白内障超声乳化手术后结膜细胞和泪膜稳定性的观察

Changes in the ocular surface and tear film after phacoemulsification

目的观察白内障超声乳化手术后结膜细胞和泪膜的稳定性。方法 2015年7月至2015年8月于福建省立医院眼科行白内障超声乳化和人工晶状体植入手术的患者23例(29眼)。观察和分析患者手术前及手术后1 d、1周、1个月和2个月的干眼症状评估OSDI量表、泪液分泌试验、泪膜破裂时间、萤光素染色和结膜印迹细胞学检查。采用单因素重复测量方差分析,进行统计学分析。结果手术前,手术后1 d、1周、1个月和2个月的泪液分泌试验结果间比较差异无统计学意义;OSDI量表评分分别是(1.00±0.58)分、(1.61±0.75)分、(2.07±1.31)分、(1.63±1.04)分和(1.60±0.95)分,P<0.05;结膜上皮细胞Nelson分级(0~3级)分别是(0.41±0.50)级、(1.89±0.77)级、(2.03±0.78)级、(1.82±0.76)级和(1.72±0.84)级,P<0.05;杯状细胞密度分别是(387.00±64.28)个/mm^2、(299.32±72.50)个/mm^2、(239.64±83.29)个/mm^2、(337.01±71.48)个/mm^2和(343.82±78.69)个/mm^2,P<0.05。泪膜破裂时间结果显示患者术后1 d和1周泪膜稳定性下降,P<0.05。手术后1周与手术后1 d、1个月和2个月比较,OSDI量表评分、泪膜破裂时间和杯状细胞密度的变化更为显著。结论白内障超声乳化手术后患者的干眼症状、泪膜稳定性和结膜印迹细胞学从手术后第1天开始变化,手术后1周眼表破坏更为严重。手术后1个月逐渐改善,但至手术后2个月仍无法完全恢复至手术前的状态。

Objective To evaluate changes in conjunctival impression cytology, tear film function, and ocular surface stability in patients after phacoemulsification. Methods In this prospective study cataract patients who underwent successful phacoemulsification were enrolled from July 2015 to August 2015 in Fujian Provincial Hospital. The trial included 29 eyes of 23 patients. Schirmer test 1, tear film breakup time, fluorescein staining, and conjunctival impression cytology were performed 1 day before and 1 day, 1 week, 1 months, and 2 months after surgery. Results The mean preoperative and postoperative Schirmer test 1 results were similar. However, OSDI Scale Score, conjunctival impression cytology and the mean goblet cell density were worse at 1 day, 1 week, 1 month and 2 month postoperatively（P〈0.05）. In addition, the stability of tear film and ocular surface became worst at 1 week postoperatively（P〈0.05）. Conclusions The microscopic ocular surface damage began from 1 day postoperatively and became more apparent at 1 week postoperatively. Although the stability of tear film and ocular surface was improved at 1 month postoperatively, it still couldn＇t return to the preoperative level even at 2 month postoperatively.