不同切口白内障超声乳化摘除术对泪膜的影响

Impacts of different incisions of phacoemulsification on tear film after operation

目的观察巩膜隧道切口和透明角膜切口对白内障超声乳化摘除术患者术后泪膜的影响。方法临床纳入63例患者共70眼行白内障超声乳化吸除联合人工晶体植入术的非干眼患者,根据切口不同分为巩膜隧道切口组(32例,35眼)与透明角膜切口组(31例,35眼),两组患者均进行折叠人工晶状体植入。术后第1、7、14、30、90天观察两组患者泪液分泌试验(SIt)、泪膜破裂时间(BUT)以及自觉干眼感觉等。结果术后第1天及第7天,两组患者自觉干眼症状明显,巩膜隧道切口组干眼症状评分[(2.55±0.96)、(1.49±0.62)分]明显高于透明角膜切口组[(1.18±0.72)、(0.98±0.71)分],差异有统计学意义(P<0.05);SIt试验显示,术后第1天,巩膜隧道切口组与透明角膜切口组患者SIt分别为(19.55±2.47)、(17.62±2.51)mm,均较术前显著升高,巩膜隧道切口组长于透明角膜切口组,差异有统计学意义(P<0.05);BUT试验显示,术后第1、7、14天,两组BUT均较术前显著缩短,巩膜隧道切口组[(4.07±0.63)、(4.62±0.86)、(6.37±0.67)s]长于透明角膜切口组[(3.42±0.67)、(4.06±0.90)、(5.88±0.77)s],差异有统计学意义(P<0.05)。结论术后早期,进行透明角膜切口白内障超声乳化摘除术的患者,对泪膜的影响较小,但临床干眼症状要重于进行巩膜隧道切口的患者。术后晚期,两种切口进行白内障超声乳化摘除术对泪膜无明显影响。

Objective To observe the impacts of scleral tunnel incision and clear corneal incision of phacoemulsifica-tion on tear film after operation. Methods 63 patients （70 eyes） received phacoemulsification and intraocular lens im-plantation were clinically chosen and divided into scleral tunnel incision group （32 cases, 35 eyes） and clear corneal incision group （31 cases,35 eyes） according to different incisions. Both groups were given fold intraocular lens implan-tation 1, 7, 14, 30 days and 90 days after operation, schirmer I test （SIt）, tear break-up time （BUT） and self-felt dry eye sensation of the two groups were observed. Results 1 day and 7 days after operation, patients of both groups had obvious self-felt dry eye sensations, and dry eye symptom score of the scleral tunnel incision group [（2.55±0.96）, （1.49±0.62） scores] were obviously higher than those of the clear corneal incision group [（1.18±0.72）, （0.98±0.71） scores], the difference was statistically significant （P〈0.05）;SIt showed that 1 day after operation, SIt of two groups were improved compared with before operation, and the scleral tunnel incision group [（19.55±2.47） mm] was obviously longer than the clear corneal incision group [（17.62±2.51） mm], the difference was statistically significant （P〈0.05）; BUT showed that, 1, 7 days and 14 days after operation, BUT of both groups were obviously shortened compared with before operation, and the scleral tunnel incision group [（4.07±0.63）, （4.62±0.86）, （6.37±0.67） s] were obviously longer than those of the clear corneal incision group [（3.42±0.67）, （4.06±0.90）, （5.88±0.77） s], the differences were statistically significant （P〈0.05）. Conclusion At early stage after operation, clear corneal incision of phacoemulsification has little impact on tear film but with more obvious dry eye symptom than scleral tunnel incision. At late stage after operation, there is no sig-nificant difference between impacts of the two kinds of incisions of phacoemulsification on tear film.