1.8mm和3.0mm透明角膜切口白内障超声乳化术后泪膜和眼表变化对比研究

Clinical comparative study of changes in the tear film and ocular surface after 1.8mm and 3.0 mm clear corneal incision phacoemulsification

目的 观察和比较1.8、3.0mm透明角膜切口白内障超声乳化术后泪膜和眼表的变化.方法 前瞻性随机对照研究.对2010年2月至2012年2月在内蒙古自治区人民医院眼科需行超声乳化术白内障吸除联合人工晶状体植入术的年龄相关性白内障患者109例（109只眼）,采用随机数字表法分为2组.微切口组（A组）：同轴1.8 mm微切口超声乳化白内障摘除人工晶状体植入术56例（56只眼）;小切口组（B组）：传统同轴3.0 mm小切口超声乳化白内障摘除人工晶状体植入术53（53只眼）.分别观察术前1d、术后2、5、10、30 d的主观干燥异物感（DES）、无麻醉下泪液分泌实验（SIT）、泪膜破裂时间（BUT）、角膜荧光素染色检查并积分（CFS）,比较各项结果在术后不同时间与术前的差异及手术对两组患者影响程度的差异.结果 小切口组与微切口组与术前相比,术后2、5、10 d DES明显提高、SIT延长、BUT缩短、CFC评分高,差异具有统计学意义（P＜0.05）;术后30 d两组患者SIT、BUT和CFS评分差异无统计学意义（P＞0.05）,DES差异具有统计学意义（P＜0.05）.结论 同轴1.8 mm微切口与传统的同轴3.0 mm小切口超声乳化白内障手术相比,对眼表的损伤较轻,且术后早期对眼表的和泪膜的影响小.

Objective To observe and compare changes in tear film and ocular surface in patients after clear corneal incision phacoemulsification with 1.8 mm and 3.0 mm.Methods A prospective randomized study.Using a random number table,109 continuously selected patients （109 eyes） with age-related cataract in our hospital received phacoemulsification cataract surgery with intraocular lens implantation were randomly divided into two groups：56 eyes in the micro-incision group A：coaxial 1.8 mm micro-incision phacoemulsification cataract extraction and intraocular lens implantation; 53 eyes in the small incision group B：The traditional coaxial 3.0 mm small incision phacoemulsification cataract extraction and intraocular lens implantation.Dried foreign body sensation （dry eye symptom,DES）,Schirmer I test without anesthesia （SIT）,tear film break-up time （BUT）,comeal fluorescent staining and integral （corneal fluorescent staining,CFS） were assessed preoperatively and postoperatively and at 2d,5d,10d,30d.Results At 2d postoperative,in micro-incision group：DES （1.98 ± 0.67）,SIT （18.37 ± 6.21） mm,BUT （5.27 ± 2.63） s,CFS score （3.41 ± 2.52）,and in small-incision group：DES （3.17 ± 0.53）,SIT （26.38 ± 5.87） mm,BUT （2.27 ± 3.68） s,CFS score （6.31 ± 2.29）; At 2d,5d,10d postoperative,DES was significantly improved,SIT extension,BUT shorten,CFS score high in the small incision group compared with the micro-incision group.The difference was statistically significant （P ＜0.05）; at 30d postoperative,SIT,BUT and CFS score were not statistically significant difference （P ＞0.05） in two groups,DES difference was statistically significant （P ＜0.05）.Conclusion Ocular surface less damage and tear film has little influence early postoperative in the micro coaxial 1.8mm incision phacoemulsification,compared with the traditional coaxial 3.0 mm incision phacoemulsification surgery.