角膜地形图引导下不同手术切口对超声乳化术后角膜表面形态和泪膜的影响

目的：分析在角膜地形图引导下不同角膜切口对白内障超声乳化术后角膜表面形态和泪膜的影响。

方法：回顾性研究。选取2019-06/2020-12在我院行白内障超声乳化术患者56例60眼为研究对象，分为透明角膜切口组和角巩膜缘切口组，对存在角膜散光的患者，做与散光同轴向切口。比较术前及术后1wk，1、3mo最佳矫正视力(BCVA)、OSDI问卷、泪膜破裂时间(TBUT)、角膜表面规则指数(SRI)、角膜表面非对称指数(SAI)和角膜表面散光值(CYL)。

结果：两组术后BCVA较术前均提高(P<0.01)； 术后1wk，3mo两组患者OSDI评分较术前有差异(P<0.01)； 术后1mo两组TBUT较术前均有不同程度缩短(P<0.05)； 两组术后SAI和SRI均呈现不同程度上升，术后1wk，1mo角巩膜缘切口组SAI值明显低于透明角膜切口组(P<0.05)； 术后1wk两组CYL增长较术前均显著(P<0.05)，随着时间的推移逐渐下降，术后3mo时透明角膜切口组较术前仍有所增高。

结论：角巩膜缘切口对术后角膜表面形态及泪膜的影响更小，能有效降低患者术后眼部不适症状。

Effects of corneal surface morphology and tear-film with different locations of incision under the guided by corneal topography after phacoemulsification

AIM:To analyze the effects of corneal surface morphology and tear-film with different incisions guided by corneal topography after phacoemulsification.

METHODS: Retrospective study. Totally 56 patients(60 eyes)were selected and divided into clear corneal incision group and angle scleral margin incision group who were treated by phacoemulsification in our hospital from June 2019 to December 2020. Best corrected visual acuity(BCVA), ocular surface disease index(OSDI)questionnaire, tear film break-up time(TBUT), corneal surface regularity index(SRI), corneal surface asymmetry index(SAI)and corneal surface astigmatism(CYL)were measured preoperatively and postoperatively, the results were statistically analyzed.

RESULTS: BCVA in both groups increased after operation(P<0.01). The OSDI score of the two groups increased significantly after surgery(P<0.01). TBUT was shortened to varying degrees after surgery(P<0.05). SAI and SRI increased to varying degrees in both groups after surgery, and SAI value of angle scleral margin incision group in 1wk and 1mo postoperatively was significantly lower than that in clear corneal incision group(P<0.05). The corneal astigmatism at 1wk postoperatively was significant increased in both groups(P<0.05). The astigmatism increase of clear corneal incision group at 3mo postoperatively was still higher than that before surgery.

CONCLUSION: Angle scleral margin incision has less effect on stability of tear film and corneal surface morphology, which is reliable on phacoemulsification.