超声乳化术巩膜切口与角膜切口术后干眼的比较

Comparison on dry eye symptom between scleral tunnel incision and transparent corneal incision in phacoemulsification

目的比较白内障晶状体超声乳化人工晶状体植入术采用巩膜隧道切口与透明角膜切口术后干眼的情况。方法194例（200眼）白内障行超声乳化人工晶状体植入术，随机分为透明角膜切口组98例（100眼）及巩膜隧道切口组96例（100眼），比较两组术后干眼症状况及基础泪液分泌。结果与术前比较，术后两组于眼症状评分均呈先升高后降低趋势，术后1、7及14d两组患者干眼症状评分均明显高于术前（P〈0．05）；而术后30d及90d两组干眼症状评分与术前相比差异无统计学意义（P〉0．05）。巩膜隧道切口组术后1、7及14d干眼症状评分均较透明角膜切口组高（P〈0．05）。术后两组基础泪液分泌呈先增大后减小趋势，两组角膜荧光素钠染色评分均呈先升高后降低趋势（P〈0．01）。术后1、7、14及30d巩膜隧道切口组基础泪液分泌评分均显著低于透明角膜切口组（P〈0．05）。与术前比较，术后两组泪液破裂时间均呈先降低后升高趋势（P〈0．01），且术后1、7及14d巩膜隧道切口组显著高于透明角膜组（P〈0．01）。结论超声乳化术经巩膜隧道切口可有效减轻对术后早期泪膜稳定性的影响，但干眼症状，较透明角膜切口者更为严重。术后晚期，两种切口的患者干眼症状均不明显。

Objective To compare dry eye symptom between scleral tunnel incision and transparent corneal incision in phacoemulsification and IOL implantation. Methods The data of 200 eyes of 194 cases with cataract underwent phacoemulsification and intraocular lens implantation were collected. They were divided randomly into the transparent corneal incision group , 100 eyes of 98 cases, and scleral tunnel incision group, 100 eyes of 96 cases. The dry eye symptom and Schirmer I test （SI t） after surgery were compared between the two groups. Results The dry eye symptom scores of the two groups were increased and decreased after a period of time. The dry eye symptom scores of the two groups at 1,7 and 14 days after surgery were significantly higher than those before operation （P 〈 0.05 ）. The difference of dry eye symptom scores was not statistically significant in the two groups between before and 30, 90 days after surgery （ P 〉 0.05）. In scleral tunnel incision group the dry eye symptom scores at 1,7 and 14 days after surgery were significantly higher than those in transparent corneal incision group （ P 〈 0.05 ）. Postoperative S I t of two groups were firstly increased and then decreased, and two groups of corneal fluorescein staining scores were decreased after increased （P 〈0. 01 ）. In scleral tunnel incision group Sit scores at 1,7,14 and 30 days after surgery were significantly lower than those in the transparent corneal incision group （ P 〈 0.05 ）. After surgery breakup time （BUT） of two groups were decreased at first and then increased （ P 〈 0.01 ）. The BUT in scleral tunnel incision group was significantly higher than that of the transparent cornea group （P 〈0.01 ）. Conclusion Through scleral tunnel incision phacoemulsification can effectively reduce the influence of stability of tear fihn in early postoperative period, but the symptom of dry eye is more severe than that with clear corneal incision. The dry eye symptom effect of two incisions is not obvious at the end of the follow-up time.