| Objective: According to the collection of basic clinical information of 50 patients who volunteer for undergoing non ophthalmic surgery under general anesthesia in our orthopedic department,we discuss the efficacy of Vitamin A palmitate ophthalmic gel on eye protection and whether it will improve the state of ocular surface and eye comfort,meanwhile maintain tear film stability.This paper finally aims to seek a more reasonable 、 safe and efficient approach for eye protection during non ophthalmic surgery under general anesthesia.Methods: This is a randomized、double-blind、prospective clinical trial.A total of 50 patients who undergoing non ophthalmic surgery under general anesthesia and whose operation time take more than 1.5 hours in orthopedics department of General Hospital of the Northern Theater Command of the People’s Liberation Army from July 2020 to October 2020 were enrolled in this research.We adopted an experiment design method that match the left and right eyes of the same individual,two eyes were randomly divided into two groups: the experimental group(n=50)and the control group(n=50).The two groups were treated separately according to the corresponding scheme.The experimental group: Vitamin A palmitate ophthalmic gel was placed into the eyes evenly followed by sterile adhesive tape attached over the eyelid.The control group: Use sterile adhesive tape only to close eyelids.We have kept records of Tear-film break-up time(BUT)、Schirmer I test(SIT)、Dry eye questionnaire、Degree of conjunctival congestion and Corneal epithelium staining rate of these selected patients when they were first admitted to hospital.These selected patients were followed up at regular intervals,the above indicators were reassessed 6 hours and 24 hours after surgery.Data in this manuscript included enumeration、measurement and ranked data.The results are analyzed by using SPSS 26.0 statistical software.The statistical methods in this paper include Two-factor repeated measure analysis of variance 、 chi-square test 、 student t test and rank sum test.The corresponding indicators between the two different groups and in each group before and after surgery are compared to find out the relationship.Results: Fifty patients(100 eyes)were included in this study,each group had 50 eyes.There were 25 males and 25 females in total,aged from 22～73 years old,the average age was(53.02±13.21)years old.The operation last from 1.5 to 6.5 hours and the average operation time was(3.05±1.12)hours.(1)At the time of enrollment,there were no significant differences in Tear-film break-up time(11.20±3.16)vs(10.74±3.57)、Schirmer Ι test(12.34±4.06)vs(12.80±5.06)、Dry eye questionnaire(1.32±1.38)vs(1.36±1.38)、Degree of conjunctival congestion between the experimental group and the control group(P>0.05).Corneal epithelium staining was not observed in any of the two groups.(2)6 hours after surgery:(1)Tear-film break-up time(BUT): The numerical value of the control group(3.60±1.54)was significantly shorter compared with the baseline value(10.74±3.57),the difference between them has significant implications(P<0.05),and BUT in the control group was obviously shorter than that in the experimental group(P<0.05).The numerical value of the experimental group(6.94±2.19)were also significantly shorter than(11.20±3.16)the baseline value(P<0.05).(2)Schirmer Ι test(SIT): The numerical value of the control group(4.44±2.56)was significantly lower than when they were enrolled(12.80±5.06),the difference between them has significant implications(P<0.05),and SIT in the control group was obviously lower than that in the experimental group(P<0.05).The numerical value of the experimental group(6.10±1.67)were also significantly lower than(12.34±4.06)when they were enrolled(P<0.05).(3)Dry eye questionnaire: The score in the control group(3.72±1.44)was higher than before(1.36±1.38)and that in the experimental group(1.54±1.23);the current score in the experimental group was the same as(1.32±1.38)the preoperative score(P=0.063).(4)Corneal epithelium staining rate: There were 7 cases of eye occurred corneal epithelium staining in the experimental group,its incidence rate within the group was 14.0%(one eye counts as 3 points,6 eyes count 1 point);and 16 cases of eye appeared corneal epithelium staining in the control group,its incidence rate within the group was 32.0%(one eye counts as 3 points,2 eyes count 2 points,13 eyes count 1 point),the difference between the two groups was significant(P=0.032).(5)Degree of conjunctival congestion : In regard to the conjunctival congestion degree score,there were statistically significant differences in the distribution of the number of eyes in 0(2 eyes in the control group,6 eyes in the experimental group)、1(11 eyes in the control group,30 eyes in the experimental group)、2(22 eyes in the control group,7 eyes in the experimental group)and 3(15eyes in the control group,7 eyes in the experimental group)points(P=0.041).There were no statistical significance both in the experimental group(P=0.779)and in the control group(P=1.000)compared with each preoperative value.(3)24 hours after surgery:(1)Tear-film break-up time(BUT): The numerical value of the control group(8.04±3.33)was significantly shorter than that in the experimental group(9.14±2.77),the difference between them has distinct implications(P=0.041).The numerical value of the control group was shorter than when they were enrolled(10.74±3.57),but longer than(3.60±1.54)6 hours after surgery(P<0.05);The BUT of the experimental group(9.14±2.77)were also shorter than when they were enrolled(11.20±3.16)but longer than 6 hours after surgery(6.94±2.19),the difference between them has apparent implications(P<0.05).(2)Schirmer I test(SIT): The numerical value of the control group(9.94±3.99)was significantly lower than that in the experimental group(11.82± 4.57),the difference has evident implications(P=0.028).The SIT of the control group was lower than when they were enrolled(12.80±5.06)but longer than 6 hours after surgery(4.44±2.65),the difference between them has apparent meaning(P<0.05);The SIT of the experimental group(11.82±4.57)was longer than 6 hours after surgery(6.10±1.67),but was the same as(12.34±4.06)baseline value(P=0.189).(3)Dry eye questionnaire: The score in the control group(1.94±1.13)were significantly higher than that in the experimental group(1.32±1.17),The score in the control group was higher than baseline value(1.36±1.38)and lower than 6 hours after surgery(3.72±1.44),all the differences were significant(P>0.05);The score in the experimental group(1.32±1.17)show no significant difference compared with baseline(1.32±1.38)or(1.54±1.23)6 hours after surgery(P=0.063).(4)Corneal epithelium staining rate: There were only 2 cases of eye still exist corneal epithelium staining in the experimental group,its incidence rate was4.0%(2 eyes count as 1 point);7 cases of eye exist corneal epithelium staining in the control group,its incidence rate was 14.0%(2 eyes count as 3 points,5 eyes count as 1point),but there was no significant difference between two groups(P=0.162).(5)Degree of conjunctival congestion:In regard to the conjunctival congestion degree score,there were statistically differences in the distribution of the number of eyes in 0(8 eyes in the control group,9 eyes in the experimental group)、1(18 eyes in the control group,31 eyes in the experimental group)、2(15 eyes in the control group,6 eyes in the experimental group)and 3(9 eyes in the control group,4 eyes in the experimental group)points(P=0.004).There were no statistical significance both in the experimental group and in the control group compared with each preoperative value and 6 hours after surgery(P>0.05).Conclusions:(1)General anesthesia may affect the stability of tear film and lead to a decrease in tear production and reduced ocular comfort.(2)The use of Vitamin A palmitate ophthalmic gel combined with sterile adhesive tape can significantly improve postoperative ocular comfort and maintain the stability of tear film and tear secretion. |
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