飞秒激光辅助的白内障超声乳化术后泪膜及角膜知觉的变化

Changes of tear film and corneal sensitivity after femtosecond laser-assisted cataract extraction surgery

目的比较飞秒激光辅助的白内障超声乳化手术与2.2 mm同轴微切口白内障超声乳化手术后泪膜及角膜知觉的变化。方法采用前瞻性队列研究方法，于2015年3—7月在武汉爱尔眼科医院纳入年龄相关性白内障患者53例53眼，根据患者自愿选择的白内障手术方式分为飞秒激光手术组和同轴微切口手术组。飞秒激光手术组26眼，接受飞秒激光辅助的白内障超声乳化手术，同轴微切口手术组27眼，接受2.2 mm同轴微切口白内障超声乳化手术。患者均随访3个月。收集术后7 d、1个月、3个月2个组术眼上方及中央角膜知觉阈值、Schirmer试验值、非侵入性泪膜破裂时间（NIBUT）及患者主观干眼感觉评分值，比较各组术眼在手术前后不同时间点各项测定指标的差异。结果各组术眼手术过程顺利。术前及术后7 d、1个月、3个月2个组上方角膜知觉阈值、NIBUT值、同轴微切口手术组的Schirmer试验值及飞秒激光手术组的主观干眼感觉评分值均出现先下降后上升的趋势，总体比较差异均有统计学意义（均P〈0.05），而2个组中央角膜知觉阈值、飞秒激光手术组的Schirmer试验值随术后时间的延长总体比较差异均无统计学意义（均P〉0.05），同轴微切口手术组的主观干眼感觉评分值随着术后时间延长逐渐增加，总体比较差异有统计学意义（P〈0.05）。术后3个月上述观察指标均接近术前水平，但同轴微切口手术组的主观干眼感觉评分值仍高于术前，差异有统计学意义（P〈0.05）。结论与2.2 mm同轴微切口白内障超声乳化手术相比，飞秒激光辅助的白内障超声乳化手术术后早期对泪液分泌的影响更小，术眼干眼症状更轻微，术后眼表舒适度更高。

ObjectiveTo compare the changes of tear film and corneal sensitivity between femtosecond laser-assisted cataract surgery and microincisional phacoemulsification surgery.MethodsA prospective cohort study was performed.Fifty-three eyes of 53 patients with age-related cataract were included in Wuhan Aier Eye Hospital from March to July 2015.The patients were divided into femtosecond laser group and microincisional group.The 26 eyes in the femtosecond laser group received femtosecond laser-assisted cataract surgery, and 27 eyes in the microincisional group received 2.2 mm microincisional phacoemulsification surgery.The patients were followed-up for 3 months.The data of corneal sensitivity, Schirmer test values, non-invasive tear film break-up time （NIBUT） and subjective score for dryness were collected in 7 days, 1 month and 3 months after surgery, and these results were compared between the two groups.This study was approved by Ethic Committee of Wuhan Aier Ophthalmology Hospital, and written informed consent was obtained from each patient prior to surgery.Results The operations were finished smoothly in all the eyes.In preoperative and 7 days, 1 month, 3 months after operation, the upper corneal sensitivity threshold and NIBUT between the two groups appeared a first reduction and a subsequent rise, the same phenomenon occurred in Schirmer test of the microincisional group and the subjective scores for dryness of the femtosecond laser group with statistically significant differences in the overall comparison （all at P〈0.05）. No significant differences were seen in the central corneal sensitivity of the two groups and Schirmer test in the femtosecond laser group （all at P〉0.05）. The dry eye scores increased gradually with the time expand after operation in the microincisional group, the difference was statistically significant （P〈0.05）. In postoperative 3 months, these parameters were restored preoperative values.However, the dry eye scores in the microincisional group were still higher than that before operation, and the difference was statistically significant （P〈0.05）. Conclusions Compared with the 2.2 mm microincisional phacoemulsification surgery, femtosecond laser-assisted cataract surgery brings less disturbance to lacrimal secretion, slight symptoms of dry eye and more comfortable sensation.