Objective: To compare the curative effect of two different artificial tears on dry eye after phacoemulsification. Methods: Prospective randomized controlled clinical trial. From March to June in 2012, 102 patients (102 eyes) with age-related cataract were treated with phacoemulsification at Beijing Tongren Hospital, Capital University of Medical Sciences, and these eyes were randomly divided into blank group (group A ) 32 cases, treatment group 1 (group B) 35 cases and treatment group 2 (group C) 35 cases. Group A was treated with conventional antibiotics. Group B was sodium hyaluronate eye drop, group C was lipid-containing carbomer gel respectively. All patients finished a dry eye questionnaire called Ocular Surface Disease Index (OSDI), and Schimmer's test (SIt), break up time (BUT) and fluorescein staining (FL) tests were performed before surgery and at 7, 30 and 90 days after surgery respectively. Optometry were performed at 90 days after surgery. The χ(2) test was used to analyze the sex of the patients, and the age of the patients was analyzed by one-way ANOVA. Partial data in eye tests and in OSDI does not meet the normal distribution. Therefore, they were analyzed by Kruskal-Wallis H test. If significant difference existed, these data were then analyzed by independent sample Wilcoxon rank sum test. Results: Twelve patients were lost to visit within 3 months. A total of 90 patients were followed up for 90 days. The mean age of all patients was (69.5±9.5) years (46.0-89.0 years), 38 males and 64 females. There were 30 patients in Group A, group B and group C respectively. The prevalence of dry eye was 56. 7% (60/102). There was no significant difference among the three groups (P>0.05). OSDI questionnaire showed that OSDI score was significantly different among the three groups at 7, 30 and 90 days after operation (H=9.89, 55.53, 45.43, P<0.05). At 30 and 90 days after operation, the median OSDI scores were 12.50 and 10.42 in group C, respectively, which were better than those of group A scores 27.09 and 20. 8 (Z=- 6.30, -5.94, P<0.05), and were better than those of group B scores 17.71 and 13. 54 (Z=-3.40, -3.52, P<0.05). At 90 days after operation, the median BUT of B and C treatment groups was 9. 00, which was better than that of group A (4.00). The difference was statistically significant (H=21.51, P<0.05), There was no significant difference between group B and group C (Z=-0.34, P>0.05). Conclusion: The treatment of artificial tears with lipid composition in the early stage after phacoemulsification is beneficial to the improvement of postoperative symptoms and signs of dry eye. (Chin J Ophthalmol, 2017, 53: 445-450).
目的： 比较两种不同的人工泪液对超声乳化白内障吸除术后干眼的疗效。 方法： 前瞻性的随机对照临床设计。选取2012年3月至6月在首都医科大学附属北京同仁医院行超声乳化吸除术的年龄相关性白内障患者102例，共102只眼，应用随机表随机数余数分组法分为空白组（A组） 32例、治疗1组（B组）35例和治疗2组（C组）35例。空白组术后予常规抗炎治疗，治疗组加用人工泪液（B组为玻璃酸钠滴眼液，C组为含脂质成分的卡波姆凝胶）点眼，分别于术前，术后7、30及90 d对患者进行干眼问卷调查（OSDI ）、基础泪液分泌试验（SIT）、泪膜破裂时间检查（BUT）、角膜荧光染色检查（FL），并在术后90 d进行显然验光。采用χ(2)检验对患者的性别进行统计分析，采用单因素方差分析对患者的年龄进行统计分析。术前及术后眼部检查以及问卷调查中因部分数据不符合正态分布，应用中位数表示平均值，并采用Kruskal-Wallis H检验对3组样本进行检验，差异存在统计学意义的再选用独立样本Wilcoxon秩和检验对数据进行统计分析。 结果： 3个月内有12例患者失访，共90例患者完成90 d的随访。所有患者平均年龄为（69.5±9.5）岁（46.0~ 89.0岁），男性38例，女性64例。其中空白组30例、治疗1组30例和治疗2组30例。术前患者干眼症患病率达到了56.7%（60/102），3组患者各项检查值的差异无统计学意义（P>0.05）。OSDI问卷结果显示，术后7、30和90 d 3组患者的OSDI评分差异具有统计学意义（H=9.89、55.53、45.43，P<0.05），在术后30和90 d ，C组OSDI评分中位数分别为12.50和10.42，优于A组评分27.09和20.8（Z=-6.30、-5.94，P<0.05），也优于B组评分17.71和13.54（Z=-3.40、-3.52，P<0.05）；在术后90 d时，B、C两治疗组的BUT检查中位数均为9.00，优于A组检查中位数4.00，差异具有统计学意义（H=21.51 ，P<0.05），B组与C组间差异无统计学意义（Z=-0.34，P>0.05）。 结论： 超声乳化白内障吸除术后早期给予含有脂质成分的人工泪液治疗，更有利于术后干眼症状与体征的改善。（中华眼科杂志，2017，53：445-450）.
Keywords: Dry eye syndromes; Ophthalmic solutions; Phacoemulsification; Tears.