普拉洛芬滴眼液对白内障围手术期角膜内皮和泪液炎症因子的影响

Effects of pranoprofen eye drops on corneal endothelium and tears inflammatory factors in perioperative period of cataract

摘要:

目的：观察眼局部滴用普拉洛芬滴眼液对白内障围手术期角膜内皮和泪液炎性指标的影响。

方法：将拟行白内障超声乳化吸除术的年龄相关性白内障患者60例60眼(术前检查排除糖尿病、其他全身疾病史、其他眼病史和非甾体类药物过敏史，患者为第一次行眼科手术)随机分为4组，每组患者15例15眼。每组患者常规术前滴用左氧氟沙星滴眼液3d，4次/d，术后滴妥布霉素地塞米松第1wk 3次/d，第2wk 2次/d，之后停药。A组患者为对照组，不加其他药物； B组仅术前3d滴普拉洛芬滴眼液，4次/d； C组仅术后滴普拉洛芬滴眼液4次/d，1wk； D组术前3d和术后1wk滴普拉洛芬滴眼液，4次/d。所有患者的手术由同一位眼科医生完成，使用同一台超声乳化机器，术中超声能量的参数设置不变。分别于手术前(滴眼药水前)、术后1wk，1、3mo随访，前节OCT测量角膜中央厚度，角膜内皮计数仪测量角膜内皮细胞计数，计数内皮细胞丢失率=(术前内皮细胞数-术后内皮细胞数)/术前内皮细胞数×100%，ELISA法测定泪液中的炎性因子白介素-6(IL-6)、肿瘤坏死因子(TNF)。

结果：患者性别、年龄和手术过程中超乳时间之间差异无统计学意义。泪液中炎性因子IL-6的含量在B组术前与术后3mo比较差异无统计学意义(P>0.05)，其他各组之间在不同时间点的比较，差异都有统计学意义(P<0.05)。术前四组之间的比较差异无统计学意义(P>0.05)。术后1wk时A组与其他三组比较差异有统计学意义(P<0.05)，B组和D组之间差异有统计学意义(P<0.05)，B组和C组、C组和D组之间比较差异无统计学意义(P>0.05)。术后1mo时A组与其他三组比较差异有统计学意义(P<0.05)，B组和C组、C组和D组比较差异有统计学意义(P<0.05)，B组和D组之间比较差异无统计学意义(P>0.05)。术后3mo时A组与其他三组比较差异有统计学意义(P<0.05)，B、C、D组各组之间差异无统计学意义(P>0.05)。泪液中炎性因子TNF的含量在各组之间在不同时间点的比较，差异都有统计学意义(P<0.05)。术前四组之间的比较差异无统计学意义(P>0.05)。术后1wk时A组与其他三组比较差异有统计学意义(P<0.05)，B、C、D组各组之间差异无统计学意义(P>0.05)。术后1mo时A组与其他三组比较差异有统计学意义(P<0.05)，B组和C组、C组和D组比较差异有统计学意义(P<0.05)，B组和D组之间比较差异无统计学意义(P>0.05)。术后3mo时A组与其他三组比较差异有统计学意义(P<0.05)，B、C、D组之间差异无统计学意义(P>0.05)。

结论：白内障围手术期何时应用普拉洛芬滴眼液都不增加角膜内皮细胞的丢失率，可安全使用。围手术期使用普拉洛芬可显著降低泪液中的炎性因子，术后开始应用普拉洛芬滴眼液对降低泪液中的炎性因子的作用在术后早期没有另外两种给药方式明显，但3mo时差异无统计学意义。术前术后都使用与单纯术前使用普拉洛芬滴眼液在降低泪液中的炎性因子的作用上无明显优势。

Abstract:

AIM: To observe the effect of pranoprofen eye drops on corneal endothelium and tears inflammatory factors in perioperative period of cataract surgery.

METHODS: Totally 60 cases(60 eyes)of senile cataract patients were enrolled in this study. Patients with diabetes or other systemic diseases, with other eye diseases or eye surgery, drug allergy were excluded. All the patients were given ophthalmic surgery for the first time. All the patients were randomly divided into 4 groups, 15 patients per group. Each group of patients had been given levofloxacin eye drops preoperatively for 3d, 4 times per day, and tobramycin dexamethasone eye drops postoperatively, 3 times per day for the first week, 2 times per day for the second week. Group A was the control group, without any other drugs. Group B was given pranoprofen eye drops 4 times per day for 3d before the operation. Group C was given pranoprofen eye drops 4 times per day for 1wk after the operation. Group D was given pranoprofen eye drops 4 times per day for 3d before the operation and 1wk after the operation. All the surgeries were done by the same ophthalmologist, using the same phacoemulsification machine and the same ultrasound energy parameters. The loss rate of endothelial cell was measured by corneal endothelium counterometry. Interleukin-6(IL-6)and tumor necrosis factor(TNF)in the tear fluid were measured by ELISA before surgery(before using eye drops)and 1wk, 1mo and 3mo postoperatively.

RESULTS: There was no significant difference in patients' gender, age and phacoemulsification time among 4 groups. The levels of inflammatory cytokines IL-6 in the tear fluid of the Group B before surgery had no significant difference compared to that at 3mo postoperatively(P>0.05), but the differences among the other groups at different time points were statistically significant(P<0.05). There was no significant difference in preoperative among the four groups(P>0.05). At 1wk after the operation, there was significant difference between the Group A and the other three groups(P<0.05), and there was significant difference between the Group B and the Group D(P<0.05), but there was no significant difference between the Group B and the Group C, the Group C and the Group D(P>0.05). At 1mo after the operation, there was significant difference between the Group A and the other three groups(P<0.05), and there was significant difference between the Group B and the Group C, the Group C and the Group D(P<0.05), but there was no significant difference between the Group B and the Group D(P>0.05). At 3mo after the operation, there was significant difference between the Group A and the other three groups(P<0.05), but there was no significant difference between the Group B, the Group C and the Group D(P>0.05). The levels of inflammatory cytokines TNF in the tear fluid at different time points among each group were significantly different(P<0.05). There was no significant difference among the four groups in preoperative(P>0.05). At 1w after the operation, there was significant difference between the Group A and the other three groups(P<0.05), but there was no significant difference between the other three groups respectively(P>0.05). At 1mo after the operation, there was significant difference between the Group A and the other three groups(P<0.05), and there was significant difference between the Group B and the Group C, the Group C and the Group D(P<0.05), but there was no significant difference between the Group B and the Group D(P>0.05). At 3mo after the operation, there was significant difference between the Group A and the other three groups(P<0.05), but there was no significant difference between the other three groups respectively(P>0.05).

CONCLUSION: Pranoprofen eye drops have no effect on the loss rate of corneal endothelium. Pranoprofen eye drops could significantly reduced the tears inflammatory factors in perioperative period of cataract surgery. The role to reduce inflammatory cytokines in the postoperative application of pranoprofen eye drops is not obvious compared to other two modes of administration, but the difference is not statistically significant at 3mo. The administration of preoperative and postoperative use of pranoprofen eye drops has no significant advantage in reducing inflammatory cytokines compared with only preoperative use.