超声乳化白内障吸除术后远期泪膜变化及相关危险因素分析

目的评价超声乳化白内障吸除术后远期泪膜变化情况，并分析其相关的独立危险因素。方法采用自身对照研究，随机选取于上海市交通大学附属第一人民医院眼科行超声乳化白内障吸除术的白内障患者256例（256眼），分别于术前1d及术后3个月时行泪膜破裂时间（BUT）、角膜荧光素基础泪液分泌试验（SIt）、染色积分（FI）的检查，采用独立样本t检验、配对t检验、卡方检验、Mann—Whitnev检验、多元线性回归分析、Spearman相关性分析和Pearson相关性分析对数据进行统计学处理。结果共96例患者最终完成了本次研究，除年龄外，96例患者可代表总体256例患者的资料。96例患者自身对照比较的结果显示，术后3个月时各项检测指标均已恢复至术前水平。分析影响术后BUT值、SIt值、FI值水平的危险因素后发现：术后BUT值与术前BUT值呈正相关（r=0．38，P〈0．01）。与患者年龄呈负相关（r=-0．22，P=0．02）；术后Sit值仅与术前Sit值呈正相关（r=0．41，P〈0．01）：术后FI值分别与术前BUT值、SIt值呈负相关（r=-0．32，P〈0．01；r=-0．22，P〈0．01），与术前FI值呈正相关（r=-0．35，P=0．01）。结论超声乳化白内障吸除术对术后远期泪膜影响小，泪膜各项指标水平的高低主要与术前基础值相关。

Long-term changes in tear film after phacoemulsification for cataract and assessment of corresponding risk factors

Objective To evaluate long-term changes of tear film after phacoemulsification surgery. Methods A self controlled study was performed. Two hundred fifty-six cataract patients （256 eyes） underwent phacoemulsification in the Department of Ophthalmology, Shanghai first People＇s Hospital, Shanghai Jiaotong University, were randomly enrolled in this prospective study. The tear film break up time （BUT）, Schirmer I test （Sit）, and Fluorenscein integral （FI） were measured 1 day preoperatively and patients were followed up for 3 months postoperatively. Statistical analysis included an independent samples t test, paired t test, chi-square test, Mann-Whitney test, multiple linear regression, Spearman correlation analysis and Pearson correlation analysis. Results Ninety-six patients participated in the 3-month postoperative follow-up period. All the information on the 96 patients and the original 256 patients was consistent, except for their ages. The 3-month postoperative scores of BUT, Sit and FI did not differ from preoperative scores. According to regression analysis, the postoperative BUT scores correlated positively with preoperative BUT scores （r=0.38, P〈O.01）, and correlated negatively with age （r=-0.22, P=0.02）. The postoperative Schirmer I test scores correlated positively with preoperative Schirmer I test scores （r=0.41, P〈0.01）. The postoperative F1 test scores not only correlated positively with preoperative FI test scores （r=0.35, P=0.01）, but also correlated negatively with preoperative BUT scores （1-=--0.32, P〈0.01） and preoperative Sit scores （r=-0.22, P〈0.01）. Conclusion At 3 month after phacoemulsification, the results of objective tear film examinations show a return to preoperative levels.