不同方位切口对角膜神经损伤及泪膜功能影响相关性研究

Effects of different incision in phacoemulsification on corneal nerve injury and tear film function

目的探讨超声乳化术对年龄相关性白内障患者眼表症状、泪膜稳定性、角膜知觉(corneal perception,CP)及角膜神经损伤修复的影响。方法年龄相关性白内障患者60例(60眼),均为右眼,随机分为A、B组,每组各30例(30眼)。A组采用上方透明角膜切口行超声乳化白内障吸出联合人工晶状体(intraocular lens,IOL)植入术,B组在颞侧透明角膜切口行超声乳化白内障吸出联合IOL植入术,术前、术后1周、1个月及3个月时行泪膜破裂时间(break up time,BUT)、泪液分泌试验(Schirmer I test,SIT)、角膜知觉计检查和角膜共焦显微镜检查。结果术前两组BUT、泪液分泌量、CP和角膜内皮密度(cornealendothelial density,CED)差异均无统计学意义(均为P>0.05);两组患者术后1周、1个月,BUT、泪液分泌量、CP和CED与术前相比差异均有统计学意义(均为P<0.05);至术后3个月时两组患者的BUT、泪液分泌量已基本恢复至对照眼水平,差异均无统计学意义(均为P>0.05),CP、CED仍存在异常(均为P<0.05)。术后1周、1个月两组间BUT、泪液分泌量及CP差异均有统计学意义(均为P<0.05),CED差异无统计学意义(均为P>0.05);术后3个月,两组间BUT及泪液分泌量比较差异均无统计学意义(均为P>0.05),而CP比较差异有统计学意义(P<0.05)。术后2周、1个月,两组前基质层细胞密度比较差异均有统计学意义(均为P<0.05);中、后基质层细胞密度两组均有减少,两组比较差异均无统计学意义(均为P>0.05)。术后3个月,两组各层基质细胞密度差异均无统计学意义(均为P>0.05)。术后1个月,两组角膜切口均未见完整神经纤维;术后3个月,两组患者角膜上皮下长神经有连接型均减少,差异有统计学意义(χ2=17.653,P<0.05),A组角膜基质中形态正常的神经纤维中出现的几率也明显高于B组,两组差异有统计学意义(χ2=9.874,P<0.05)。结论对于年龄相关性白内障,上方切口行超声乳化联合IOL植入术可以改善泪膜情况和角膜知觉,减轻角膜神经损伤,提高患者的视觉质量。

Objective To observe the effects of different incision in phacoemulsification on symptom of ocular surface,tear film stability corneal nerve and perception of patients with age-related cataract.Methods Sixty patients(60 right eyes)with age-related cataract were randomly divided into two groups:Group A received superior corneal incision phacoemulsification surgery and intraocular lens(IOL)implantation,and group B received temple incision phacoemulsification surgery and IOL implantation,30 cases(30 eyes)in each group.The break-up time(BUT)of tear film Schirmer I test(SIT),corneal perception(CP)and confocal microcopy were examined at pre-operation and postoperative 1 week,1 month,3 months.Results There was no statistical difference in preoperative BUT,SIT,CP and corneal endothelial density(CED)between two groups(all P>0.05).Compared with pre-operation,there were statistical differences in postoperative BUT ST,CP and CED at 1 week,1 month of two groups(all P<0.05),no statistical difference in BUT and SIT at preoperative 3 months(all P>0.05)Whereas statistical differences in C P and CED(all P<0.05).There were statistical differences in BUT,SIT and CP at postoperative 1 week and 1 month between two groups(all P<0.05),no statistical difference in C ED(P>0.05).There was no statistical difference in BUT and SIT at postoperative 3 months between two groups(all P>0.05),but statistical difference in CP(P<0.05).T here were statistical difference in the density of anterior stromal cell at postoperative 2 weeks and 1 month(all P<0.05)Whereas no statistical difference in the density of middle and posterior stromal cell(all P>0.05).No obviously whole corneal nerve fiber in corneal incision was found at postoperative 1 month in two groups;Corneal branch nerve fiber density of subbasal nerve plexus decreased in group A as compared with group B(x^2=17. 653,P<0.05),the proportion of patients with an normal morphologic nerve fibers in corneal stroma in group A was greater than that in group B,the difference was statistically significant(x^2=9.874,P<0.05).Conclusion For age-related cataract patients, phacoemulsification and IOL implantation with superior incision can improve the tear film and CP reduce the corneal nerve injury and therefore improve the visual quality.