云南省多民族人群白内障术后干眼发病因素分析

Pathogenic factors of dry eye in multi-ethnic population after cataract surgery in Yunnan Province

目的通过收集云南省不同民族人群行白内障超声乳化+人工晶状体植入术(Phaco+IOL)术后的干眼数据,分析各民族及云南省各地区干眼发病特点及影响因素。方法采用多阶段分层抽样的方法,在云南省不同少数民族聚集地面对面调查9740人(18908眼),将既往有Phaco+IOL手术史并符合干眼诊断标准的227眼设为Phaco组,分别随机抽取既往无手术史符合干眼诊断的227眼为干眼组、健康眼227眼为正常组。对3组受试者泪河高度、泪膜破裂时间(BUT)、睑板腺开口堵塞、上睑板腺缺失面积及临床症状评分(OSDI评分)依次进行统计学分析,分析Phaco+IOL术后干眼的特点以及危险因素。结果调查对象未手术眼(18020眼)中干眼发生率21.98%,其中哈尼族最高,为14.65%;苗族最低,为2.80%。Phaco组患者术后干眼发生率为25.56%,其中拉祜族最高,为20.26%;景颇族最低,为0.88%。与干眼组和正常组受试者相比,Phaco组患者年龄大、睑板腺开口阻塞率高、上睑板腺缺失面积>1/2者占比高、泪河高度低、BUT短及OSDI评分高,差异均有统计学意义(均为P<0.05)。结论云南省多民族白内障患者Phaco+IOL术后,普洱市拉祜族患者干眼发生率最高、德宏州景颇族最低;患者年龄大、睑板腺开口阻塞及上睑板腺缺失面积>1/2均是干眼发生的危险因素。

Objective To analyze the clinical characteristics and risk factors of dry eye after phacoemulsification and intraocular lens implantation(Phaco+IOL)in different minority groups in Yunnan Province.Methods Multistage stratified sampling method was used in this study.Totally 9740 residents(18908 eyes)in different minority groups in Yunnan Province were interviewed face to face.Among them,227 eyes that received Phaco+IOL surgery and met the diagnostic criteria for dry eye were selected into the Phaco group,227 eyes without receiving surgery but meeting the diagnostic criteria for dry eye were selected into the dry eye group,and 227 healthy eyes were selected into the normal group.The tear meniscus height(TMH),break-up time(BUT),meibomian gland obstruction,upper meibomian gland loss,and the symptom score(OSDI)of all eyes were analyzed.The clinical characteristics of dry eye after Phaco+IOL and the risk factors were also analyzed.Results The mean prevalence of dry eye in the untreated eyes(18020 eyes)was 21.98%,with the highest rate of 14.65%in the Hani ethnic group and the lowest rate of 2.80%in the Miao ethnic group.The mean prevalence of dry eye after Phaco was 25.56%,with the highest rate of 20.26%in the Lahu ethnic group and the lowest rate of 0.88%in the Jingpo ethnic group.Compared with the dry eye group and the normal group,patients in the Phaco group were the oldest,with the highest rate of meibomian gland obstruction and upper meibomian gland loss(>1/2),the lowest TMH,the shortest BUT,and the highest OSDI score(all P<0.05).Conclusion The prevalence of dry eye is highest among Lahu people in Puer and lowest among Jingpo people in Dehong after Phaco+IOL surgery.The age,meibomian gland obstruction,and upper meibomian gland loss(>1/2)are risk factors for the development of dry eye in Yunnan Province.