作者：江利红，史 春，张靖华，应 坚 作者单位：(200438)中国上海市杨浦区市东医院眼科
【摘要】 目的:探讨经透明角膜及经巩膜隧道两种不同切口行白内障超声乳化联合人工晶状体植入术后泪膜的情况。方法:选择术前无干眼症单纯老年性白内障患者108例128眼，随机分组:A组55例68眼经透明角膜切口行白内障超声乳化联合人工晶状体植入术;B组53例60眼经巩膜隧道切口行白内障超声乳化联合人工晶状体植入术。观察分析术前、术后l,7,30,90d的所有患者干眼症状评分,基础泪液分泌试验(SⅠt)，泪膜破裂时间(BUT),角膜荧光素染色情况。结果:两组术前各项干眼指标差异无统计学意义(P>0.05), 所有术眼SⅠt值术后1d增加,术后7,30d下降,术后1,7,30d干眼症状评分增高,BUT缩短、角膜荧光素染色增加,较术前差异均有统计学意义(P<0.05),而两组比较术后1,7,30d,A组干眼症状评分高,SⅠt值改变大，BUT短、角膜荧光素染色多,较B组差异有统计学意义(P<0.05);术后90d时,所有术眼干眼症状评分、SⅠt值、BUT 程度及角膜荧光素染色接近术前水平,两组差异无统计学意义(P>0.05)。结论:相对于经巩膜隧道切口，经透明角膜切口的白内障超声乳化联合人工晶状体植入术术后短期对泪膜的影响较大,临床上应积极采取预防措施。
【关键词】 白内障超声乳化术;透明角膜切口;巩膜隧道切口;泪膜
Changes of tear film after phacoemulsification with clarity corneal incision or sclera tunnel incision
LiHong Jiang,Chun Shi,JingHua Zhang,Jian Ying
Department of Ophthalmology,Shidong Hospital, Yangpu District, Shanghai 200438,China
Abstract
AIM: To study the changes of tear film after phacoemulsification combined with intraocular lens implantation through clarity corneal incision or sclera tunnel incision.
METHODS: One hundred and eight cases (128 eyes) with agerelated cataract who hadnt got dry eye syndrome before the operations were randomly divided into two groups.There were 55 cases (68 eyes) through clarity corneal incision in group A,and 53 cases (60eyes) through sclera tunnel incision in group B. The subjective complains of dry eye, Schimer Ⅰ test (SⅠt), tear breakup time (BUT) and corneal fluorescein staining value were analyzed preoperatively and 1 day,7 days,30 days,90 days postoperatively.
RESULTS: The two group data of subjective complains of dry eye, SⅠt, BUT and corneal fluorescein scores were all statistical significance (P<0.05) on the first day, 7 days, 30 days after operation respectively, but 90 days after operation they all recovered their preoperative values,and they had no statistical significance (P>0.05).
CONCLUSION: Influences of phacoemulsification combined with intraocular lens implantation on tear film stability through clarity corneal incision seems to be more than that through sclera tunnel incision in short period. Protective measure should be taken clinically.
KEYWORDS: phacomulsification; clarity corneal incision; sclera tunnel incision; tear film
0引言
眼球的表面覆盖一层泪膜，稳定的泪膜使眼部感觉舒适，并可作为眼部良好的屈光间质。泪膜稳定性的降低常导致干眼症,角膜并发症等眼表疾病的发生。有研究表明,部分眼部手术可导致泪膜功能的异常,甚至干眼症的发生。超声乳化白内障摘除术以其组织损伤小、切口愈合快及术后视力恢复快等优点,已经得到广大眼科医师及患者的认同和普及。但患者术后出现不同程度的眼部干涩、异物及烧灼感等干眼症表现。因此超声乳化白内障摘除术后泪膜的变化受到了广泛的关注。我们通过对我科经不同切口方式行超声乳化白内障摘除联合人工晶状体植入术患者泪膜的变化情况进行分组研究，观察结果如下。
1对象和方法
1.1对象 随机抽取200703/200805在我科行超声乳化白内障摘除联合人工晶状体植人术的单纯老年性白内障患者108例128眼，男50例58眼，女58例70眼，年龄56～83(平均72.4±5.2)岁。所选病例术前均无任何干眼症状，无影响泪液分泌及泪膜稳定的眼部用药史，无全身结缔组织病及自身免疫性疾病。分为A组：经透明角膜切口组55例68眼，B组：经巩膜隧道切口组53例60眼。 表1 A,B组两组白内障超声乳化术前术后不同时间泪膜检查比较
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