灌注液下与黏弹剂下白内障超声乳化吸除术对眼表影响的比较研究

Comparison of influence on the ocular surface during phacoemulsification applying anterior chamber maintainer versus ophthalmic those using viscoelastic agent

目的:对比灌注液下与黏弹剂下行白内障超声乳化吸除术后对眼表的影响。方法:收集2015年9月至2016年3月在行白内障超声乳化吸除联合人工晶状体植入术的白内障患者68例(68眼),随机分为灌注液组(A组)和粘弹剂组(B组),每组34例(34眼)。A组采用多孔前房维持器连接灌注液维持前房下超声乳化,B组采用黏弹剂维持前房下超声乳化。分别观察术前及术后1d、7d、30d主观干燥异物感、泪膜破裂时间(BUT)、角膜荧光素染色检查(CFS)积分及无表面麻醉下泪液分泌实验(SIt)的变化情况。结果:术后30d,A组干眼症状的发生率高于B组,但两组比较差异无统计学意义(χ~2=0.243,P=0.622)。A组术后1d的CFS及SIt显著高于B组,且差异均有统计学意义(均P<0.05)。术后7d、30d,两组BUT、CFS及SIt比较,差异均无统计学意义(均P>0.05)。结论:与黏弹剂下行白内障超声乳化手术比较,灌注液下行白内障超声乳化在术后早期会轻微加重角膜上皮损伤和增加泪液分泌量,但术后中晚期并未加重眼表组织的损害,且能减少黏弹剂的使用,简化手术流程,值得临床推广应用。

Objective： To compare the influence of applying anterior chamber maintainer （ACM） and ophthalmic viscoelastic agent on the ocular surface during phacoemulsification. Methods： 68 cases of cataract patients （68 eyes） undergoing phacoemulsification in our hospital from September 2015 to March 2016 were selected and randomly divided into two groups： group A in which the patients received phacoemulsification using ACM to maintain anterior chamber depth, and group B in which the patients received phacoemulsification using ophthalmic viscoelastic agent. The incidence of dry eye symptoms, break-up time of tear film （BUT）, corneal fluorescent staining （CFS） score and Schirmer Ⅰ test without anesthesia （Sit） at pre-operation and at 1 d, 7 d and 30 d post-operation were observed and compared. Results： At 30 d post-operation, the incidence of dry eye symptoms in group A was higher than that in group B, but the difference was not statistical significant （ P 〉0.05）. At 1 d post-operation, the CFS score and Sit in group A were significantly higher than those in group B （ P 〈0.05）. No significant differences were found in BUT, CFS and Sit between the two groups at 7 d and 30 d after operation （ P〉0.05）. Conclusion： Compared with ophthalmic viscoelastic agent, ACM application in phacoemulsification could slightly aggravate iatrogenic dam age to the corneal epithelium and increase lacrimal secretion at early post-operative period, but it did not increase ocular surface damage at late post-operative stage.