目的：探讨白内障超声乳化术中应用角膜保护剂(2% HPMC)对年龄相关性白内障(ARC)伴2型糖尿病患者术后眼表泪膜稳定性的影响。

方法：前瞻性平行对照试验。将我院2017-03/2018-05行白内障超声乳化术的ARC伴2型糖尿病患者107例(107眼)纳入该研究。按照随机数字表将患者分为HPMC组和平衡盐溶液(BSS)组，HPMC组纳入57眼，术中角膜表面均匀覆盖2% HPMC； BSS组纳入50眼，术中不断向角膜上滴注BSS。所有患者手术前1d及术后7、30、60、90d行泪膜破裂时间(BUT)、泪液分泌试验(SⅠt)、角膜荧光素染色(CFS)检查，并观察其变化。

结果：白内障术后7、30、60d，与BSS组术眼比较，HPMC组术眼BUT明显延长，且CFS着色点明显减少； 术后7d，HPMC组SⅠt值明显低于BSS组，术后30、60d时HPMC组SⅠt值高于BSS组(P<0.05)。术后60d，HPMC组BUT、SⅠt、CFS结果与术前比较无差异(P>0.05)，BSS组BUT、SⅠt、CFS结果与术前比较有差异(P<0.05)。

结论：白内障超声乳化术中应用2% HPMC对ARC伴2型糖尿病患者眼表泪膜稳定性有一定保护作用，术后60d泪膜稳定性各项指标可恢复至术前水平。

METHODS: Prospective parallel controlled trial. Totally 107 cases(107 eyes)of the patients with ARC and type 2 diabetes who underwent phacoemulsification in our hospital from March 2017 to May 2018 were included in this study. According to the random number table, the patients were divided into HPMC group and BSS group. All 57 eyes were enrolled in HPMC group and 2% HPMC was evenly covered on the corneal surface during operation; 50 eyes were enrolled in BSS group and BSS was continuously dripped on the cornea during operation. Break up time(BUT), Schimer Ⅰ test(SⅠt)and corneal fluorescein staining(CFS)were performed 1d before operation and 7d, 30d, 60d and 90d after operation, and observed their changes.

RESULTS: At 7d, 30d and 60d after cataract surgery, compared with BSS group, BUT was significantly prolonged and CFS staining spots were significantly reduced in HPMC group; At 7d after surgery, SⅠt in HPMC group was significantly lower than that in BSS group; At 30d and 60d after surgery, SⅠt in HPMC group was significantly higher than that in BSS group(P<0.05). At 60d after operation, there was no difference in BUT, SⅠt and CFS between HPMC group and preoperative group(P>0.05), while there was difference in BUT, SⅠt and CFS between BSS group and preoperative group(P<0.05).

CONCLUSION:2% HPMC in phacoemulsification can protect the stability of tear film on the ocular surface of ARC patients with type 2 diabetes. The tear film stability indexes can be restored to the preoperative level 60d after operation.