白内障超声乳化术后应用活血化淤汤的临床观察

背景白内障超声乳化联合人工晶状体（IOL）植入术后的黄斑水肿是影响视功能的主要原因，中医药疗法减轻组织水肿疗效独特，但其对白内障超声乳化术后黄斑水肿的防治作用少有报道。目的探讨口服活血化淤汤对白内障超声乳化联合IOL植入术后黄斑区的保护作用。方法采用病例对照研究设计。单纯年龄相关性白内障行常规超声乳化联合IOL植入术150例180眼分为单纯手术组和手术＋药物组。单纯手术组86例100眼仅行手术治疗，手术＋药物组64例80眼手术后给予活血化瘀汤12I服14d。两组分别于术前，术后1、2、4、6、8和12周对比患眼的最佳矫正视力、角膜反应及前房反应、黄斑中心凹视网膜厚度及黄斑区组织变化情况。结果术后12周手术＋药物组视力≥1．0的跟数分布基本与单纯手术组持平，差异无统计学意义（χ^2=1．066，P〉0.05）。术后1周手术＋药物组房水闪辉的眼数明显少于单纯手术组，差异有统计学意义（χ^2=9．341，P〈0.05）。单纯手术组、手术＋药物组术后2～8周中心凹厚度与术前比较差异均有统计学意义（P〈0.05），术后2～8周手术＋药物组中心凹厚度低于单纯手术组，差异均有统计学意义（t=2．315、2．323、3．104、2．470，P〈0.05）。单纯手术组13眼（13／100，占13％）出现术后黄斑水肿，均发生于术后2～6周，包括中心凹增厚11眼，黄斑囊样水肿2眼，其中10眼术后12周内水肿消失。手术＋药物组3眼（3／80，占3．75％）出现术后黄斑水肿，包括黄斑中心凹增厚2眼及黄斑囊样水肿1眼，发生于术后4—6周，术后12周水肿消失。结论活血化淤汤能够促进超声乳化联合IOL植入术后眼前节炎症的恢复，改善术后黄斑区的功能。

Protective and treating effect of huoxuehuayu decoction on macular edema after phacoemulsification with intraocular lens implantation

Background Macular edema following phacoemulsification with intraocular lens （IOL） implantation is a main factor to influent visual function. The administration of traditional medicine can relieve tissue edema,but its preventive and treatment efficacy on macular edema after phacoemulsification with IOL implantation remaines unclear. Objective This study was to investigate the protective effect of huoxuehuayu decoction on macula after phacoemulsification with IOL implantation. Methods A case-controlled observational study was designed. One hundred and eighty eyes of 150 patients with age-related cataract were randomized into operation group and operation ＋ medicine group. Phacoemulsification with IOL implantation was performed in both groups, but huoxuehuayu decoction was orally administered for 14 days in operation＋medicine group. The best corrected visual acuity,inflammatory reaction of the ocular anterior segment,and macular edema were recorded before operation and 1 week,2,4,6,8 and 12 weeks, and the central macular thickness was measured using optical coherence tomography. Results Twelve weeks after surgery,the ratio of visual acuity ≥ 1. 0 was in significantly higher in operation＋medition group than that of in operation group（χ^2 = 1. 066,P〉0.05 ）. One week after surgery, the eyes of the aqueous flare were much more in the operation group than that of operation＋medicine group（χ^2 = 9. 341,P〈0.05 ）. The thickness of the central fovea was significantly increased in both groups at 1 week, 2,4,6,8 and 12 weeks after surgery, showing significant differences in comparison with preoperation （ operation group ： P 〈 0.01 ; operation ＋ medicine group ： P 〈 0.05 ）. Macular edema occurred in 13 eyes in operation group during the following-up duration, including 11 eyes with thickened fovea and 2 eyes with cystoid macular edema. Macular edema disappeared in 10 eyes 12 weeks later. In the operation＋medition group,3 eyes happened macular edema,including thickened fovea in 2 eye and cystoid macular edema in 1 eye. Four to six weeks after surgery, macular edema disappeared in 3 eyes 12 weeks later. The fovea thickness in the operation＋medicine group was statistically significantly lower from 2 through 8 weeks after surgery than that in the operation group（t = 2. 315,2. 323,3. 104,2. 470,P〈0.05）. Conclusions Oral administration of huoxuehuayu decoction is helpful for the restoration of the anterior ocular segment. Huoxuehuayu decoction can protect macula from the edema induced by phacoemulsification.