2型糖尿病患者白内障超声乳化吸出术后泪膜的变化

Changes of tear film after phacoemulsification in diabetes

目的探讨2型糖尿病患者行白内障超声乳化吸出术后泪膜的变化。方法跟踪观察2006年4月至10月行白内障超声乳化吸出术的2型糖尿病白内障患者50例(80眼,A组)和单纯老年性白内障患者108例(158眼,B组),比较2组术前、术后7d、30d、90d的角膜知觉、角膜荧光素(fluorescein,Fl)染色、泪膜破裂时间(break-up time,BUT)以及基础泪液分泌试验(Schirmer test,SIt)等情况。结果术前2组比较,A组BUT缩短,Fl增多,SIt减少,角膜知觉减退,差异有显著性(P<0.05);干眼症状差异无显著性(P>0.05)。2组术后7d与术前比较,干眼症状加重,角膜知觉减退,BUT缩短,SIt和Fl增加,差异有显著性(P<0.01)。术后30d与术前比较,A组干眼症状加重,角膜知觉减退,BUT缩短,差异有显著性(P<0.05),Fl和SIt差异无显著性(P>0.05);B组干眼症状加重,BUT缩短,差异有显著性(P<0.05),角膜知觉、Fl和SIt差异无显著性(P>0.05)。术后90d与术前比较,2组干眼症状、角膜知觉、BUT、Fl和SIt差异均无显著性(P>0.05)。结论合并2型糖尿病的白内障患者,泪膜功能较差,是干眼的易患人群,行白内障超声乳化吸出术后早期泪膜稳定性明显下降且恢复较慢。

Objective To investigate the changes of tear film after phacoemulsiflcation in patients with type 2 diabetes. Methods Fifty cases （80 eyes, group A） with diabetic cataract and 108 cases （ 158 eyes, group B） with age-related cataract underwent phacoe-mulsiflcation were chose from April, 2006 to October, 2006. Corneal sensitivity, corneal fluoreseein （F1） staining,break-up time（ BUT）of tear film,and Schinner I test （ Sit ） value were analyzed and compared between two groups preoperatively and 7 days,30 days,90 days postoperatively. Results Before the operation, the assessment of corneal sensitivity, BUT and Sit of group A was less, but the F1 was more （ P 〈 0.05 ）. There was no significantly difference between two groups subjective complains of dry eye （ P 〉 0.05 ）. Compared with preoperation, the complains of dry eye,Sit and F1 of both two groups increased,but corneal sensitivity and BUT of both two groups decreased at 7 days postoperatively（P 〈0.01 ）. Compared 30 days postoperatively with preoperation,in group A, the subjective complains of dry eye deteriorated, corneal sensitivity decreased, BUT reducesd significantly （P 〈 0. 05） ,both F1 and Sit had no difference （ P 〉 0.05 ） ; there was no significant difference in subjective complains of dry eye,F1 and Sit of group B（P 〉 0.05） ;but the subjective complains of dry eye deteriorated and BUT reduced significantly （ P 〈 0. 05 ）. Compared 90 days postoperatively with preoperation, both two groups had no significant difference of the subjective complains of dry eye, assessment of corneal sensitivity,F1,BUT and SIt（P〉0.05）.Conclusion Type 2 diabetic cataract patients have tear film dysfunction and are susceptible to dry eye. The tear film stability of diabetic cataract reduce significantly at early stage after phacoemulsiflcation and recover much slowly.