手法小切口白内障摘除手术治疗白内障的效果及对泪膜功能和视神经纤维层的影响

Efficacy of Manual Small Incision Cataract Extraction in Treatment of Cataract Patients and Its Effect on Tear Film Function and Optic Nerve Fiber Layer

目的探讨手法小切口白内障摘除手术(MSICS)治疗白内障的效果及对患者泪膜功能及视神经纤维层的影响。方法选取2017年2月—2018年8月收治的92例白内障患者,根据手术方法不同分为MSICS组与超声乳化白内障吸除术(PE)组,每组46例。比较2组术前与术后1 d的视力恢复情况、泪膜破裂时间(BUT)、泪液分泌试验(SIt)、主观干眼症状问卷积分(SDES)以及全周平均视神经纤维层厚度,比较2组术后并发症发生率。结果术后1 d,2组的视力恢复情况均优于术前(P<0.01),2组颞侧、上方、鼻侧、下方以及全周的平均视神经纤维层厚度均较术前显著增大(P<0.05),但2组间上述指标比较差异均无统计学意义(P>0.05)。术后1个月,2组的BUT均较术前显著降低,SIt和SDES均较术前显著升高(P<0.05)。MSICS组术后1个月的BUT显著高于PE组,SIt与SDES显著低于PE组(P<0.05)。MSICS组的角膜水肿和晶状体表面色素沉着发生率显著低于PE组(P<0.05)。结论MSICS与PE治疗白内障均可有效恢复患者视力,其中MSICS对患者泪膜功能的影响更轻,且术后并发症相对减少,治疗白内障更具优势。

Objective To investigate efficacy of manual small incision cataract extraction(MSICS)in treatment of cataract patients and its effects on tear film function and optic nerve fiber layer.Methods A total of 92 cataract patients admitted during February 2017 and August 2018 were divided into MSICS group and phacoemulsification cataract extraction(PE)group(n=46 in each group)according to different surgical methods.In two groups,visual recovery,breakup time(BUT)of tear film,Schirmer test(SIt),subjective dry eye symptom(SDES)questionnaire score and average thickness of optic nerve fiber layer were compared before and on the 1 st d after operation,and incidence rate of postoperative complications was compared.Results On the 1 st d after operation,conditions of vision visual acuity were better than those before operation in two groups(P<0.01).Values of average thickness of optic nerve fiber layer in bitamporal,above side,nasal side,bottom and whole were significantly increased compared with those before operation in two groups(P<0.05),but there were no significant differences in the above indexes between two groups(P>0.05).In 1 month after operation,BUT values were significantly decreased,while values of SIt and SDES were significantly increased compared with those before operation in two groups(P<0.05).In 1 month after operation in MSICS group,BUT value was significantly higher,while values of SIt and SDES were significantly lower than those in PE group(P<0.05).Incidence rates of corneal edema and surface pigmentation of lens crystallina in MSICS group were significantly lower than those in PE group(P<0.05).Conclusion Both MSICS and PE may effectively restore vision visual acuity of cataract patients.MSICS has a lesser effect on tear film function and little postoperative complications,and therefore it is more advantageous to treat cataract patients.