| Objectives: To observe the changes of dry eye symptoms and signs after cataract phacoemulsification combined with intraocular lens implantation in patients with mild and moderate dry eye treated before cataract surgery,and to explore the effect and mechanism of Chinese herbal fumigation on dry eye after cataract surgery.Methods: From July 2022 to December 2022,55 cases(62 eyes)of age-related cataract patients with mild to moderate dry eye syndrome who underwent phacoemulsification and intraocular lens implantation in our ophthalmology department were selected as the study group,including 29 cases(32 eyes)in the Chinese medicine group,1-2 days before surgery,traditional Chinese medicine eye fumigation combined with meibomian gland massage treatment was given(formula:12g cassia seed,12 g chrysanthemum,15 g sophora flavescens,12 g goji berry,15 g fangfeng,15 g atractylodes macrocephala,12 g white fresh skin,6g Guanzhong,12 g Qinpi,200 ml water added,decocted for 20 minutes);26 cases(30 eyes)in the non traditional Chinese medicine group were treated with saline fumigation combined with meibomian gland massage 1-2 days before surgery.Twenty eight patients(32eyes)with age-related cataract and mild to moderate dry eye disease who underwent phacoemulsification and intraocular lens implantation at the same time were selected as the control group.Inquire and collect basic medical history data from all patients,improve eye related examinations(vision,intraocular pressure,I-master,etc.),and record the International Eye Disease Index(OSDI)scores,tear film rupture time(BUT),tear secretion test(SIT),corneal fluorescence staining(FL)scores of three groups before surgery(before treatment),one week after surgery,and one month after surgery Scoring of the opening status of the meibomian gland and the occurrence of adverse events(eyelid edema,conjunctival congestion,corneal injury)during the treatment process.Nine patients in each group were selected to measure their tear levels of IL-6 and IL-1β、TNF-α before surgery(before treatment),one week after surgery,and one month after surgery.Results: There were no significant differences in age and gender among all groups(P > 0.05),and no significant differences in preoperative(before treatment)OSDI,BUT,SIT,FL scores and meibomian gland opening scores among all groups(P >0.05).OSDI,FL scores and meibomian gland opening status scores of 3 groups 1week after surgery were increased compared with those before surgery(P < 0.05),BUT decreased compared with those before surgery(P < 0.001),and there was no statistical significance in SIT compared with those before surgery(P > 0.05).At 1week after operation,FL score and meibomian gland opening status score in TCM group were significantly lower than those in control group(P < 0.05),BUT significantly higher than those in control group(P < 0.05).One month after surgery,FL score and meibomian gland opening status score of the study group were lower than that of the first week after surgery(P < 0.05),while FL score and meibomian gland opening status score of the control group were not significantly different than that of the first week after surgery(P > 0.05).There were no significant differences in SIT,OSDI and BUT among the three groups 1 month after surgery compared with 1week after surgery(P > 0.05).One month after surgery,the OSDI score of the control group was still higher than that before surgery(P < 0.05),the OSDI score of the non-Chinese medicine group was not significantly different from that before surgery(P > 0.05),and the OSDI score of the Chinese medicine group was lower than that before surgery(P < 0.05).One month after surgery,BUT of the control group was still lower than before surgery(P < 0.05),BUT of the study group was not statistically significant compared with before surgery(P > 0.05).One month after surgery,the SIT of the study group was higher than that before surgery(P < 0.05),while the SIT of the control group was not statistically significant(P > 0.05).1 month after surgery,FL score of control group was still higher than that before surgery(P < 0.05),but there was no significant difference in FL score of study group compared with that before surgery(P > 0.05).One month after operation,the score of meibomian gland opening status in control group was still higher than that before surgery(P < 0.05),there was no significant difference in the score of meibomian gland opening status in non-Chinese medicine group compared with that before surgery(P > 0.05),and the score of meibomian gland opening status in Chinese medicine group was lower than that before surgery(P < 0.05).1 month after surgery,OSDI score and meibomian gland opening status score in Chinese medicine group were significantly lower than those in control group(P < 0.05),while SIT was significantly higher than that in control group(P < 0.05).BUT of the study group was significantly higher than that of the control group(P < 0.05),and FL score was significantly lower than that of the control group(P < 0.05).The older the patients and the higher the nuclear hardness,the greater the changes of OSDI score,BUT score,FL score and meibomian gland opening status after surgery(P < 0.05).In the study group,2 cases of conjunctival congestion and 1 case of corneal injury occurred after treatment in the Chinese medicine group.After treatment,1 case of eyelid edema,1 case of conjunctival congestion and 1 case of corneal injury occurred in the non-Chinese medicine group.There was no significant difference in the levels of IL-6,IL-1β and TNF-α in the tears of three groups before surgery(P > 0.05).There were no significant differences in IL-6 and TNF-α concentrations among the three groups at the same time period or among the three groups at different time periods(P > 0.05).There was no significant difference in IL-1β concentration at different time periods in the study group(P > 0.05).The IL-1β concentration in control group was higher 1 week after surgery than before surgery(P < 0.05),and the IL-1β concentration 1 month after surgery was higher than before surgery(P < 0.05).The IL-1β concentration in the TCM group was lower than that in the control group one week after operation(P <0.05).The IL-1β concentration in the TCM group was lower than that in the control group one month after operation(P < 0.05).Conclusions: Preoperative ocular surface intervention in patients with mild and moderate dry eye complicated with cataract can effectively reduce the signs and symptoms of DE after cataract surgery,improve meibomian gland dysfunction,and promote tear film repair.Ocular fumigation with traditional Chinese medicine combined with meibomian gland massage before cataract surgery has the best effect in preventing and alleviating postoperative DE,and the incidence of adverse events is low and the safety is high.After cataract phacoemulsification combined with intraocular lens implantation,the concentration of IL-1β in the tears of patients with dry eye increased.Preoperative fumigation with traditional Chinese medicine and meibomian gland massage inhibited the expression of IL-1β in the tears after surgery. |
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