白内障患者手术前后干眼的临床观察

目的探讨白内障患者手术后干眼症的发病情况。方法对37例（50只眼）白内障患者在白内障手术前3d、术后1周、1和3个月进行眼部检查。检查项目包括：裂隙灯显微镜观察眼表情况、角膜和结膜荧光素染色、泪液膜破裂时间（BUT）、Schirmer试验Ⅰ（STⅠ）、结膜印迹细胞学（IC）检查。使用眼表疾病指数调查表评价干眼症对生活质量的影响,应用25项改良美国国家眼科研究所视觉功能问卷了解患者眼部情况、日常生活和视功能的总体情况。结果白内障患者经白内障手术获得了良好的视功能,但术后部分患者出现顽固性干眼症状。白内障术后患者可出现泪河线变窄,BUT变短、STⅠ减少,角结膜荧光素染色加重。此现象可在术后1周即可出现,术后1个月时达到最明显的状态,术后3个月时部分患者的症状可有一定程度恢复。IC检查显示：术后结膜杯状细胞的密度明显低于术前。结论白内障手术后患者可能出现明显的干眼症状和体征,应及时给予干预和治疗。

Clinical observation of dry eye in patients before and after cataract surgery

OBJECTIVE: To investigate dry eye in patients before and after cataract surgery. METHODS: 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ25) and Ocular Surface Disease Index (OSDI) were used for the study in 37 patients (50 eyes) 3 days before cataract surgery and repeated after surgery 1 week, 1 month and 3 months. Slit lamp microscope examination, cornea and conjunctiva fluorescein staining, tear break-up time (BUT), Schirmer test I (STI), impression cytology (IC) were carried out at the same time. RESULTS: After cataract surgery, the incidence of dry eye increased dramatically. Tear river was narrowed, BUT and STI were decreased and shorted in patients after cataract surgery. IC examination showed there was serious squamous metaplasia in epithelial layer of conjunctiva. NEI-VFQ25 was increased from 27.66 +/- 22.08 (before cataract surgery) to 74.69 +/- 11.67 (3 months after cataract surgery). All items of OSDI were remarkable increased, ocular surface abnormal was increased from 2.60 +/- 2.91 (before cataract surgery) to 12.66 +/- 11.40 (3 months after cataract surgery) and environmental trigger was increased from 3.57 +/- 2.67 (before cataract surgery) to 11.40 +/- 10.24 (3 months after cataract surgery). CONCLUSION: Dry eye can be induced or deteriorated after cataract surgery, if it can not be treated on time.