透明角膜切口超声乳化人工晶状体植入术后患者不适感的临床分析

Analysis of various post-operative symptoms of discomfort caused by phacoemulsification with a foldable intraocular lens implanted through a small,clear corneal incision

目的探讨透明角膜小切口超声乳化白内障摘除联合折叠人工晶状体植入术后患者的各种不适感,并分析其原因。方法自2004年2月至2004年5月期间,对在我院接受超声乳化手术的78例白内障患者(105眼)进行临床随访,排除有手术并发症的病例。术后1 d、1周、1个月3、个月复诊,常规术后检查,并重点记录患者的不适症状,分析其可能的原因。结果26眼在颞上方切口处有异物感;12眼有干涩感,其中10眼泪膜破裂时间(breaking up time,BUT)<10 s,7眼泪液分泌实验为5~10 mm/5 min;7眼有眩光感,植入人工晶状体均为Acrysof MA60BM;9眼有眼胀感,其中5眼为术后一过性高眼压,经前房侧切口放液和短期应用降眼压药物治疗后恢复正常;其余4眼眼压正常,屈光状态为+1.0^+1.5 D,3眼术后1~3个月后自行好转,1眼配镜后症状消失;9例患者(9眼)术后视近困难比较明显,其中6例患者年龄在60岁以上,在行另眼手术时,设计为双眼单视,症状消失,另3例患者年龄在40~50岁,为高度近视眼患者;6例双眼患者行单眼术后,术眼有视物变蓝的感觉。结论眼异物感多与切口位置有关。某些人工晶状体类型与术后眩光有相关性。屈光状态的改变可导致不适感。双眼白内障患者行单眼术后,术眼容易出现视物变蓝的症状。

Objective To investigate the various post-operative symptoms of discornfort caused by phaoemulsification with a foldable intraocular lens implanted through a small, clear corneal incision and to analyze the causes. Methods Seventy-eight patients （ 105 eyes） who underwent phacoemulsification .surgery in our bospital from March 1, 2004 to May 1, 2004 were retrospectively reviewed. The ahsence of significant surgical comphcations was used as the inclusion criterion. Follow-up visits were scheduled for 1 day, 1 week, 1 month and 3 month after surgery. After routine, post-operative examinations were performed, symptoms of discomfort were .specifically recorded and probable reasons were. analyzed. Results Twenty-six eyes had foreignbody sensation at the. supratemporal incision and this sensation was correlated with position. Twelve eyes experienced a sensation of dryness Of these, break-up lime. （BUT） was 〈 10 s in 10 eyes and the Schirmer teat was 5 - 10 mm/5 min in 7 eyes.Symptoms of dry eye. were reduced in all cases with artificial tear drops. All 7 eyes with Acrysof IOL implants had sensations of dazzle. Distension occurred in 9 eyes, of which 5 eyes had temporarily high intraocular pressure. （IOP） and the other 4 had a normal IOP but a post-operative refraction of ＋ 1.0 - ＋ 1.5 D. Discomfort cansed by poor near vision and blue vision occurred in 9 eyes and 6 eyes, respectively. Various discomforts often occurred 2- 3 days after phacoemulsification was done with a clear, comeal incision and pearsisted for about 1 month. discomforts appeared to be correlated with the site of the. incision, the effect of the. proedure, post-operative intraocular pressure, a change, in refractive status, the type of intraocular lens used and other factors.