不同切口方式白内障摘除对泪膜稳定性的影响

The effect of cataract extraction surgery with different incisions position on tear film stability

目的:探讨不同方式小切口白内障摘除及人工晶状体植入术后泪膜稳定性的变化。方法:随机抽取2004-07/2005-07我院行小切口白内障摘除术的老年性白内障患者96例102眼,分3组。A:透明角膜切口组30例32眼;B:巩膜隧道切口组35例(38眼);C:角膜缘切口组31例(32眼);平均年龄(65.2±11.5)岁。检测术前1d,术后1,7,14,30d的泪膜破裂时间(breakuptime,BUT)、基础泪液分泌试验(SchirmerItest,Sit)、角膜荧光素染色积分(fluorescenceintegral,FI),下睑中央泪河高度。结果:与术前相比,透明角膜切口组术后1dBUT明显缩短;Sit,下睑中央泪河高度和角膜荧光素染色程度明显增高,差异均有显著性意义;7d时SIt,14d时下睑中央泪河高度,30d时BUT、角膜荧光素染色积分恢复至术前水平。巩膜隧道切口组术后1d仅BUT明显缩短,SIt明显增高(P<0.05),下睑中央泪河高度、角膜荧光素染色积分无明显变化;术后7d时BUT已恢复至术前水平。角膜缘切口组,4项检测指标与术前比较,差异无显著意义。结论:透明角膜切口行白内障摘除术显著降低泪膜的稳定性,巩膜隧道切口行白内障摘除术轻微影响泪膜的稳定性,而角膜缘切口行白内障摘除术对泪膜影响最小。

AIM： To study the tear film stability after small-incision cataract extraction and intraocular lens （IOL） implantation with different incision positions. METHODS： From 3anuary to August 2005, 96 patients （102 eyes） underwent small-incision cataract extirpation were randomly divided into three groups： 30 cases （32 eyes） with clarity corneal incision in group A; 35 cases （38 eyes） with sclera tunnel incision in group B; and 31 cases （32 eyes） with corneal edge incision in group C （mean age： 65.2＋ 11.5 years）. Break up time of the tear film （BUT）, Schirmer I test （Sit）, corneal fluorescence integral （FI）, the middle tear river altitude of the lower eyelid were checked at pre-operative ld and post-operative 1, 7, 14 and 30d. RESULTS： In group A, BUT reduced significantly; Sit and corneal fluorescence dying integral and the middle tear river altitude of the down eyelid increased significantly at postoperative ld; the Slt at postoperative 7d, the middle tear river altitude of the lower eyelid at postoperative 14d and FI at postoperative 30d were recovered to the level before surgery. In group B, BUT decreased and Sit increased significantly （P〈0.05）, but there were no significant changes in the middle tear river altitude or FI 1d after surgery at postoperative 1d; BUT was completely recovered at postoperative 7d. There were no significant changes in all these indexes in group C. CONCLUSION： The cataract extraction surgery by corneal incision can significantly depress the tear film stability; the surgery by the sclera tunnel incision can mildly affected the tear film stability; the corneal edge incision has the least influence on tear film.