氯替泼诺、氟米龙、环孢素、溴芬酸钠分别联合玻璃酸钠治疗中重度干眼的临床观察

目的:观察氯替泼诺、氟米龙、环孢素、溴芬酸钠分别联合玻璃酸钠治疗中重度干眼的疗效及安全性。方法:将100例(200只眼)中重度干眼患者随机均分为5组,均以0.1%玻璃酸钠滴眼液(qid)为基础用药,4个研究组分别联合0.5%氯替泼诺滴眼液(tid)、0.1%氟米龙滴眼液(tid)、1%环孢素滴眼液(tid)、0.1%溴芬酸钠水合物滴眼液(bid),对照组不联用其他药物,各组疗程均为8周。于治疗前及治疗2、4、6、8周后比较各组患者的干眼症状评分、泪膜破裂时间(BUT)、角膜荧光素染色(FL)评分、泪液分泌试验(SchirmerⅠ)结果、非接触眼压,并观察不良反应发生情况。结果:联合氯替泼诺组、联合氟米龙组患者治疗2、4、6、8周后的干眼症状评分、BUT、FL评分均较治疗前显著改善(P<0.05),且均显著优于对照组、联合环孢素组、联合溴芬酸钠组(P<0.05),而两组间比较差异均无统计学意义(P>0.05);联合环孢素组患者治疗4、6、8周后的干眼症状评分、BUT、FL评分均较治疗前显著改善(P<0.05),且均显著优于对照组、联合溴芬酸钠组(P<0.05)。各组患者治疗后不同时间的SchirmerⅠ结果、非接触眼压均无显著变化(P>0.05)。联合环孢素组患者眼部刺痛、烧灼感发生率显著高于其他几组(P<0.05);仅联合氟米龙组患者发生1例眼压显著升高。结论:氯替泼诺、氟米龙联合玻璃酸钠治疗中重度干眼起效快,可以明显改善症状、缩短疗程,优于其他3种方案,而氯替泼诺较氟米龙相对更安全。环孢素联合玻璃酸钠疗效优于溴芬酸钠联合玻璃酸钠和单用玻璃酸钠,但耐受性较差。

Clinical Observation of Loteprednol,Fluorometholone, Cyclosporine or Bromfenac Sodium Combined with Sodium Hyaluronate in the Treatment of Moderate and Severe Dry Eye Syndrome

OBJECTIVE： To observe therapeutic efficacy and safety of loteprednol, fluorometholone, cyclosporine or bromfe- nac sodium combined with sodium hyaluronate in the treatment of moderate and severe dry eye syndrome. METHODS： 100 pa- tients （200 eyes） with moderate and severe dry eye syndrome were randomly divided into 5 groups. All groups were given 0.1% Sodium hyaluronate eye drops （qid） as routine treatment. 4 study groups were given 0.5% Loteprednol eye drops （tid）, 0.1% Fluo- rometholone eye drops （tid）, 1% Ciclosporin eye drops （rid） or 0.1% Bromfenac sodium hydrate eye drops （bid）, respectively. Control group was not given any other drugs. Treatment course of them lasted for 8 weeks. Finally, dry eye syndrome score, break- up time （BUT） of lacrimal film, corneal fluorescein staining （FL）, Schirmer test （Sehirmer I ）, non-contact lOP and ADR were observed before and 2, 4, 6 and 8 weeks after treatment. RESULTS： Compared with before treatment, dry eye syndrome score, BUT and FL of combined with loteprednol group and combined with fluorometholone group were improved significantly after 2, 4, 6 and 8 weeks of treatment （P〈0.05）, and significantly better than those of control group, combined with ciclosporin group and combined with bromfenac sodium hydrate group （P〈0.05）; there was no statistical significance between 2 groups （P〉 0.05）. Compared with before treatment, dry eye syndrome score, BUT and FL of combined with ciclosporin group were all improved significantly after 4, 6 and 8 weeks of treatment, and significantly better than those of control group and combined with bromfenac sodium hydrate group （P〈0.05）. Schirmer 1 and non-contact IOP of those groups had no significant change after treatment （P〉 0.05）. The incidence of smarting pain around eye and burning sensation in combined with cielosporin group were significantly high- er than other 4 groups （P〈0.05）. Only one patient in combined with fluorometholone group suffered from sig