[关键词]
[摘要]
目的：观察术前干眼综合治疗在白内障合并糖尿病患者中的术前及术后临床疗效，重点比较两组患者术后干眼症状、泪膜功能、视力恢复及并发症发生情况的差异，为该类患者围手术期管理及长期预后改善提供有效方案。
方法：选取2023年5月至2024年12月收治于本院并确诊为白内障合并糖尿病，同时存在不同程度干眼症状，拟行白内障手术的患者作为研究对象，按随机数字法分为两组：对照组仅接受玻璃酸钠滴眼液治疗，试验组采用术前干眼综合治疗(玻璃酸钠滴眼液+热敷+睑板腺清洁按摩+中药熏蒸+健康指导)。分别比较两组患者治疗前，治疗4 wk的泪膜破裂时间(BUT)、角膜荧光染色(FL)情况、眼表疾病指数(OSDI)评分、泪河高度(TMH)、非侵入性泪膜破裂时间(NIBUT)，并评估睑板腺缺失情况及泪膜脂质层厚度、基础眼部症状。
结果：本研究纳入患者60例60眼，对照组30例30眼(年龄56.24±10.24岁，男13例，女17例)，试验组30例30眼(年龄58.01±9.79岁，男15例，女15例)。治疗4 wk后，试验组BUT从4.09±1.13 s升至10.35±1.46 s，对照组从4.15±1.05 s升至8.26±1.36 s，两组具有差异(t=5.737，P<0.001)； 试验组FL评分从6.83±0.46分降至2.86±0.38分，对照组从6.79±0.39分降至5.32±0.43分(t=23.480，P<0.001)； 治疗4 wk后，试验组NIBUT从5.19±1.12 s升至9.36±1.47 s，对照组从5.21±1.04 s升至7.18±1.25 s(t=6.188，P<0.001)。试验组泪膜脂质层偏薄比例均显著高于对照组(均P<0.01)。两组患者治疗后的眼部临床症状评分均较前下降，且试验组低于对照组(均P<0.001)。
结论：术前干眼综合治疗可从多维度改善白内障合并糖尿病患者干眼症状与泪膜稳定性，为白内障患者围手术期管理提供有效方案。
[Key word]
[Abstract]
AIM: To observe the preoperative and postoperative clinical efficacy of comprehensive dry eye treatment in cataract patients complicated with diabetes mellitus, with a focus on comparing the differences between the two groups in terms of postoperative dry eye symptoms, tear film function, visual recovery, and complication rates, aiming to provide an effective protocol for the perioperative management and long-term prognosis improvement in this patient population.
METHODS:Patients diagnosed with both cataract and diabetes mellitus and presenting with varying degrees of dry eye symptoms, scheduled for cataract surgery at the hospital from May 2023 to December 2024, were enrolled as study subjects. They were divided into two groups using a random number method: the control group received sodium hyaluronate eye drops alone, and the experimental group underwent comprehensive preoperative dry eye treatment(sodium hyaluronate eye drops+warm compress+meibomian gland cleaning and massage+Chinese herbal fumigation+health guidance). Tear film breakup time(BUT), corneal fluorescein staining(FL), Ocular Surface Disease Index(OSDI)score, tear meniscus height(TMH), and non-invasive first tear film breakup time(NIBUT)were compared between the two groups before and after 4 wk of treatment. Meibomian gland loss, tear film lipid layer thickness, and basic ocular symptoms were also assessed.
RESULTS:This study included 60 eyes of 60 patients, with a control group of 30 eyes of 30 patients(aged 56.24±10.24 y, 13 males and 17 females)and an experimental group of 30 eyes of 30 patients(aged 58.01±9.79 y, 15 males and 15 females).After 4 wk of preoperative treatment, the BUT in the experimental group increased from 4.09±1.13 s to 10.35±1.46 s, and from 4.15±1.05 s to 8.26±1.36 s in the control group, showing a significant intergroup difference(t=5.737, P<0.001). The FL score in the experimental group decreased from 6.83±0.46 points to 2.86±0.38 points, whereas in the control group it decreased from 6.79±0.39 points to 5.32±0.43 points(t=23.480, P<0.001). After 4 wk of treatment, the NIBUT in the experimental group increased from 5.19±1.12 s to 9.36±1.47 s, compared to an increase from 5.21±1.04 s to 7.18±1.25 s in the control group(t=6.188,P<0.001). The proportion of patients with a thin tear film lipid layer was significantly higher in the experimental group than in the control group(all P<0.01). Ocular clinical symptoms decreased after treatment in both groups, with the experimental group showing lower scores than the control group(all P<0.001).
CONCLUSION:Preoperative comprehensive dry eye treatment can multi-dimensionally improve dry eye symptoms and tear film stability in cataract patients with diabetes mellitus, providing an effective strategy for the perioperative management of cataract patients.
[中图分类号]
[基金项目]
惠州市科技计划项目(No.2024CZ010192)
