Abstract: Objective To evaluate the protective effect of the ocular surface of medical sodium hyaluronate(HA)and balanced salt solution(BSS)in patients with proliferative diabetic retinopathy(PDR)performing minimally invasive vitreorentinal surgery(MIVS). Methods A retrospective case-controlled study was designed. Forty patients(40 eyes)with PDR performed with anti-vascular endothelial growth factor-assisted MIVS surgery were enrolled in this study, randomly divided into the HA group ［20 cases(20 eyes)］ and the BSS group ［20 cases(20 eyes)］. During surgery, HA and BSS were applied to keep the ocular surface moist according to grouping. Ocular surface disease index(OSDI), Schirmer Ⅰ test(SⅠt), non-invasive tear film break-up time(NITBUT), corneal fluorescein staining(CFS)and corneal transparency during the surgery were performed preoperatively and at 1, 7 and 30 days postoperatively. Results The OSDI of the HA group was superior to that of the BSS group at all postoperative time points(P_{1 d}=0.001、P_{7 d}<0.001、P_{30 d}=0.001). Intragroup comparison showed that the HA group was more damaged 1 day after surgery than preoperative(P_HA1d<0.001), and 30 days after surgery was better than preoperative(P_HA30d=0.002), and the BSS group was more damaged 1 day and 7 days after surgery than preoperative(P_BSS1d<0.001, P_BSS7d<0.001). Intragroup comparison in the SⅠt 2 group showed that the damage in the HA group and the BSS group was worse than preoperative(P_HA1d<0.001, P_HA7d<0.001, P_BSS1d<0.001, P_BSS7d<0.001), and damage in the HA group was better than preoperative(P_HA30d<0.001). Compared to the NITBUT group, the 7 d HA group was better than the BSS group(P_{7 d}<0.001). Intragroup comparison showed that the damage to the HA group and the BSS group was greater at 7 and 30 days postoperatively than preoperatively(P_HA7d<0.001, P_HA30d=0.027, P_BSS7d<0.001, P_BSS30d=<0.001). Among the CFS groups, the HA group was better than the BSS group on 1d postoperatively(P_{1 d}<0.001). Intragroup comparison showed that the damage in the HA group and the BSS group was greater than before the operation(P_HA1d<0.001, P_HA7d<0.001, P_BSS1d<0.001, P_BSS7d<0.001), and the damage in the BSS group was still greater than before the operation and 30 days after the operation(P_BSS30d=0.024). Intraoperative corneal transparency in the HA group was better than that in the BSS group(P=0.038). Conclusion Compared to BSS, HA has better protection of the ocular surface during MIVS in patients with PDR, remains the corneal transparency during surgery and shortens the repair time of the ocular surface tissue after surgery.

Key words: Vitreorentinal surgery, Minimally invasive, Proliferative diabetic retinopathy, Sodium hyaluronate, Balance salt solution, Tear film