有晶状体眼后房型人工晶状体植入术对患者眼表泪膜影响临床研究

Effect of implantable collamer lens implantation on ocular surface tear film

目的:探究有晶状体眼后房型人工晶状体(ICL)植入术对眼表泪膜的影响,为临床防治ICL术后干眼症提供科学依据。方法:纳入行ICl手术矫正治疗的患者76例149眼为研究对象,根据术后3个月是否发生干眼症分为干眼组和对照组,比较两组术前3 d、术后7 d、术后1个月泪河高度(TMH)、首次泪膜破裂时间(NIF-BUT)、平均泪膜破裂时间(NIAvg-BUT)、睑板腺成像评分、脂质层评分、视觉质量评分(QoV)、眼表疾病指数(OSDI)的差异。结果:两组患者术前膜染色评分、睑缘形态评分、NIF-BUT评分、NIAvg-BUT评分、OSDI评分低于术后7 d与术后1个月(均P<0.05);干眼组术前OSDI评分高于对照组(P<0.05);干眼组术后7 d角膜染色评分、睑缘形态评分、NIF-BUT、NIAvg-BUT、Qov评分、OSDI评分高于对照组,TMH低于对照组(均P<0.05);干眼组术后1个月角膜染色评分、睑缘形态评分、睑板腺成像评分、NIF-BUT、NIAvg-BUT、QoV评分、OSD评分高于对照组,TMH低于对照组(均P<0.05)。Logistic回归分析结果显示,术后7 d、术后1个月角膜染色评分、睑缘形态评分、NIF-BUT、NIAvg-BUT、QOV评分及术后1个月睑板成像评分偏高是干眼症发生的独立危险因素,较高的TMH评分是干眼症发生的独立保护因素(均P<0.05)。结论:ICL植入术对患者眼表泪膜稳定性同样存在影响,应当注意术前评估及术后复查,给予针对性的术前预防性治疗和术后干预性治疗措施。

Objective:To investigate the effect of implantable collamer lens(ICL)implantation on the tear film on the ocular surface in patients with crystalline eyes,and to provide scientific basis for the clinical prevention and treatment of dry eye syndrome after ICL surgery.Methods:A total of 76 patients(149 eyes)who underwent ICL surgical correction treatment were included as the study subjects.They were divided into dry eye group and control group based on whether they developed dry eye syndrome at 3 months after surgery.The differences in tear height(TMH),first tear film rupture time(NIF-BUT),average tear film rupture time(NIAvg-BUT),meibomian gland imaging score,lipid layer score,visual quality score(QoV),and Ocular Surface Disease Index(OSDI)at 3 days before surgery,7 days and 1 month after surgery between the two groups were compared.Results:The preoperative membrane staining score,eyelid margin morphology score,NIF-BUT score,NIAvg BUT score,and OSDI score of both groups of patients were lower than those at 7 days and 1 month after surgery(all P<0.05);the preoperative OSDI score of the dry eye group was higher than that of the control group(all P<0.05);the corneal staining score,eyelid margin morphology score,NIF-BUT,NIAvg-BUT,Qov score,and OSDI score of the dry eye group were higher than those of the control group at 7 days after surgery,and the TMH score was lower than that of the control group(all P<0.05);the corneal staining score,eyelid margin morphology score,meibomian gland imaging score,NIF-BUT,NIAvg-BUT,QoV score,and QoV score of the dry eye group were higher than those of the control group at 1 month after surgery,and the OSDI score was higher than that of the control group,while the TMH score was lower than that of the control group(all P<0.05).The Logistic regression analysis results showed that the corneal staining score and eyelid margin morphology score were higher High NIF-BUT,NIAvg-BUT,QOV scores,and 1-month postoperative meibomian imaging scores at 7 days and 1 month after surgery were independent risk factors for dry eye syndrome,while higher TMH score was independent protective factors for dry eye syndrome(all P<0.05).Conclusion:ICL implantation surgery also has an impact on the stability of the tear film on the patient’s ocular surface.Preoperative evaluation and postoperative follow-up should be paid attention to,and targeted preoperative preventive treatment and postoperative intervention treatment measures should be given.