporary and reversible, and so it can be cured more easily. The test results before and after treatment was significantly different, and the results before and after drug withdrawal wa

26、s not significantly different. These results showed that the patients conditions had been controlled; the curative effect of sodium hyaluraonate and bFGF in the treatment of dry eye after eye surgery is significant.【參考文獻(xiàn)】1 Perry HD. Dry eye disease: pathophysiology, classification, and diagnosis. Th

27、e American Journal of Managed Care 2008;14(3):79872 Tu Y, Pei S, Jin SH. Analysis of causes of 96 cases with ophthalmoxerosis. Int J Ophthalmol(Guoji Yanke Zazhi)2008;8(3):6416423 Pan LL, Jia H. Clinical feature analysis of middleand oldage patients with dry eye. Int J Ophthalmol(Guoji Yanke Zazhi) 2006; 6(5): 120312064 Yu HH, Deng JY. The clinical research on dia