白内障超声乳化手术前后眼表的变化

Changes of ocular surface before and after phacoemulsification

目的:应用眼表综合分析仪联合结膜印记细胞学观察白内障超声乳化手术前后眼表参数的变化。方法:选择2016-12/2017-12于福建省立医院眼科行白内障超声乳化和人工晶状体植入手术的患者39例39眼。观察和分析患者术前,术后1d,1wk,1、2mo的干眼症状评估OSDI量表。应用眼表综合分析仪(Keratograph5M)测量泪河高度、泪膜破裂时间、结膜充血以及进行结膜印迹细胞学检查。结果:术前,术后1d,1wk,1、2mo的OSDI量表的评分:9.30±3.80、19.8±3.42、33.2±5.63、18.8±3.49、20.3±8.65分(P<0.05);结膜杯状细胞密度分别是376.00±73.88、289±69.50、243.02±80.81、336.72±81.60、346.70±67.35个/mm 2(P<0.05);首次泪膜破裂时间分别是6.91±4.52、6.12±3.55、5.18±3.37、6.28±4.70、5.96±3.17s,平均泪膜破裂时间分别是10.21±5.20、8.89±4.47、6.87±3.68、7.35±3.52、9.00±4.23s,术后1wk的泪膜破裂时间与术前有差异(P<0.05)。结论:白内障超声乳化手术破坏眼表,患者的泪膜稳定性和结膜细胞损害于术后1d开始,术后1wk加剧,术后2mo患者的眼表状态仍然无法完全恢复。

AIM:To evaluate ocular parameters changes after age-related cataract phacoemulsification surgery using Keratograph 5M combined with conjunctival impression cytology.METHODS:This prospective study included 39 eyes(39 patients)from December 2016 to December 2017,who underwent cataract phacoemulsification and intraocular lens implantation in Fujian Provincial Hospital.OSDI questionnaire,tear meniscus height,tear break-up time,conjunctival hyperemia and impression cytology were performed preoperatively at 1d,1wk,1mo and 2mo after surgery.RESULTS:GCD and OSDI were worsen at 1d,1wk,1mo,2mo,postoperatively(P<0.05).The first-time tear break-up time was significantly shorter at 1wk(6.91±4.52,6.12±3.55,5.18±3.37,6.28±4.70,5.96±3.17s,P<0.05).The average tear break-up time was significantly shorter at 1wk(10.21±5.20,8.89±4.47,6.87±3.68,7.35±3.52,9.00±4.23s,P<0.05).CONCLUSION:phacoemulsification will influence ocular surface parameters.The tear instability and conjunctival cell damage began at 1d postoperatively,and aggravated at 1wk postoperatively.It still couldn t return to preoperative level even at 2mo postoperatively.