摘要
目的探讨年龄相关性白内障超声乳化手术不同切口对泪膜稳定性的影响。方法收集2012年7月到2013年12月之间的白内障超声乳化及人工晶状体(IOL)植入术的年龄相关性白内障患者152例243眼。随机将患者分为A、B组,其中角巩膜缘切口组67例113眼,透明角膜切口组85例130眼,各组资料的人口统计学特征差异无统计学意义(P>0.05)。在术前1天,术后第1周、第1个月、第3个月、第6个月、第12个月分别对各组患者进行眼部干眼症状评分、Schirmer试验(SIt)、泪膜破裂时间(BUT)以及角膜荧光素染色(CFS)一共4项指标的检测。采用SPSS 19.0统计软件,对数据进行卡方检验和配对t检验分析。结果 1对各组手术后1d和7d眼表的干眼症状进行评估,测出分值较术前有明显的提高,组间差异有统计学意义(P<0.01)。角巩膜缘切口组和透明角膜切口组分别在手术后的14d和30d眼表的干眼症状评估,测出分值都降低至术前水平。白内障超声乳化术后1d、7d角巩膜缘切口组眼表的干眼症状评估分小于透明角膜切口组,组间差异均有统计学意义(P<0.05)。其他时间点检查眼表的干眼症状各组间差异均无统计学意义(P>0.05);2SIT试验:A组和B组在术后1周时明显增加,其差异具有统计学意义(P<0.01),其他各时间点差异均无统计学意义(P>0.05);3BUT:A组和B组在术后1周;1,3个月时明显缩短,其差异具有统计学意义(P<0.05),其余各点差异均无统计学意义(P>0.05);4CFS评分:A组和B组在术后1周;1,3个月时增加,其差异均有统计学意义(P<0.05),其余各点差异无统计学意义(P>0.05)。结论角巩膜缘切口相对于透明角膜切口对于白内障术后泪膜的稳定性影响较小,是干眼症高危患者白内障超声乳化术较为理想的选择。角巩膜缘切口与透明角膜切口1月后两者对泪膜影响均恢复至术前。
Objective Purpose of this study was to explore the changes of tear film after phacoemulsification and intraocular lens（ IOL） implantation via corneoscleral rim incision. Methods Small incision phacoemulsification and IOL implantation was performed in 243 eyes of 152 patients with age- related cataract from July 2012 to December 2013.The surgery eyes were randomly divided into corneoscleral rim incision group（ 113 eyes of 67 cases）,corneal transparency incision group（ 130 eyes of 85 cases）. No significant differences were found in demography of clinical data among these two groups（ P 〉 0. 05）. Dry eye symptoms score,Schirmer test（ SIt）,tear film break- up time（ BUT） and corneal fluorescein staining in operative eyes were evaluated before surgery and 1 day,1 week,1months,3month,6month and 12 month after surgery. Written informed consent was obtained from each subjectprior to the trial. Results The clinical score of dry eye symptoms was showed to be significantly different among corneoscleral rim incision group and corneal transparency incision group in different time points. The score was gradually declined from 1 day to 14 days after operation and was stable after that,showing obvious differences in comparison with preoperation（ P 〈 0. 01）,and that in corneoscleral rim incision group was evidently lower than corneal transparency incision group（ P 〈 0. 01）. The BUT was significantly less within 14 days after operation than that of preoperation in corneal transparency incision group（ P 〈0. 01）,but no obvious difference was found in corneoscleral rim incision group in different time points（ P 〉 0. 05）,and the BUT value was lowest in corneal transparency incision group from 1 day through 14 days after operation. In corneoscleral rim incision group,Schirmer test was reduced from 1 day through 14 days after operation with the highest value in the first day after operation,showing statistically significant difference in various groups（ P 〈 0. 01）. The corneal fluorescein staining revealed that the score was significantly increased from 1 day through 14 day after operation in comparison with before operation in corneal transparent incision group（ P 〈 0. 05）,and the score was higher than corneoscleral rim incision groups in these time points（ P 〈 0. 05）. No considerable difference was seen in corneal fluorescein staining score among various time points in corneoscleral rim incision group（ P 〉 0. 05）. Conclusion Corneoscleral rim incision does not product adverse influence on the stability of tear film after small incision phacoemulsification and IOL implantation. These results suggest that corneoscleral rim incision is a better select in phacoemulsification cataract surgery for the cataractous eye with a high risk of dry eye.
出处
《医药论坛杂志》
2016年第2期27-30,共4页
Journal of Medical Forum
