不同方位手术切口白内障超声乳化术后眼表的观察

Clinical observation of ocular surface after Phacoemulsification with different direction of clear cornea incisions

目的探讨年龄相关性白内障在表面麻醉下不同方位手术切口的超声乳化白内障抽吸联合后房型人工晶状体植入术后眼部的观察。方法68例（78只眼）均在表麻下行上方或水平方位透明角膜缘切口的白内障超声乳化联合后房型人工晶状体植入术，术后根据切口位置归为两组：上方透明角膜缘切口组31例（41只眼），水平透明角膜缘切口组31例（37只眼）。每组均在术前和术后1周，1个月，3个月时行泪膜破裂时间（BUT），泪液分泌实验Ⅰ（SchirmerⅠ）和角膜荧光素实验指标的眼部观察。结果所有入选的病例均在表麻下接受手术治疗，术后随访3个月。两组在视力，年龄，结膜充血，房水闪辉差异无统计学意义（P〉0．05）。上方透明角膜缘切口组和水平组之间在泪膜破裂时间（BUT）及泪液分泌实验Ⅰ（SchirmerⅠ）在各个观察时间点差异均有统计学意义（P〈0．05），而角膜切口局部染色（FL）在同一时间点则差异无统计学意义（P〉0．05）。每组均显示在术后1周时各项指标与术前差异有统计学意义（P〈0．05）。上方透明角膜缘切口组在术后3个月除SchirmerⅠ外，另两项指标基本恢复至术前水平。在水平透明角膜缘切口同一时间点BUT，SchirmerⅠ仍未基本恢复至术前水平。结论白内障超声乳化抽吸联合后房型人工晶状体植入术后水平透明角膜缘切口可能比上方透明角膜缘切口更容易出现类似干眼症状，且相关指标异常出现的高峰期在术后1周左右。

Objective To investigate ocular surface in patients after Phacoemulsification with different direction of clear cornea incisions. Methods A total of 62 patients （78 eyes） were divided in- to two groups： one group was through a clear corneal incision at margin level, the other was through a clear corneal incision above margin. In each group, the values such as subjective dry eye symptoms （Sx）, tear break-up time （tBUT）, Schirmer Ⅰ test （ST-I）, and cornea incisions fluorescein staining （FL） were measured before Phacoemulsification and 1 week, 1 month and 3 months after surgery. Results All the operations were achieved in the surface anesthesia. Two groups was no statistical significance in vision, age, conjunctival congestion and aqueous flare （P 〉0.05）. Two groups was statistical significance in tear break-up time （tBUT）, Schirmer Ⅰ test （ST-Ⅰ） （P 〈0.05）, but in cornea incisions fluorescein staining .（FL） had no statistical significance （P 〉0.05）. The three values were obvious changes in each group after surgery 1 week compared with the preoperative. The group in a clear corneal incision above margin, at 3 months of post-operation, the fluorescein staining （FL） and tear break-up time （tBUT） was basically equal to the level of group in a clear corneal incision margin level was also less than preoperation. emulsification through a clear corneal incision margin level is more likely to symptoms than through a clear corneal incision above margin, and also those mal appear in the early time on 1 week after operation. pre-operation. But the Conclusions Phacohave similar dry eye related values abnormal appear in the early time on 1 week after operation.