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目的探讨短期局部应用抗青光眼药物对患者眼表的影响。设计前瞻性病例系列。研究对象原发性开角型青光眼患者18例32眼,激光周边虹膜切除术后眼压偏高需要联合局部抗青光眼药物治疗的原发性闭角型青光眼患者9例12眼。方法将研究对象根据用药种类分为3组:噻吗洛尔组、酒石酸溴莫尼定组和布林佐胺组。所有患者均局部使用一种抗青光眼药物,每日滴用2次。用药前、用药后1个月、2个月和3个月行泪膜破裂时间(BUT)、基础泪液分泌试验(ST)、结膜印迹细胞(IC)检查和评分。主要指标泪膜破裂时间、泪液分泌值和印迹细胞检测评分。结果全部患者用药前BUT的平均值为(5.83±3.74)秒,用药后1个月、2个月和3个月分别为(5.75±3.32)秒、(5.14±3.02)秒和(4.58±2.87)秒;用药前ST平均值为(6.39±3.98)mm,用药后1个月、2个月和3个月分别为(6.16±3.52)mm、(5.59±3.62)mm和(5.02±3.23)mm。用药后1个月BUT值(P=0.335)和ST值(P=0.504)与用药前比较无统计学差异;用药2个月后BUT值和ST值均显著低于用药前水平(P=0.000)。各用药组BUT和ST的变化趋势与总体变化趋势一致。用药后3个月结膜印迹细胞学发生改变,表现为结膜上皮细胞角化,杯状细胞减少,IC评分与用药前比较有统计学差异(P=0.046)。结论使用噻吗洛尔、酒石酸溴莫尼定或布林佐胺滴眼液2个月即可导致患者泪膜稳定性下降,泪液分泌减少;使用3个月后可引起结膜上皮的损伤。
Objective To investigate the short-term topical application of anti-glaucoma drugs on the ocular surface of patients. Design prospective case series. The study included 32 eyes of 18 patients with primary open-angle glaucoma and 9 eyes of 12 patients with primary angle-closure glaucoma treated with topical anti-glaucoma medications underwent high IOP after laser iridectomy. Methods The subjects were divided into three groups according to the types of drugs: timolol group, brimonidine tartrate group and brinzolamide group. All patients were topically treated with an anti-glaucoma medication twice daily. The tear film break-up time (BUT), basal tear secretion test (ST), conjunctival impression cell (IC) examination and score were performed before treatment, 1 month, 2 months and 3 months after treatment. The main indicators of tear film rupture time, tear secretion value and imprinted cell test score. Results The average value of BUT before treatment in all patients was (5.83 ± 3.74) s and (5.75 ± 3.32) s, (5.14 ± 3.02) s and (4.58 ± 2.87) at 1 month, 2 months and 3 months after treatment, ), The average value of ST before treatment was (6.39 ± 3.98) mm, and were (6.16 ± 3.52) mm, (5.59 ± 3.62) mm and (5.02 ± 3.23) at 1 month, 2 months and 3 months after treatment, mm. There was no significant difference in BUT value (P = 0.335) and ST value (P = 0.504) at 1 month after treatment and BUT value and ST value at 2 months after treatment were significantly lower than those before medication (P = 0.000 ). The change tendency of BUT and ST in each treatment group was consistent with the overall change trend. The cytology of conjunctival imprints changed 3 months after treatment, showing keratoconjunctival conjunctival epithelial cells, goblet cells decreased, IC score compared with before treatment was statistically significant (P = 0.046). Conclusion The use of timolol, brimonidine tartrate or brinzolamide eye drops 2 months can lead to decreased tear film stability in patients with tear secretion decreased; 3 months after use can cause conjunctival epithelial damage.