The Repair Function Of The Recombinant Human Epithelial Growth Facter For The Ocular Surface' Injury Of Phacomulsification Combined With IOL Implanation

Background: Recentely phacoemulsification combined with IOL implantation have already being the clinically classic surgury method.Compared with traditionary extracapsular cataract extraction, phacoemulsification has many good qualities, such as short incision, slight lesion,rapid recovery and fewer complication. So phacoemulsification has been approved and favored by clinician.But in clinic we find that there are many patients with the complaint of dry eye after surgery step by stap as phacoemulsification has being widely carried out and we have been knowing the ocular surface disease more and more deeply. The dry eye symptom less or more make patients'linving qualities fall down. Most of the patients are the olders. It is identified that the density and the branch number of corneal nerve descend obviously in the olders'cornea compared with that in the youngers'cornea and the content of goblet cell that excrete mucin in the olders'conjunctiva decrease obviously compared with that in the youngers'conjunctiva. At the sametime clinical analysis manifest the stability of the olders'tear film descends. The operation will precipitate the happening and exacerbation of the dry eye symptom.The effect of phacoemulsification on the surface of ocular comprise five aspects: The first,after surgery the edematization of cornea and conjunctiva,the local eminence of operative incision,the healing of cut and the mechanical injury of operation to the microvillus of corneal epithelium lead to the irregulatity of ocular surface,which induce decreased stability of tear film.The second , After surgery corneal nerve is cut off .Operative procedure cause the transportation disorder of acetylcholine and cholinesterase in the peripheral nerve around the incision no matter which incision is used, clear corneal incision or sclerotic tunnel incision. Not only the ocular suiface shape changes,but also the damage to cornea affects the feedback system which is comprised of lacrimal gland,ocular surface,the nerve on the ocular surface,which causes reduced lacrimal secretion.The third,the topical anesthetic drug applied preoperatively influences the stability of tear film,which damages the microvillus on the ocular surface epithelial cell and lead to punctiform denudation of corneal epithelium,corneal edema,increased irregularity of corneal shape and decreased tear film stability.The forth,the steriod and non-steriod anti-inflammatory agent applied postoperatively impaired tear film function on the ocular surface.Glucocorticoid eye drop applied for more than 3months will damage the tear film to some degree and cause decurtated tear film breakup time and decreased lacrimal secretion.The fifth,Operation evokes the inflammatory reaction on the ocular surface.The transforming growth factor-β1 and nuclear factor-κB in the conjunctival epithelial cells express increasingly after phacoemulsification.The decreased tear film stability has a close relationship with the inflammotory level.Clear vision′aquiring and continuing not only need complete ocular surface epithelial cells concluding cornea epithelial cells and conjunctival epithelial cells, but also there is stable tear film .Artifical tear (HA) can carry negative ion with a lot of negative charges,absorb much moisture,prolong tear flims breaking time. The rhEGF is recently applied to clinical usage , The rhEGF is the main element of the Genesoft eye drops. There were experiments shows that the rhEGF function the"actively reparition"with the effect to promote the ocular surface cells to moving, slipting, multiplying. To compare the reparation function to the ocular surface injuries of the two eye drops , and further reasurch the mechanism of dry eyes after surgery, that is significant to guide the clinical practice and the reparation of the ocular surface after surgery.Objective: To access the repair function of the recombinant human epithelial growth facter for the ocular surface'injury of phacomulsification combined with IOL implanation.Methods: 120 eyes of 89 cases with age-related cataract performed the phacomulsification combined with IOL implanation were randomly divided into three groups, A group 40 eyes (rhEGF) were treated with rhEGF drops ;B group 40 eyes (artificial tears) were treated with artificial tears;C group 40 eyes (vacant group) with nothing. The dry eye symptom ( drying,cauterizing,foreign body feeling ), tear film break-up time(BUT). Schrimer'Ⅰtest (SIT) without topical anesthesia, corneal fluorescein staining were measured and constrasted preoperatively and 1 day,1 week,2 weeks,1month postoperatively, and analysed statisitcly.Results: The comparing result of the function of tear film of Group A postoperatively with that of preoperation: At 2 weeks and 1 month postoperatively, the mean tear film break-up time, corneal fluorescein staining score and the value of Schirmer'I test returned to the preoperative level(P>0.05). At 1 week,2 weeks and 1 month postoperatively ,the drying and foreign body feeling reduced greatly(P > 0.05),at 2 weeks,1 month postoperatively ,the cauterizing reduced greatly (P>0.05).The comparing result of the function of tear film of Group B postoperatively with that of preoperation: At 1 month postoperatively, the mean tear film break-up time,corneal fluorescein staining score returned to the preoperative level(P>0.05). At 2 weeks and 1 month the value of Schirmer'I test returned to the preoperative level(P > 0.05).At 1 month postoperatively ,the drying and the cauterizing reduced greatly(P>0.05),at 2 weeks and 1 month postoperatively , foreign body feeling reduced greatly (P>0.05).The comparing result of the function of tear film of Group C postoperatively with that of preoperation: At 1 month postoperatively, the mean tear film break-up time, corneal fluorescein staining score and the value of Schirmer'I test returned to the preoperative level(P > 0.05).At 1 month postoperatively , the foreign body feeling reduced greatly(P>0.05),the other symptoms didn't reduce greatly(P>0.05).There is obvious disparity in the recovery of the fluorescein staining among the three groups at 1 week,2 weeks,1 month postoperatively(P<0.05); there is obvious disparity in the recovery of the tear film break-up time(BUT) among the three groups at 2 weeks,1 month postoperatively(P<0.05); there is obvious disparity in the recovery of the Schrimer'Ⅰtest (SIT) among the three groups at 1 week,2 weeks,1 month postoperatively(P<0.05).Conclusion: The recombinant human epithelial growth facter obviously can obviously help the repair of the ocular surface'injury of phacomulsification combined with IOL implanation.