白内障患者手术前后干眼的临床观察

Clinical observation of dry eye in patients before and after cataract surgery

目的探讨白内障患者手术后干眼症的发病情况。方法对37例（50只眼）白内障患者在白内障手术前3d、术后1周、1和3个月进行眼部检查。检查项目包括：裂隙灯显微镜观察眼表情况、角膜和结膜荧光素染色、泪液膜破裂时间（BUT）、Schirmer试验Ⅰ（STⅠ）、结膜印迹细胞学（IC）检查。使用眼表疾病指数调查表评价干眼症对生活质量的影响，应用25项改良美国国家眼科研究所视觉功能问卷了解患者眼部情况、日常生活和视功能的总体情况。结果白内障患者经白内障手术获得了良好的视功能，但术后部分患者出现顽固性干眼症状。白内障术后患者可出现泪河线变窄，BUT变短、STⅠ减少，角结膜荧光素染色加重。此现象可在术后1周即可出现，术后1个月时达到最明显的状态，术后3个月时部分患者的症状可有一定程度恢复。IC检查显示：术后结膜杯状细胞的密度明显低于术前。结论白内障手术后患者可能出现明显的干眼症状和体征，应及时给予干预和治疗。

Objective To investigate dry eye in patients before and after cataract surgery. Methods 25-item National Eye Institute Visual Function Questionnaire （NEI-VFQ25） and Ocular Surface Disease Index （OSDI） were used for the study in 37 patients（50 eyes） 3 days before cataract surgery and repeated after surgery 1 week, 1 month and 3 months. Slit lamp microscope examination, cornea and conjunctiva fluorescein staining, tear break-up time （BUT）, Schirmer test Ⅰ （ST Ⅰ ） ,impression cytology （IC） were carried out at the same time. Resalts After cataract surgery, the incidence of dry eye increased dramatically. Tear river was narrowed, BUT and ST Ⅰ were decreased and shorted in patients after cataract surgery. IC examination showed there was serious squamous metaplasia in epithelial layer of conjunctiva. NEI-VFQ25 was increased from 27.66±22.08 （ before cataract surgery） to 74.69 ± 11.67 （ 3 months after cataract surgery）. All items of OSDI were remarkable increased, ocular surface abnormal was increased from 2.60 ± 2.91 （before cataract surgery） to 12.66 ± 11.40 （3 months after cataract surgery） and environmental trigger was increased from 3.57±2.67 （before cataract surgery） to 11.40 ± 10.24 （3 months after cataract surgery）. Conclusion Dry eye can be induced or deteriorated after cataract surgery, if it can not be treated on time.