表皮生长因子在白内障超声乳化术后眼表损伤修复过程中的作用

背景 随着白内障超声乳化联合后房型人工晶状体(IOL)植入术治疗年龄相关性白内障的广泛应用,部分患者术后感到明显的烧灼感、异物感,该手术对患者眼表的损伤及影响多有报道. 目的 观察重组人表皮生长因子(rhEGF)对年龄相关性白内障患者行白内障超声乳化联合IOL植入术后眼表损伤的修复作用.方法 采用前瞻性研究方法.选择确诊为年龄相关性白内障并行白内障超声乳化联合IOL植入术的患者89例120眼,依据术后第1天给予滴眼液的不同分为rhEGF组、玻璃酸钠组和空白对照组,每组40眼.各组间术前角膜荧光素染色、泪膜破裂时间(BUT)及泪液分泌(Schirmer Ⅰ)试验结果差异均无统计学意义(均P＞0.05).各组基础用药为质量分数0.3％氧氟沙星眼膏和妥布霉素地塞米松滴眼液,持续2周.术后第1天rhEGF组和玻璃酸钠组分别给予rhEGF滴眼液、玻璃酸钠滴眼液点眼,每日4次,持续4周.患者分别于术前1d及术后1d、1周、2周和1个月时行角膜荧光素染色、BUT及Schirmer Ⅰ试验检测,并进行比较分析.结果 3个组间人口基线特征差异均无统计学意义(F年龄=3.740,x2性别=0.615,P＞0.05),术前1d眼表检查差异亦无统计学意义(角膜荧光素染色评分:F=0.247,P＞0.05:BUT:F=0.579,P＞0.05；Schirmer Ⅰ试验:F=0.475,P＞0.05).随着术后时间的延长,各组内角膜荧光素染色评分、Schirmer Ⅰ试验结果均出现先升高后下降的趋势,BUT出现先缩短后延长的趋势,3个组术前1d,术后1d、1周、2周、1个月时角膜荧光素染色评分值、BUT、Schirmer Ⅰ试验结果各时间点间差异均有统计学意义(F时间=6.754、6.233、6.079,P＜0.01)；3个组间差异亦有统计学意义( F分组=4.953、4.071、4.511,P＜0.05).rhEGF组术后2周和术后1个月角膜荧光素染色评分明显低于玻璃酸钠组(P=0.039、0.014),1个月时恢复至术前水平(P=0.137).rhEGF组术后1周和2周时BUT均明显高于玻璃酸钠组(P=0.019、0.007),于2周时恢复至术前水平(P=1.009).rhEGF组在术后1周、2周、1个月时Schirmer Ⅰ试验值均明显低于玻璃酸钠组(P=0.022、0.003、0.019),于2周时恢复至术前水平(P=0.052).结论 rhEGF可明显促进白内障超声乳化术后眼表损伤的修复.

The effects of recombinant human epithelial growth factor on ocular surface injury after phacomulsification

Background With the widely application of phacoemulsication for cataract, dry eye-associated symptoms, such as foreign body sensation and burning frequently occur after cataract surgery in some patients. Objective This study was to evaluate the repair effects of recombinant human epithelial growth factor （rhEGF） on ocular surface injuriy after phaeomulsifieation. Methods This was a prospective study, and informed consent was obtained from eaeh subjeet before the experiment. One hundreds and twenty eyes of 89 consecutive patients after phacomulsification for age-related cataract were collected and randomized into rhEGF group,hyaluronic acid group and control group and 40 eyes for eaeh. RhEGF drops and hyaluronie aeid drops were topieally administered 4 times per day for consecutive 4 weeks after surgery in corresponding group, and no drops mentioned above was used in the control group. The 0.3% ofloxacin eye ointment and tobramyein＋dexamethasone drops were used as the element drops in all patients of each group. Corneal fluoreseein staining score, tear film break-up time （BUT） , Schirmer Ⅰ test without topical anesthesia were performed 1 day before surgery and 1 day, 1 week,2 weeks and 1 month after surgery. Results The demography and the relevant surface examinational outcomes were no significantly different among the rhEGF group,hyaluronie acid group and control group in preoperation （age： F = 3.74; gender：Х^2= 0. 615; corneal fluorescein staining： F=0. 247 ; BUT： F = 0. 579 ; Schirmer Ⅰ test： F = 0. 475 ; all P〉0.05 ）. With the prolong of the time,the corneal fluorescein staining scores and Schirmer Ⅰ test values appeared a early ascent and latterly decline, and the BUT value showed a early shorten and latterly restore,with a statistically significant differences among various time points （ F时间 = 6. 754,6. 079,6. 233, P 〈 0.01 ）. Meanwhile, statistically significant differences were found in the corneal fluorescein staining scores, Schirmer Ⅰ test values and BUT among these 3 groups （F分组 = 4. 953,4. 511, 4. 071 , P〈0.05 ）. The corneal fluorescein staining scores in the rhEGF group were significantly lower than those in the hyaluronic acid group at 2 weeks and 1 month after operation（P=0. 039,0. 014） ,and the BUT values in the rhEGF group were significantly longer than ones in the hyaluronic acid group at 1 week and 2 weeks after operation （ P = 0. 019,0. 007）. The Schirmer Ⅰ test values were significantly reduced in the rhEGF group compared with hyaluronic acid group at 1 week,2 weeks and 1 month after operation （P=0.022,0.003,0.019）. Conclusions RhEGF promotes the repair of the ocular surface injury in the patients with age-related cataract after phacomulsification.