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DISCUSSION
As the knowledge about dry eye are developing and long time follow up after surgery, dry eye after eye surgery are more and more diagnosed. But not every oculist keep their eyes on the ball[2,3], so dry eye often be misdiagnosed and not be treated in time, so the disease went worse. In our research, many patients had the symptoms of burning, foreign body sensation and tired eye. We can make sure the dry eye because of the patients chief complaint and the result of experiment tests. The mechanism of dry eye after eye surgery is not clear, but earlier studies suggested the following contributory factors to it.
Firstly, the structure and function of eye surface may be destroyed by the eye surgery, so the quantity and/or quality of tear may be changed, and then dry eye occurred. For example, when trabeculectomy be operated, although the concentration and time of mitomycin be controlled strictly, and rinsed carefully, the conjunctiva may be injured[4]. When we did excision of pterygium, if much conjunctiva be excised, the number of goblet cells and the mucoprotein which secreted by conjunctiva reduced, the quality of tear be changed, then dry eye occurred[5].
Secondly, Ofloxacin and Tobramycindexamethasone had been used by patients in our experiment, they are used as the Firstline drugs for treatment, have good curative effect. But the side effects can not be ignored[1], it has been reported that antibiotic can reduce the lysozyme in the tear[6], long time use of tobramycin can reduce the regeneration capacity of cell[7]. Dexamethasone can cause the dry eye if used continuously for a long time.
Thirdly, preservative can also cause the dry eye, Benzalkonium Chloride is a kind of antiseptic which is generally used now, it can destroy the tight junction and the microvilli of the cornea epithelium, cause the cells apoptosis and necrosis, inhibit cell mitosis and destroy the stabilization of lachrymal film[8].
Liu[7] pointed out that etiological treatment is the key point of dry eye treatment. Relief the symptoms is prerequisite thing. In this study, we stopped using the eye drops of Ofloxacin and Tobramycindexamethasone after the required period in order to prevent further damage. And use the artificial tears which not containing antiseptic, we used sodium hyaluronate, it was reported[9] that sodium hyaluronate can relieve pain and reduce the oxygenderived free radicals, so it can inhibit the inflammatory of ocular surface. It can also accelerate the cell mobility and proliferation, promote wound healing and keep the eye moist. The bFGF is a kind of growth factor which can promote cell regeneration and prevent the corneal neovascularization[10]. Xu had used sodium hyaluronate and bFGF for the treatment of druginduced dry eye, and the result was very good[11].
Table 1 Eye surgeries performed in 149 eyes（略）
PCIOL = posterior chamber intraocular lens implantation
Table 2Schirmer test I (mm) at different times(n=149 eyes) （略）
A:Before eye surgery(t1);B:After 2 weeks of eye surgery(t2);C:After 4 weeks of eye surgery (t3)
Table 3 BUT test (seconds) at different times (n=149 eyes)（略）
A：Before eye surgery(t1)；B：After 2 weeks of eye surgery(t2)；C：After 4 weeks of eye surgery(t3)
Table 4 Schirmer test I (mm) before and after drug withdrawal (n=105 eyes) （略）
A：After 4 weeks of eye surgery(t3)；B：After 5 weeks of eye surgery(t4)
Table 5 BUT test (seconds) before and after drug withdrawal (n=105 eyes)（略）
A：After 4 weeks of eye surgery(t3)；B：After 5 weeks of eye surgery(t4)
The cases in our study are all after eye surgery, maybe the change of ocular surface and tear are temporary and reversible, and so it can be cured more easily. The test results before and after treatment was significantly different, and the results before and after drug withdrawal was not significantly different. These results showed that the patients conditions had been controlled; the curative effect of sodium hyaluraonate and bFGF in the treatment of dry eye after eye surgery is significant.
【参考文献】
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