同轴微切口超声乳化白内障吸出术后泪膜及角膜知觉的变化

Changes in tear film and corneal sensitivity after microincisional phacoemulsification

目的比较1．8mm、2．2mm两种微切口白内障手术与标准切口白内障手术后泪膜及角膜知觉的变化。方法随机选取2010年9月至2011年2月期间行超声乳化白内障吸出术的老年性白内障患者205例（205只眼），根据患者对人工晶状体的选择分为1_8mm、2．2mm、3．0mm切口3组。随访3个月，比较各组非侵犯性泪膜破裂时间（NIBUT）、上方及中央角膜知觉、Schirmer试验值及患者主观干眼感觉评分值。结果术后7d、1个月1．8mm、2．2mm组NIBUT明显长于3．0mm组差异有统计学意义（P〈0．05）。术后3个月坶恢复至术前水平，3组间差异无统计学意义（P〉0．05）。术后30d，1．8mm组Schirmer试验值高于3．0mm组差异有统计学意义（P〈0．05）。术后90d，3组均恢复至术前水平，组间无差异。术后7、30d，1．8mm、2．2mm组干眼感觉评分值明显低于3．0mm组。术后90d，3组患者问差异无统计学意义（P〉0．05）。术后7d、1个月，3．0mm组上方角膜知觉测量值短于2．2mm、1．8mm组（P〈0．05）。术后3个月，3组上方角膜知觉均恢复至术前水平，组间差异无统计学意义（P〉0．05）。3组术后各时间段中央角膜知觉差异无统计学意义（P〉0．05）。1．8mm、2．2mm组间各观察指标于术后各个时间段差异无统计学意义。结论与标准切口白内障手术相比，微切口超声乳化白内障吸出术对眼表的骚扰更小，患者术后干眼症状更轻微，角膜知觉恢复快，舒适度更高。但同属微切口组的1．8mm与2．2mm手术组术后干眼症状及各项检查结果无明显差异。

Objective To compare the changes in tear film and corneal sensitivity after microin-cisional phacoemulsification and standard phacoemulsification. Methods From Sep. 2010 to Feb. 2011, 205 eyes of 205 consecutive patients with age-related cataract were divided into 3 groups according to the IOL selection. Schirmer test without anesthesia, non-invasive tear break time （NIBUT）, corneal sensitivity and subjective score for dryness were compared among three groups. Results Seven days and 1 month postoperatively, the mean NIBUT of 3.0rnm group reduced greatly than the other two groups. The value recovered to preoperative levels at 3 months postoperatively. One month postoperatively, the mean Schirmer test values of 1.8ram group were higher than 3.0ram group, and returned to the preoperative levels at 3 months postoperatively. At 7 days, 30 days post- operatively, the mean subjective score for dryness of 3.0mm group were higher than the other two groups; and no statistically significant difference among the three groups at 90 days postoperatively. At 7 days, 30 days postoperatively, the upper corneal sensitivity of 3.0mm group was shorter than the other two groups, and all recovered to the preoperative levels at 3 months postoperatively. There was no statistically significant difference among the three groups at any time point for central corneal sensitivity, and there was no statistically significant difference between 1.8mm and 2.2mm groups for any observing indexes. Conclusions Microincisional phacoemulsification bring less disturbance to ocular surface, brighter symptoms of dry eye, faster recovery of corneal sensitivity and the patients feel more comfortable. There is no statistically significant difference between 1.Smm and 2.2mm group of microincisional phacoemulsification for any observing indexes and symptoms of dry eye.