摘要
目的比较不同位置的角膜缘切口对有晶状体眼后房型人工晶状体(ICL V4c)植入术后泪液功能的影响。方法前瞻性自身对照研究。纳入2022年7月至2023年6月在西安市人民医院拟接受ICL V4c植入术的屈光不正者43例(86只眼)。根据角膜缘切口位置不同分为两组,将右眼(上方12点位角膜缘切口)作为干预组,左眼(颞侧3点位角膜缘切口)作为对照组。对术前、术后1个月和术后3个月的泪河高度(TMH)、非侵入性首次泪膜破裂时间(NIF-BUT)和非侵入性平均泪膜破裂时间(NIA-BUT)、上睑板腺缺失面积(UMGL),下睑板腺缺失面积(LMGL)、眼红指数分析、角膜荧光素染色(FCS)分级,眼表疾病指数(OSDI)问卷等检查进行评估。使用广义估计方程分析组间效应、时间效应、组间与时间交互效应。以OSDI为因变量,TMH、BUT等为自变量构建广义估计方程模型,分析OSDI的影响因素。结果NIA-BUT干预组术前、术后1个月和术后3个月分别为10.92(5.53,14.67),10.86(5.00,11.26),11.10(6.07,15.44)s;对照组分别为7.74(4.93,10.30),9.86(5.01,15.15),8.26(5.58,10.77)s,术后组间差异有统计学意义(均P<0.05);FCS干预组和对照组术后1个月分别为0.00(0.00,0.00),0.00(0.00,0.00)分,较术前0.00(0.00,0.00),0.00(0.00,0.00)分降低,差异均有统计学意义(均P<0.001);术后3个月FCS干预组和对照组均为(0.00±0.00)分,较术前评分降低,差异均有统计学意义(均P<0.001);其它干眼各项指标术前及术后差异均无统计学意义(均P>0.05);OSDI影响因素分析发现TMH与OSDI显示出显著负相关[β=-8.79,95%CI(-10.61,-6.97),P<0.001],NIA-BUT与OSDI呈显著负相关[β=-0.27,95%CI(-0.33,-0.21),P<0.001],眼红指数与OSDI呈显著正相关[β=2.12,95%CI(1.64,2.60),P<0.001]。结论不同位置的角膜缘切口植入ICL V4c,均未增加屈光不正者术后的干眼症状,但上方角膜缘切口的泪膜功能优于水平颞侧角膜缘切口。
ObjectiveTo compare the effect of corneal limbal incisions at different locations on tear function during posterior chamber phakic intraocular lens(ICL V4c)implantation.MethodsA prospective self-controlled study was conducted.A total of 43 patients(86 eyes)with refractive error who were scheduled to undergo ICL V4c implantation at Xi′an People′s Hospital between July 2022 and June 2023 were selected.Depending on the position of corneal limbal incision,the patients were divided into two groups:the intervention group(12 o′clock superior corneal limbal incision to the right eye)and the control group(3 o′clock temporal corneal limbal incision to the left eye).Tear meniscus height(TMH),non-invasive first tear film break-up time(NIF-BUT),non-invasive average tear film break-up time(NIA-BUT),upper meibomian gland loss area(UMGL),lower meibomian gland loss area(LMGL),redness index analysis,corneal fluorescein staining(FCS)grade,and ocular surface disease index(OSDI)questionnaire were assessed preoperatively and at 1 and 3 months postoperatively.Generalized estimating equations(GEE)were used to analyze intergroup effects,time effects,and group×time interaction effects.A GEE model was constructed to analyze the influencing factors of OSDI with OSDI as the dependent variable and TMH,BUT,etc.as independent variables.ResultsThe NIA-BUT in the intervention group at preoperation,1 month postoperatively,and 3 months postoperatively was 10.92(5.53,14.67),10.86(5.00,11.26),and 11.10(6.07,15.44),respectively.In the control group,the corresponding values were 7.74(4.93,10.30),9.86(5.01,15.15),and 8.26(5.58,10.77)s.The differences between the two groups were statistically significant(all P<0.05).The FCS in the intervention group and control group before surgery were 0.00(0.00,0.00)and 0.00(0.00,0.00)score.At 1 month after surgery,they decreased to 0.00(0.00,0.00)score and 0.00(0.00,0.00)score,with a statistically significant reduction compared to the baseline(all P<0.001).At 3 months postoperatively,the FCS was(0.00±0.00)score in both groups,which was also significantly lower than the baseline levels(P<0.001).Other dry eye indicators did not show significant differences(all P>0.05).Analyses of factors influencing OSDI revealed that TMH[β=-8.79,95%CI(-10.61,-6.97),P<0.001]and NIA-BUT[β=-0.27,95%CI(-0.33,-0.21),P<0.001]were significantly negatively correlated with OSDI;while the red eye index was significantly positively correlated[β=2.12,95%CI(1.64,2.60),P<0.001].ConclusionThe implantation of ICL V4c at different corneal limbal incision locations for patients with refractive error does not increase postoperative dry eye symptoms,but better tear film function can be achieved with the superior corneal limbal incision than with the horizontal temporal corneal limbal incision.
作者
郭琳
张子敔
孙婕
马波
吴琼
Guo Lin;Zhang Ziyu;Sun Jie;Ma Bo;Wu Qiong(Department of Ophthalmology,Xi′an People′s Hospital(Xi′an Fourth Hospital),Xi′an 710004,China)
出处
《中华眼外伤职业眼病杂志(中英文)》
2025年第5期336-342,共7页
Chinese Journal of Ocular Trauma and Occupational Eye Disease
基金
陕西省重点研发计划项目(S2023-YF-YBSF-0954)。
