有晶状体眼后房型人工晶状体植入术后患者干眼情况

Study of dry eye after phakic posterior chamber intraocular lens implantation

目的:研究有晶状体眼后房型人工晶状体(ICL)植入术后患者干眼相关的临床变化,评价其眼表疾病的严重程度。方法:前瞻性研究。纳入2019-09/10拟行ICL植入手术矫正近视的患者50例50眼。分别于术前,术后1wk,1、3mo时进行眼表疾病指数(OSDI)问卷评分和角膜染色评分(Oxford法)、泪膜破裂时间(TBUT)、基础泪液分泌量(SⅠt)、下睑中央泪河高度检查。结果:OSDI问卷评分在术后1wk,1mo时较术前明显增加(P<0.05),至术后3mo恢复至术前水平,角膜染色评分在术后3mo基本恢复至术前水平,术后3mo与术后1wk比较有差异(χ^(2)=5.267,P=0.022)。角膜染色评分在各个时间点均和OSDI问卷评分呈显著的正相关(rs>0,P<0.05)。TBUT在术后1wk及1mo较术前明显降低(P<0.05),术后3mo恢复至术前水平。SⅠt和下睑中央泪河高度在术后各个时间点与术前相比无差异(P>0.05)。结论:ICL植入术后早期会影响患者眼表泪膜的稳定性,使患者出现不同程度的干眼相关症状,OSDI问卷评分可以评价其主观不适症状。但到术后3mo,患者眼表泪膜稳定性恢复至术前水平。角膜染色阳性评分越高的患者,干眼相关症状越明显。

AIM:To study the clinical changes related to dry eye and evaluate the severity of ocular surface diseases in patients with posterior chamber intraocular lens(ICL)implantation.METHODS:Prospective study.Totally 50 eyes of 50 cases with myopia who were underwent ICL surgery from September 2019 to October 2019.Ocular surface disease index questionnaire(OSDI),fluoresceine staining of cornea tear break up time(TBUT),SchirmerⅠtest(SⅠt),and tear meniscus were measured before and 1wk,1 and 3mo after surgery.RESULTS:The scores of OSDI questionnaire and corneal staining were significantly increased at 1wk and 1mo after operation(P<0.05).There was a difference between 3mo and 1wk pastoperatve(χ^(2)=5.267,P=0.022),and recovered to the preoperative level at about 3mo.Corneal staining scores were significantly positively correlated with OSDI questionnaire scores at all time points(rs>0,P<0.05).TBUT decreased significantly at 1wk and 1mo after operation(P<0.05),and returned to the preoperative level 3mo after operation.There was no significant difference in the basal tear volume(SⅠt)and the height of lacrimal river in the middle of lower eyelid between before and after operation(P>0.05).CONCLUSION:The stability of tear film on the ocular surface will be affected by ICL implantation in the early postoperative period,and the patients will have different degrees of dry eye related symptoms.OSDI questionnaire score can be used to evaluate their subjective discomfort symptoms.However,at 3mo after operation,the stability of tear film on the surface of eyes recovered to the preoperative level.The higher the positive score of corneal staining was,the more obvious the subjective discomfort was.