超声乳化白内障摘除联合小梁切除术对眼表的影响

目的：采用Keratograph 5M眼表综合分析仪比较小梁切除术和超声乳化白内障摘除联合小梁切除术对眼表的影响。

方法：纳入原发性闭角型青光眼合并白内障患者62例62眼，按手术方式分为两组：小梁切除术组32例32眼，超声乳化白内障摘除联合小梁切除术组(青白联合手术组)30例30眼。运用Keratograph 5M评估术前，术后3d，1、 3mo的非侵入性首次泪膜破裂时间(NifBUT)、非侵入性平均泪膜破裂时间(NiaBUT)、泪河高度(TMH)和角膜荧光素染色评分(CFS)。

结果：术前两组患者眼表参数比较差异均无统计学意义(P>0.05)。术后3d青白联合手术组的NiaBUT、NifBUT、CFS、TMH最差，分别为10.13±1.48、12.59±1.96s、0.80±0.22分与0.31±0.02mm，变化幅度明显高于小梁切除组(均 P<0.05)，术后1mo两组的各项指标均有所恢复，但直到术后3mo仍未完全恢复到术前水平。

结论：眼表综合分析仪可以客观、精确地用于评估抗青光眼手术后泪膜功能的变化。在术后3mo短期内超声乳化白内障摘除联合小梁切除术比单纯小梁切除术对眼表的影响更为严重，提示在此期间应加强对眼表的护理。

Effect of trabeculectomy and phacoemulsification combined with trabeculectomy on the ocular surface

AIM: To compare the effects of trabeculectomy and phacotrabeculectomy on the ocular surface using ocular Keratograph 5M.

METHODS: Totally 62 eyes of 62 patients with coexisting primary angle-closure glaucoma(PACG)and cataract were recruited. Thirty-two eyes accepted trabeculectomy, and the remaining thirty eyes accepted phacotrabeculectomy. Ocular surface parameters, including noninvasive first tear film break-up time(NifTBUT), noninvasive average tear film break-up time(NiaTBUT), corneal fluorescein staining scores(CFS)and tear meniscus height(TMH), were analyzed preoperatively, 3d, 1mo and 3mo postoperatively, with ocular Keratograph 5M.

RESULTS: There was no significant difference in ocular surface parameters between the two groups preoperatively(P>0.05). The values of NifTBUT, NiaTBUT, CFS and TMH in phacotrabeculectomy eyes were at the worse levels, i.e. 10.13±1.48s, 12.59±1.96s, 0.80±0.22 and 0.31±0.02mm, respectively at 3d postoperatively, then improved gradually at 1mo postoperatively, but did not return to the preoperative levels at 3mo postoperatively.

CONCLUSION: Ocular Keratograph 5M can be used to evaluate the changes of tear film in combined anti-glaucoma surgery accurately. The effects of phacotrabeculectomy on ocular surface are worse than that of trabeculectomy during 3mo after surgery. It is suggested that more eye care should be paid during that period of time.