不同手术方式对青光眼合并白内障患者干眼症状的影响

Effects of Different Surgical Methods on Dry Eye Symptoms in Patients with Glaucoma Complicated with Cataract

目的:比较超声乳化白内障摘除术(Phaco-IOL)、超声乳化白内障摘除联合房角分离术(Phaco-IOLGSL)和超声乳化白内障摘除联合小梁切除术(Phaco-IOL-Trab)这3种术式对干眼症状的影响。方法:非随机回顾性平行对照研究。收集2019年6月至2020年6月在青岛市市立医院就诊并符合纳入标准的患者92例(118眼),按手术方式分为:A组:Phaco-IOL 32例(40眼),B组:Phaco-IOL-GSL 30例(38眼),C组:Phaco-IOL-Trab 30例(40眼)。采用Keratograph 5M眼表综合分析仪、SchirmerⅠ试验(SⅠT)、CochetBonnet角膜知觉计检测患者术前1 d及术后3 d、1周、1个月、3个月非侵入性首次泪膜破裂时间(NIF-BUT)、非侵入性平均泪膜破裂时间(NIA-BUT)、泪河高度(TMH)、睑板腺缺失评分、基础泪液分泌及角膜知觉(CP)并进行对比研究。定量资料符合正态分布采用重复测量方差分析,组内两两比较采用LSD-t检验,组间比较采用单因素方差分析。不符合正态分布数据多组间比较采用Kruskal-Wallis H检验。结果:术后3 d至3个月,C组NIF-BUT和NIA-BUT较术前明显降低,且变化程度高于其他2组(均P<0.05)。在A组和B组中,NIF-BUT和NIA-BUT在术后1个月恢复至术前水平。术后3 d、1周,C组TMH、基础泪液分泌量较术前升高(均P<0.05),术后1个月恢复至术前水平。A组和B组术后各时间点TMH、基础泪液分泌量同术前相比差异均无统计学意义。C组在术后3个月睑板腺缺失评分较术前增加(t=-9.48,P<0.001)。A组和B组术后各时间点睑板腺缺失评分同术前相比差异均无统计学意义。C组术后3 d至1个月CP明显降低,变化程度高于其他2组(均P<0.05),术后3个月恢复到术前水平。A组和B组CP在术后1个月恢复至术前水平。结论:超声乳化白内障摘除联合小梁切除术对眼表及CP影响较大,术后3个月CP恢复正常,但泪膜稳定性仍有明显降低且开始出现明显睑板腺缺失。

Objective:To compare the effects on dry eye symptoms from phacoemulsification(phaco)combined with intraocular lens(IOL)implantation,phaco-IOL-goniosynechialysis and phaco-IOL-trabeculectomy.Methods:This was a retrospective control study.Ninety-two patients were recruited from June 2019 to June 2020 in the Department of Ophthalmology at Qingdao Municipal Hospital.Group A(40 eyes)underwent phacoemulsification,group B(38 eyes)underwent phaco-IOL-goniosynechialysis,and group C(40 eyes)underwent phaco-IOL-trabeculectomy.Noninvasive first tear film break-up time(NIFBUT),noninvasive average tear film break-up time(NIA-BUT),tear meniscus height(TMH),meibomian gland loss scores,basal tear secretion,and corneal perception were analyzed and compared at 1 day preoperatively and 3 days,1 week,1 month,and 3 months postoperatively using the Oculus Keratograph 5M,SchirmerⅠtest(SⅠT)and Cochet-Bonnet Asthesiometer.Quantitative data consistent with normal distribution were analyzed by repeated measures ANOVA.The LSD-t test was used for intra-group comparison and one-way ANOVA was used for inter-group comparison.Kruskal-Wallis H test was used to compare the data that did not conform to normal distribution.Results:From postoperative 3 days to 3 months,the NIF-BUT and NIA-BUT of group C dropped more significantly than those of the other two groups(P<0.05).NIF-BUT and NIA-BUT both returned to preoperative levels at 1 month after surgery in groups A and B.TMH and SⅠT in group C increased at 3 days and 1 week postoperatively(P<0.05),and returned to preoperative levels at 1 month postoperatively.At each time point postoperatively,TMH and SⅠT of groups A and B were not significantly different compared to baseline.At 3 months postoperatively,meibomian gland loss scores increased significantly,and there was a statistically significant difference in group C(t=-9.48,P<0.001).At each time point postoperatively,meibomian gland loss scores were not significantly different compared to baseline between groups A and B.The corneal perception of each group receded and the perception in group C was more serious and different than the other two groups from 3 days to 1 month postoperatively(P<0.05).At 3 months postoperatively,corneal perception in group C returned to the preoperative level and there was no statistically significant difference.It was restored to the preoperative level at 1 month postoperatively and there was no statistically significant difference between group A and B.Conclusions:Phaco-IOL-trabeculectomy has a great influence on SⅠT and corneal perception.Corneal perception recovered at 3 months postoperatively,but tear film stability and meibomian gland loss was still lost.