超声乳化白内障手术不同切口对术后泪膜变化的影响

Effect of different incisions on tear film after phacoemulsification

目的探讨超声乳化白内障手术不同切口对术后泪膜变化的影响。方法行白内障超声乳化吸除术的非干眼患者54例(60眼),年龄为54～78岁。随机分为两组:A组28例(30眼),行透明角膜切口;B组26例(30眼),行巩膜隧道切口。两组的年龄、性别等差异无统计学意义,具有可比性。分别于术前,术后第1天、第7天、第14天、第30天、第90天对患者行干眼主观症状问卷调查、基础泪液分泌试验(SchirmerⅠtest,SIt)、泪膜破裂时间(break-up time,BUT)和角膜荧光素染色(cornea fluorescein staining,CFS)检查。采用SPSS10.0统计软件,对数据进行卡方检验和t检验分析。结果①主观症状:术后第1天和第7天,患者干眼主观症状明显,B组干眼症状评分大于A组,差异有统计学意义(t=-6.208,-2.868;P<0.01);其他时间点两组的干眼症状评分差异无统计学意义(t=-1.643,-0.832,-0.281;P>0.05)。②SIt试验:术后第1天,SIt明显增加,B组SIt较A组长,差异有统计学意义(t=-2.916;P<0.01);其他时间点两组SIt差异无统计学意义(t=-1.224,-1.189,-0.632,-1.031;P>0.05)。③BUT:术后第1天、第7天、第14天,BUT明显缩短,B组BUT较A组长,差异有统计学意义(t=-3.719,-2.442,-2.507;P<0.05),其他时间点两组BUT差异无统计学意义(t=-0.800,1.227;P>0.05)。④CFS评分:术后第1天、第7天、第14天,CFS评分增加,A组CFS评分大于B组,差异有统计学意义(t=3.478,3.261,2.466;P<0.05),其他时间点两组CFS评分差异无统计学意义(t=-0.382,1.227;P>0.05)。结论术后早期,行巩膜隧道切口超声乳化白内障吸除术对泪膜稳定性的影响较小,但干眼症状重于行透明角膜切口的患者。术后晚期,两种切口对泪膜的影响无明显差异。

Objective To investigate the effect of different incisions on tear film after phacoemulsification.Methods Tear film was monitored in 54 patients （60 eyes） after phacoemulsification.Patients were divided into two groups according to the type of incision：group A （28 patients,30 eyes） with a clear corneal incision and group B （26 patients,30 eyes） with a sclerotic tunnel incision.Symptoms of dry eye,Schirmer Ⅰ test （SIt）,break-up time （BUT）,and cornea tluorescein staining （CFS） were observed at 3 days preoperatively and 1 day, 7 clays 14 days, 30 days, and 90 days postoperatively. The results were analyzed using a X^2 test and t-test with SPSS 10.0. Results ①There was a large increase in symptoms of dry eye at l day and 7 days postoperatively. The increase in group B was much greater than in group A and the difference was significat （t=-6.20g, -2.86g; P〈0.01）. However, there were no significant differences between the two groups at other times （t= -1.643, -0.832, -0.281; P〉0.05）.②There was a large increase in Sit at 1 days postoperatively. The increase in group B was much greater than in group A and the difference was significant （t= -2.916; P〈0.01）. However, there were no significant differences between the two groups at uther times （t=-1.224, -1.189, -0.632, -1.031; P〉0.05）. ③There was a large reduction in BUT at 1 day, 7 days, and 14 days postoperatively. The reduction was more prolonged in group B compared to group A and the difference between the two groups was significant （t=-3.719, -2.442, -2.507; P〈 0.05）. However, there were no significant differences between the two groups at other times （t=-0.800, 1.227; P〉0.05）. ④There was a large increase in CSF at l day, 7 days, and 14 days postoperatively. There was a greater increase in group A compared to group B and the difference hetween the two groups was significant （t= 3.478, 3.261, 2.466; P〈0.05）. However, there were no significant differences between the two groups at other times （t=-0.382, 1.227; P〉0.05）. Conclusion The stahility of tear fihn in patients with seleral tunnel incisions is much better than in patients with clear corneal incisions lint symptoms of dry eye are much more serious during the early postoperative period. There is no significant difference between the two groups during later postoperative periods.