白内障术后早期患者配戴绷带镜对泪膜质量及其动态变化影响的临床研究

The effect of silica wearing bandage lens on the quality and dynamic changes of tear film in early postoperative cataract patients

目的观察白内障患者术后早期配戴绷带镜对泪膜质量及动态变化的影响。方法选择2020年2月至2020年5月就诊于潍坊眼科医院晶状体病区诊断为年龄相关性白内障的患者50例(60只眼)作为研究对象。其中,男性25例(31只眼),女性25例(29只眼);年龄48~85岁,平均年龄(65.6±10.0)岁。全部患者行超声乳化白内障吸除联合后方房型人工晶状体植入术治疗。术后,部分患者配戴绷带镜。根据患者术后是否配戴绷带镜,将所有患者按照随机数字表法分为绷带镜组和非绷带镜组,各25例(30只眼)。检测并记录所有患者术前、术后1 d、术后1周及1个月后的最佳矫正视力(BCVA)、泪膜破裂时间(TBUT)、SchirmerⅡ试验及欧卡斯双通道系统视觉质量。患者的年龄、BCVA、TBUT、SchirmerⅡ、调制传递函数截止频率(MTF cut off)、客观视力(OVA)、基础客观散射指数(OSI)及泪膜客观散射指数(TF-OSI)结果符合正态分布,以(±s)表示,各时间点的组间比较采用两因素重复测量方差分析,当差异有统计学意义时,进一步采用SNK法进行两两比较。结果绷带镜组患者术前、术后1 d、术后1周及术后1个月的最小分辨角度对数视力(logMAR)BCVA分别为(0.60±0.33)、(0.09±0.11)、(0.09±0.13)及(-0.01±0.05);非绷带镜组分别为(0.64±0.31)、(0.03±0.06)、(-0.01±0.06)及(-0.02±0.05)。经单因素方差分析,各时间点两组logMAR BCVA结果比较的差异均有统计学意义(t=19.478,22.600;P<0.05)。绷带镜组患者术前、术后1周及术后1个月的TBUT分别为(9.213±1.928)s、(7.214±1.477)s及(9.643±2.170)s;非绷带镜组患者分别为(10.500±2.175)s、(5.714±1.489)s及(9.071±1.730)s。各时间点两组TBUT比较的差异均有统计学意义(t=6.651,24.183;P<0.05)。绷带镜组患者术前、术后1周及术后1个月的SchirmerⅡ检测值分别为(16.928±3.771)mm、(14.643±4.181)mm及(14.143±3.231)mm;非绷带镜组患者分别为(16.500±3.299)mm、(14.143±2.685)mm及(14.714±1.267)mm。绷带镜组各时间点SchirmerⅡ检测值比较的差异有统计学意义(t=7.501,P<0.05)。绷带镜组患者术前、术后1 d、术后1周及术后1个月的TF-OSI分别为(0.752±1.137)、(0.909±1.918)、(1.073±0.618)及(0.865±0.812);OSI分别为(8.657±6.363)、(2.200±1.202)、(1.721±1.147)、(1.243±0.472);非绷带镜组患者TF-OSI分别为(0.625±0.788)、(1.225±0.605)、(1.166±0.891)及(1.063±0.793);OSI分别为(9.107±7.117)、(1.450±0.664)、(1.321±0.891)及(1.100±0.679)。术后1 d,两组患者TF-OSI和OSI比较的差异均有统计学意义(t=-2.440,2.043;P<0.05)。绷带镜组患者术前、术后1 d、术后1周及术后1个月的MTF cut off分别为(9.914±6.524)c/deg、(33.114±11.634)c/deg、(27.048±12.795)c/deg及(33.116±10.373)c/deg,OVA分别为(0.335±0.231)、(1.121±0.289)、(0.993±0.410)及(1.193±0.350);非绷带镜组患者MTF cut off分别为(7.734±5.511)c/deg、(32.515±8.709)c/deg、(34.618±9.159)c/deg及(33.892±9.666)c/deg;OVA分别为(0.401±0.497)、(0.401±0.497)、(1.242±0.279)及(1.214±0.303)。术后1 d,两组患者OVA比较的差异有统计学意义(t=-2.361,P<0.05)。经两因素重复测量方差分析,两组患者各时间点logMAR BCVA、TBUT、TF-OSI、OSI、MTF cut off及OVA组间比较均有统计学意义(F=3.037,2.172,4.899,31.957,0.103,4.054,7.775;P<0.05);SchirmerⅡ检测值组间比较无统计学意义(F=0.261,P>0.05);logMAR BCVA、TBUT、SchirmerⅡ、TF-OSI、OSI、MTF cut off及OVA组内比较均有统计学意义(F=87.675,24.843,4.899,15.735,1.854,38.563,30.491;P<0.05);交互作用无统计学意义(F=0.959,5.424,0.041,0.751,0.15,2.043,1.556;P>0.05)。结论超声乳化白内障吸除联合后方房型人工晶状体植入术后早期配戴绷带镜有利于稳定泪膜,且不会影响患者的视觉质量。

Objective To observe the effect of wearing bandage lens on the quality and dynamic change of tear film in early postoperative cataract patients.Methods From February 2020 to May 2020,50 patients(60 eyes)diagnosed with age-related cataract in the Lens Wards of Weifang Eye Hospital were selected.There were 25 males(31 eyes)and 25 females(29 eyes)with the average age of(65.6±10.0)years(ranged from 48 to 85 years).All patients underwent phacoemulsification combined with posterior chamber intraocular lens implantation.After surgery,some patients wore bandage lens.According to the patients wore bandage lens or not after surgery,they were divided into bandage group and non-bandage group according to the random number table method,25 cases(30 eyes)for each group.The best corrected visual acuity(BCVA),tear film rupture time(TBUT),SchirmerⅡtest and visual quality of orca dual-channel system of all patients were recorded before operation,after operation for 1 day,1 week and 1 month.The results of age,BCVA,TBUT,SchirmerⅡ,modulation transfer function(MTF)cut off,objective visual acuity(OVA),basic objective scattering index(OSI),and tear film objective scattering index(TF-OSI)were in accordance with normal distribution and expressed as(±s).Two-factor repeated measures ANOVA was used for comparison between groups at each time point.When the difference was statistically significant,SNK method was further used for pairwise comparison.Results The logarithm of minimal angel resolutuion vision(logMAR)BCVA of the bandage group before operation,after operation for 1 day,1 week and 1 month were(0.60±0.33),(0.09±0.11),(0.09±0.13)and(-0.01±0.05),respectively;for the non-bandage group were(0.64±0.31),(0.03±0.06),(-0.01±0.06)and(-0.02±0.05),respectively.There were significant differences in logMRA BCVA between two groups at different time points through ANOVA(t=19.478,22.600;P<0.05).The TBUT of patients in the bandage group before operation,after operation for 1 week and 1 month were(9.213±1.928)s,(7.214±1.477)s and(9.643±2.170)s,respectively;for the non-bandage group were(10.500±2.175)s,(5.714±1.489)s and(9.071±1.730)s,respectively.There were significant differences in TBUT between the two groups at different time points(t=6.651,24.183;P<0.05).The SchirmerⅡof bandage group were(16.928±3.771)mm,(14.643±4.181)mm and(14.143±3.231)mm before operation,after operation for 1 week and 1 month,respectively;for the non-bandage group were(16.500±3.299)mm,(14.143±2.685)mm and(14.714±1.267)mm,respectively.There were significant differences in SchirmerⅡof bandage group at different time points(t=7.501,P<0.05).In the bandage group,the TF-OSI before operation,after operation for 1 day,1 week and 1 month were(0.752±1.137),(0.909±1.918),(1.073±0.618)and(0.865±0.812),respectively;OSI were(8.657±6.363),(2.200±1.202),(1.721±1.147)and(1.243±0.472),respectively.In the non-bandage group,TF-OSI were(0.625±0.788),(1.225±0.605),(1.166±0.891)and(1.063±0.793),respectively;OSI were(9.107±7.117),(1.450±0.664),(1.321±0.891)and(1.100±0.679),respectively.There were not statistically significant differences in TF-OSI and OSI between two groups after operation for 1 day(t=-2.440,2.043;P<0.05).MTF cut of patients in bandage group before operation,after operation for 1 day,1 week and 1 month were(9.914±6.524)c/deg,(33.114±11.634)c/deg,(27.048±12.795)c/deg and(33.116±10.373)c/deg,respectively;OVA were(0.335±0.231),(1.121±0.289),(0.993±0.410)and(1.193±0.350),respectively.MTF cut off of the non-bandage group were(7.734±5.511)c/deg,(32.515±8.709)c/deg,(34.618±9.159)c/deg and(33.892±9.666)c/deg,respectively;OVA were(0.401±0.497),(0.401±0.497),(1.242±0.279)and(1.214±0.303),respectively.There was a significant difference in OVA between two groups after operation for 1 day(t=-2.361,P<0.05).After two-factor repeated measurement ANOVA,there were statistically significant differences in logMAR BCVA,TBUT,TF-OSI,OSI,MTF cut off and OVA between two groups at each time point(F=3.037,2.172,4.899,31.957,0.103,4.054,7.775;P<0.05),excepts SchirmerⅡgroups(F=0.261,P>0.05).The difference among logMAR BCVA,TBUT,TF-OSI,OSI,MTF cut off and OVA within groups was statistically significant(F=87.675,24.843,4.899,15.735,1.854,38.563,30.491;P<0.05),the interaction among them with non-significant difference(F=0.959,5.424,0.041,0.751,0.15,2.043,1.556;P>0.05).Conclusions Early wearing of bandage lens after phacoemulsification combined with posterior chamber intraocular lens implantation is beneficial to stabilize the tear film and does not affect the visual quality of patients.