不同尺寸角膜切口对白内障超声乳化术后患者泪膜及泪液功能的影响
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摘要
目的:探讨不同尺寸角膜切口对白内障超声乳化术后患者泪膜及泪液功能的影响。方法:64例白内障患者,均分为对照组和实验组,对照组行3.0 mm透明角膜切口白内障超声乳化术,实验组行1.8 mm透明角膜切口白内障超声乳化术;于手术前、术后1周、1个月及3个月时比较2组患者干眼频率、强度及加重情况评分,比较两组患者泪膜破裂时间(t BUT)、泪液分泌量(SⅠt)、上泪新月面积(UTMA)、下泪新月面积(LTMA)及总泪新月面积(TTMA)。结果:术前2组患者干眼频率、强度及加重情况评分,t BUT、SⅠt、UTMA、LTMA及TTMA比较,差异无统计学意义(P>0.05);术后2组患者干眼频率、强度及加重情况评分均较术前呈先升高后降低趋势,仅术后1周及1个月时显著高于术前(P<0.05或P<0.01),实验组术后1周时患者的干眼频率、强度评分显著低于对照组(P<0.05或P<0.01);术后1周及1个月时,2组t BUT及SⅠt均明显低于术前(P<0.05或P<0.01),且实验组术后1周时的t BUT及SⅠt均明显高于对照组(P<0.05或P<0.01);对照组患者术后1周时及1个月时的LTMA、TTMA,实验组术后1周时的LTMA及TTMA均显著低于术前(P<0.05或P<0.01)。结论:不同尺寸切口的白内障超声乳化术后早期均会导致不同程度的干眼症状,小切口手术对术后早期泪液功能相关指标影响较小。
Objective: To investigate the effect of different sizes of corneal incisions on tear film and tear function of patients with cataract after phacoemulsification. Methods: 64 patients with cataract after phacoemulsification were selected and randomly divided into the control group( n = 32) and the experimental group( n = 32). The control group underwent 3 mm clear corneal incision phacoemulsification,while the experimental group underwent 1. 8 mm clear corneal incision phacoemulsification. The Dry Eye Subjective Symptom Score( DES),Tear Film Break-up Time( t BUT) and Schirmer Ⅰ test( SIt) were compared between 2 groups before and after surgery. The tear Meniscus Area( TMA) was quantitatively detected by Optical Coherence Tomography( OCT). Results: The frequency,intensity and dry eye exacerbation scores increased at first and decreased later,and the above scores of 2 groups1 week and 1 month after surgery were significantly higher than those before surgery. The frequency and intensity scores of the experimental group 1 week after surgery were significantly lower than those of the control group( P < 0. 05 or P < 0. 01). The t BUT and SIt of 2 groups all decreased at first and then increased after surgery. The t BUT and SIt in 2 groups 1 week and 1 month after surgery were significantly lower than those before surgery,and the t BUT and SIt of the experimental group 1 week after surgery were significantly higher than those of control group( P < 0. 05 or P < 0. 01). The Upper/Lower Tears Meniscus Area,( LTMA/UTMA) and Total Tears Meniscus Area( TTMA) of 2 groups after surgery decreased at first and then increased,and LTMA,UTMA and TTMA 1 month after surgery of the experimental group were significantly higher than those of the control group( P < 0. 05 or P <0. 01). Conclusion: Different sizes of corneal incision after phacoemulsification can cause different degrees of dry eye symptoms in early stage,but small incision surgery has less influence on tear function related indexes at early stage after surgery.
Objective: To investigate the effect of different sizes of corneal incisions on tear film and tear function of patients with cataract after phacoemulsification. Methods: 64 patients with cataract after phacoemulsification were selected and randomly divided into the control group( n = 32) and the experimental group( n = 32). The control group underwent 3 mm clear corneal incision phacoemulsification,while the experimental group underwent 1. 8 mm clear corneal incision phacoemulsification. The Dry Eye Subjective Symptom Score( DES),Tear Film Break-up Time( t BUT) and Schirmer Ⅰ test( SIt) were compared between 2 groups before and after surgery. The tear Meniscus Area( TMA) was quantitatively detected by Optical Coherence Tomography( OCT). Results: The frequency,intensity and dry eye exacerbation scores increased at first and decreased later,and the above scores of 2 groups1 week and 1 month after surgery were significantly higher than those before surgery. The frequency and intensity scores of the experimental group 1 week after surgery were significantly lower than those of the control group( P < 0. 05 or P < 0. 01). The t BUT and SIt of 2 groups all decreased at first and then increased after surgery. The t BUT and SIt in 2 groups 1 week and 1 month after surgery were significantly lower than those before surgery,and the t BUT and SIt of the experimental group 1 week after surgery were significantly higher than those of control group( P < 0. 05 or P < 0. 01). The Upper/Lower Tears Meniscus Area,( LTMA/UTMA) and Total Tears Meniscus Area( TTMA) of 2 groups after surgery decreased at first and then increased,and LTMA,UTMA and TTMA 1 month after surgery of the experimental group were significantly higher than those of the control group( P < 0. 05 or P <0. 01). Conclusion: Different sizes of corneal incision after phacoemulsification can cause different degrees of dry eye symptoms in early stage,but small incision surgery has less influence on tear function related indexes at early stage after surgery.
引文
[1]杨建刚,宋金鑫,龚玉静.白内障超声乳化术治疗原发性闭角型青光眼合并白内障的临床观察[J].国际眼科杂志,2015,15(11):1984-1986.
[2]张东兴.白内障超声乳化摘除术联合人工晶体植入术应用于闭角型青光眼临床体会[J].世界中医药,2016,11(6):2069-2069.
[3]朱天文,黎海平.白内障超声乳化术后干眼的研究进展[J].现代中西医结合杂志,2016,25(3):336-339.
[4]朱冬梅.白内障超声乳化术后低视力分析[J].中国眼耳鼻喉科杂志,2015,25(2):86-88.
[5]陈鼎,黄芳,朱秋健,等.不同尺寸角膜切口的白内障超声乳化手术对泪液功能的影响[J].温州医科大学学报,2014,44(5):342-347.
[6]赵娴,刘婕,左建霞,等.不同切口白内障超声乳化手术对糖尿病患者术后泪膜功能的影响[J].河北医科大学学报,2016,37(8):932-934.
[7]贝政平,舒怀,周梁.眼、耳鼻咽喉科疾病诊断标准[M].北京:科学出版社,2007.
[8]SCHIFFMAN R M,CHRISTIANSON M D,JACOBSEN G,et al.Reliability and validity of the ocular surface disease index[J].Archives of Ophthalmology,2000,118(5):615-621.
[9]杨静,曾明兵.不同透明角膜切口白内障超声乳化术对眼表的影响[J].广东医学,2016,37(4):564-566.
[10]梁先军,何锦贤,林英杰,等.不同方位透明角膜切口白内障超声乳化手术对泪膜变化的影响[J].临床眼科杂志,2017,25(2):109-113.
[11]裴瑞.不同年龄白内障患者超声乳化术中瞳孔直径的变化对手术时间及疗效的影响[J].贵阳医学院学报,2015,40(12):1420-1423.
[12]杜永卓.白内障超声乳化技术并发症的处理及分析[J].中国医药指南,2015,9(18):122-123.
[13]刘晓熹.不同药物治疗白内障超声乳化术后干眼症的临床效果[J].中国医药导报,2015,12(36):125-128.
[14]李晓鹏,李彦,焦军杰,等.白内障超声乳化术对泪膜功能的影响[J].国际眼科杂志,2015,15(4):669-671.
[15]朱清明.不同切口白内障超声乳化术对患者术后眼表状态的影响[J].国际眼科杂志,2015,15(2):331-333.
[16]蓝倩倩,满平仪,曾思明.泪膜稳定性检测方法的研究概况[J].中国临床新医学,2016,9(2):175-178.
[17]王理论,马雄雄,杨林声,等.溴芬酸钠滴眼液对干眼症患者自觉症状和体征、泪膜破裂时间及泪液分泌量的影响[J].临床和实验医学杂志,2017,16(13):1344-1347.
[18]于世伟,夏媛玲.糖尿病白内障患者行超声乳化吸除及人工晶状体植入术后房水NO水平[J].贵州医科大学学报,2017,42(8):937-941.
[19]周双双,谭钢,邵毅.扫频光学相干断层扫描在眼科的应用进展[J].眼科新进展,2017,37(8):788-792.
[20]高超,王春芳,梁庆丰.前节OCT泪河测量的相关参数在干眼诊断中的应用研究[J].眼科,2016,4(3):148-153.
[2]张东兴.白内障超声乳化摘除术联合人工晶体植入术应用于闭角型青光眼临床体会[J].世界中医药,2016,11(6):2069-2069.
[3]朱天文,黎海平.白内障超声乳化术后干眼的研究进展[J].现代中西医结合杂志,2016,25(3):336-339.
[4]朱冬梅.白内障超声乳化术后低视力分析[J].中国眼耳鼻喉科杂志,2015,25(2):86-88.
[5]陈鼎,黄芳,朱秋健,等.不同尺寸角膜切口的白内障超声乳化手术对泪液功能的影响[J].温州医科大学学报,2014,44(5):342-347.
[6]赵娴,刘婕,左建霞,等.不同切口白内障超声乳化手术对糖尿病患者术后泪膜功能的影响[J].河北医科大学学报,2016,37(8):932-934.
[7]贝政平,舒怀,周梁.眼、耳鼻咽喉科疾病诊断标准[M].北京:科学出版社,2007.
[8]SCHIFFMAN R M,CHRISTIANSON M D,JACOBSEN G,et al.Reliability and validity of the ocular surface disease index[J].Archives of Ophthalmology,2000,118(5):615-621.
[9]杨静,曾明兵.不同透明角膜切口白内障超声乳化术对眼表的影响[J].广东医学,2016,37(4):564-566.
[10]梁先军,何锦贤,林英杰,等.不同方位透明角膜切口白内障超声乳化手术对泪膜变化的影响[J].临床眼科杂志,2017,25(2):109-113.
[11]裴瑞.不同年龄白内障患者超声乳化术中瞳孔直径的变化对手术时间及疗效的影响[J].贵阳医学院学报,2015,40(12):1420-1423.
[12]杜永卓.白内障超声乳化技术并发症的处理及分析[J].中国医药指南,2015,9(18):122-123.
[13]刘晓熹.不同药物治疗白内障超声乳化术后干眼症的临床效果[J].中国医药导报,2015,12(36):125-128.
[14]李晓鹏,李彦,焦军杰,等.白内障超声乳化术对泪膜功能的影响[J].国际眼科杂志,2015,15(4):669-671.
[15]朱清明.不同切口白内障超声乳化术对患者术后眼表状态的影响[J].国际眼科杂志,2015,15(2):331-333.
[16]蓝倩倩,满平仪,曾思明.泪膜稳定性检测方法的研究概况[J].中国临床新医学,2016,9(2):175-178.
[17]王理论,马雄雄,杨林声,等.溴芬酸钠滴眼液对干眼症患者自觉症状和体征、泪膜破裂时间及泪液分泌量的影响[J].临床和实验医学杂志,2017,16(13):1344-1347.
[18]于世伟,夏媛玲.糖尿病白内障患者行超声乳化吸除及人工晶状体植入术后房水NO水平[J].贵州医科大学学报,2017,42(8):937-941.
[19]周双双,谭钢,邵毅.扫频光学相干断层扫描在眼科的应用进展[J].眼科新进展,2017,37(8):788-792.
[20]高超,王春芳,梁庆丰.前节OCT泪河测量的相关参数在干眼诊断中的应用研究[J].眼科,2016,4(3):148-153.
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