| Research purposes:By comparing the results of various ocular surface-related indicators within three months of surgery between the experimental group,which received preoperative treatment of meibomian gland massage and ultrasound-assisted nebulization therapy,and the control group,which received routine treatment,this study aims to explore the therapeutic effect of this treatment on improving the ocular surface of patients with diabetic cataract combined with dry eye,and to provide clinical guidance for perioperative management of such patients.Research methods:This study is a prospective clinical randomized controlled trial that collected 110patients(110 eyes)diagnosed with diabetic cataract combined with dry eye and requiring cataract surgery in the Department of Ophthalmology at the First Affiliated Hospital of Chengdu Medical College from July 2021 to December 2022.All cataract patients included in this study were randomly divided into experimental and control group,with55 patients(55 eyes)in each group.The control group received routine preoperative medication treatment for cataracts,while the treatment group received additional ultrasound mist therapy(once a day for 3 days before surgery)and eyelid gland massage(once a day,1 day before surgery)on the basis of the control group.All study subjects were followed up for 3 months,and eye-related examinations were performed on all study subjects before and after treatment at 1 week,1 month,and 3 months to record changes in the ocular surface disease index(OSDI),Fluorescein break up time(FBUT),Schirmer I test,corneal fluorescein staining score(CFS),eyelid margin grade,meibum secretion grade,and lipid layer thickness(LLT)of both groups of patients at four time points before and after treatmentResults:1.The study included a total of 110 subjects(110 eyes),of which 107 subjects completed the study,resulting in a loss to follow-up rate of 2.72%.The general characteristics and preoperative ocular examination results of the two groups of subjects were statistically analyzed(both P>0.05),indicating no significant differences and comparability between the groups.2.Intra-group comparison: After one week post-operation,the OSDI and CFS scores for both experimental groups significantly increased compared to pre-operation,and began to decrease after one month.By the third month post-operation,the experimental group’s scores had decreased further from pre-operation levels,while the control group remained higher than pre-operation levels.The Schirmer I test,FBUT,and LLT for both experimental groups significantly decreased at one week post-operation compared to preoperation,improved after one month,and further improved at three months postoperation,with all differences being statistically significant(P < 0.05).The experimental group’s meibomian gland opening score and meibomian gland secretion grade significantly decreased at one week post-operation compared to pre-operation due to preoperative meibomian gland massage,increased from one week to one month postoperation,and remained higher at three months post-operation than at one month postoperation,but still lower than pre-operation levels,with all differences being statistically significant(P < 0.05).In contrast,the control group’s meibomian gland opening score and meibomian gland secretion grade significantly increased at one week post-operation compared to pre-operation,decreased slightly at one month post-operation,and gradually decreased to pre-operation levels by three months post-operation.3.The OSDI and CFS scores of the two groups of experimental subjects increased significantly one week after surgery,while the Schirmer I test,FBUT,and lipid layer thickness(LLT)all decreased significantly compared to pre-surgery values.However,the control group had a greater magnitude of change than the experimental group.Cataract surgery resulted in less ocular surface damage to the experimental group’s study subjects compared to the control group,and the inter-group differences were statistically significant(P<0.05)based on analysis.The OSDI and CFS scores,Schirmer I test,FBUT,LLT,meibomian gland orifice score,and meibomian gland secretion evaluation scores of the experimental group were compared to those of the control group at one week,one month,and three months after surgery,and the differences were significant and statistically significant(all P<0.05).4.During the perioperative period,no significant adverse drug reactions were observed in either the experimental or control groups.Conclusion:1.Cataract phacoemulsification combined with intraocular lens implantation causes severe damage to the ocular surface in diabetic cataract patients with dry eye,manifested by significantly worsening dry eye symptoms.The severity of dry eye reached its peak one week after surgery and was difficult to recover to preoperative levels in a short period of time.2.The management and treatment of diabetic cataract patients with dry eye can be effectively improved by preoperative management with meibomian gland massage combined with ultrasonic nebulization.This approach not only reduces the damage to the ocular surface caused by surgery and enhances the recovery ability of the ocular surface,but also significantly delays the progression of dry eye and improves visual experience.It has broad clinical application value. |
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