1．8mm和3．0mm大小透明角膜切口对白内障术后泪膜影响的差异

Difference of the tear film changes of 1.8mm and 3.0mm clear corneal incision after cataract surgery

目的利用光学相干断层扫描仪（spectral—domain OCT，SD—OCT）和传统泪液评估指标探讨白内障超声乳化术透明角膜切口大小对白内障术后泪液功能影响的差异。方法将44只眼分为A、B两组，A组（21只眼）行3．0mm常规透明角膜切口白内障手术，B组（23只眼）行1．8mm微透明角膜切口白内障手术。使用SD—OCT和泪膜破裂时间（tBUT）、基础泪液分泌试验（ST—II）、干眼症状评分（sx）比较两组手术前和手术后1天、1周、1月及3月泪新月及其他泪液指标的变化，并比较两组间的差异。结果A组下}目新月面积（LTMA）、总}目新月面积（TrMA）在术后1d和1周与术前相比均有不同程度的减小（P〈0．05）；Sx在术后1天、1周要高于术前（P〈0．05），tBUT、ST-Ⅱ在术后1周要明显低于术前（P〈0．05）。B组，sx在术后1d和1周评分要高于术前（P〈0．05），其余变化均无统计学意义（P〉0．05）。两组比较，B组术后1d的TTMA高于A组（P〈0．05）；在术后1周，TrMA、LTMA、tBUT、ST—Ⅱ的结果B组要高于A组（P〈0．05），SxB组低于A组（P〈0．05）；术后1月差异均无统计学意义（P〉0．05）。LTMA及TrMA与tBUT、ST-Ⅱ有良好的正相关性（P〈0．05），与sx有良好的负相关性（P〈0．05）。结论1.8mm微透明角膜切口对泪液的影响要小于3．0mm常规透明角膜切口。

Objective To changes in tear meniscus by study the effect of incision size spectral-domain OCT, （SD-OCT） on the tear function by comparing the and some traditional examinations between 3.0mm clear corneal incision cataract surgery and 1,8mm clear corneal incision cataract surgery. Methods This clinical study included 21 eyes having 3.0ram clear corneal incision cataract surgery （group A） and 23 eyes having 1.Smm （group B）. Tear meniscus was measured preoperatively and 1 day, 1 week, 1 month and 3 months postoperatively, so as schirmer test II （ST-]I ）, tear break-up time （tBUT）, dry eye symptoms （Sx）. Results In the group A, the mean value for lower tear meniscus area （LTMA）, total tear meniscus area （TTMA） and Sx were statistically significantly （P 〈0.05） worse than before cataract surgery at 1 day and 1 week postoperatively. TTMA did not return to normal at 1 month, tBUT and ST-II were statistically significantly （P 〈0.05） decreased than before cataract surgery at 1 week. However, only Sx higher than before surgery at 1 day and 1 week in group B （P 〈0.05）. Between two groups, all examinations were better in group A than in group B （P 〈 0.05）. LTMA and TTMA showed significantly positive correlation with ST-II, tBUT （P 〈0.05） and negative correlation with Sx （P 〈0.05）. Conclusions 1.8mm clear corneal incision has an advantage over 3.0mm incision in minimizing the effect of incision size on surgery-induced dry eye.