青光眼合并白内障联合手术后眼表的变化

Ocular surface changes after combined surgery of glaucoma and cataract

目的:探讨超声乳化白内障吸除人工晶状体植入联合复合式小梁切除术治疗青光眼合并白内障术后对眼表的影响。方法:选择2016-02/2017-02于我院治疗的45例青光眼合并白内障患者,所有患者均为单眼患病,对患者的病历资料进行回顾性分析。将术眼设为观察组,对侧健眼设为对照组。比较两组患者治疗前和治疗1wk,1、3mo后干眼症评分、泪膜破裂时间(break-up time,BUT)、角膜荧光素染色(fluorescein staining,FL)评分、基础泪液分泌试验(SchirmerⅠtest,SⅠt)和结膜上皮杯状细胞(conjunctival impression cytology,CIC)密度。结果:干眼症评分:术前观察组与对照组比较,差异无统计学意义(P>0.05);术后1wk,1mo显著高于术前与对照组,差异有统计学意义(P<0.05);术后3mo与术前和对照组比较,差异无统计学意义(P>0.05)。BUT:术前观察组与对照组比较,差异无统计学意义(P>0.05);术后1wk,1、3mo均显著低于术前与对照组,差异有统计学意义(P<0.05)。FL评分:术前观察组显著高于对照组,观察组术后1wk,1、3mo FL评分与术前比较,差异有统计学意义(P<0.05),且显著高于对照组,差异有统计学意义(P<0.05)。SⅠt评分:术前观察组与对照组比较,差异无统计学意义(P>0.05);术后1wk,1、3mo,观察组SⅠt评分均显著低于术前与对照组,差异有统计学意义(P<0.05)。CIC密度:术前观察组与对照组比较,差异无统计学意义(P>0.05);术后1wk,1、3mo显著低于术前与对照组,差异有统计学意义(P<0.05)。结论:超声乳化白内障吸除人工晶状体植入联合复合式小梁切除术治疗青光眼合并白内障会加重干眼症状,降低泪膜稳定性和泪液分泌量。

AIM:To investigate the effect of phacoemulsification intraocular lens implantation combined with trabeculectomy on ocular surface in the treatment of glaucoma and cataract.METHODS:Totally 45 cases of patients with glaucoma and cataract in our hospital from February 2016 to February 2017 were enrolled.All the patients had unilateral disease,and the medical records of the patients were analyzed retrospectively.The sicked eyes were set as the observation group and contralateral eyes were set as the control group.The dry eye score,break-up time(BUT),corneal fluorescein staining score(FL),tear secretion test(SⅠ t) and conjunctival epithelium goblet cell density(CIC) was compared between two groups before operation and at 1 wk,1 and 3 mo after operation. RESULTS:The preoperative dry eye score of the observation group had no significant difference with that of the control group(P > 0.05).At 1 wk,1 mo after operation,data of the observation group was significantly higher than that of the control group and before operation,with statistical significance(P < 0.05),no significant difference was shown at postoperative 3 mo(P>0.05).Preoperative BUT of the observation group had no significant difference with that of the control group(P>0.05);at 1 wk,1 and 3 mo after operation,data of the observation group was significantly lower than that of thecontrol group and before operation,with statistical significance(P<0.05).The preoperative FL score of the observation group was significantly higher than that of the control group,while the postoperative FL score of the observation group at 1 wk,1 and 3 mo had sharp difference with that before operation(P<0.05),all were significantly higher than that of the control group,there was statistical significance(P<0.05).There was no significant difference in S Ⅰ t score between the observation group and the control group preoperatively(P > 0.05),and the postoperative S Ⅰ t scores of the observation group at1 wk,1 and 3 mo postoperatively was evidently lower than that of the control group and before operation(P<0.05).There was no significant difference in CIC density between the two groups preoperatively.While the postoperative data of the observation group at 1 wk,1 and 3 mo postoperatively was significantly lower than that of the control group and before operation,with statistical points(P<0.05). CONCLUSION:Phacoemulsification intraocular lens implantation combined with trabeculectomy for treatment of glaucoma and cataract can aggravate dry eye symptoms,as well as reduce tear film stability and tear secretion,impair conjunctival epithelium goblet cell.