糖尿病合并白内障患者超声乳化术后干眼分析

背景白内障超声乳化摘出联合人工晶状体（IOL）植入术是治疗白内障、重建视功能的惟一有效手段，部分糖尿病患者行白内障摘出术后泪膜的稳定性和眼表结构受到一定影响，而研究表明泪膜功能异常是导致干眼的重要原因。目的探讨糖尿病合并白内障患者行白内障超声乳化术后泪液的变化。方法采用非随机病例对照研究设计。纳入2010年10月至2011年5月在天津市第一中心医院眼科就诊的糖尿病合并白内障患者36例54眼及同期就诊的单纯年龄相关性白内障患者32例40眼，两组患者性别及年龄匹配，均行白内障超声乳化联合IOL植入术，术前与术后局部用药相同。分别于术前3d及术后1d、1周、1个月、3个月以干眼调查问卷的方式获得患者的主觉症状结果并进行评分，同时行泪膜破裂时间（BUT）、基础泪液分泌试验（SIt）、角膜荧光素染色（FL）检查，对两组患者的上述检测指标进行比较。结果本组患者术前有干眼症状者占36．2％，术后有干眼症状者占75．8％。糖尿病合并白内障组患者术后干眼症状的评分明显重于单纯白内障组，且2个组随着术后时间的延长干眼症状评分均增加，总体差异均有统计学意义（F组别=139．347，P=0．000；F时间=342．741，P=0．000）。2个组术眼FL评分不同组间和不同时间点间的变化差异均有统计学意义（F时间=332．697，P=0．000；F组别=14．073，P=0．000），其中2个组患者术后各时间点FL评分均明显高于术前值，差异均有统计学意义（P〈0．05），但术后3个月FL评分与术前比较差异无统计学意义（P〉0．05），糖尿病合并白内障组患者术后FL评分明显高于单纯白内障组。2个组手术前后不同时间BUT值的总体比较差异有统计学意义（F组别=28．198，P=0．000；F时间=868．364，P=0．000），其中糖尿病合并白内障组术后各时间点BUT均缩短，与术前比较差异均有统计学意义（P〈0．05）。2个组手术前后不同时间点的sIt值总体比较差异有统计学意义（F时间=564．017，P=0．000），其中2个组术后1d、1周sIt值与术前比较差异均有统计学意义（P〈0．05），术后1～3个月，2个组sIt值均恢复至术前水平。结论糖尿病患者泪膜功能较差，是干眼症的易患人群，行白内障超声乳化术后干眼症状较单纯年龄相关性白内障患者发生得早，症状更明显，持续时间更长。

Dry eye analysis of diabetes with cataract patients after phacoemulsification

Background Cataract phacoemulsification combined with intraocular lens（IOL） implantation is a primary treatment for cataract. However, tear film stability and ocular surface structure are affected after surgery, especially some cataract patients with diabetes. Researches determined that tear film dysfunction is an important causative factor of dry eye. Objective This study was to investigate the change of tear film after phacoemulsification in cataract patient with diabetes. Methods A non-randomized cases-controlled study was designed. Thirty-six cataract patients with diabetes （54 eyes）and matched 52 patients （40 eyes）with age-related cataract were included in this study in Tianjin First Center Hospital from October, 2010 to May, 2011. Phacoemulsification and IOL implantation was performed on the all patients with the same topical eyedrops in both groups. Dry eye-related symptom was surveyed and scored by questionnaire, and tear film break-up time （BUT） , Schirmer I test（S I t）and corneal fluorescein（FL）were examined 3 days before operation and 1 day, 1 week, 1 month,3 months after operation. Written informed consent was obtained from each patient before entering this trial. Results The percentage with preoperative symptoms of dry eye was 36. 2% and postoperative dry eye symptoms accounted for 75.8%. Significant differences were seen in dry eye symptom score, FL score, BUT value and S I t value between the diabetic cataract group and only cataract group as well as among 4 time points（dry eye symptom score： Fgroup = 139. 347 ,P = 0. 000 ; Ftime = 342. 741, P = 0. 000 ; FL score ： Fgrou0 = 14. 073, P = 0. 000 ; ftime = 332. 697, P = 0. 000 ;BUT value ： Fgrouo = 28. 198 ,P=0. 000 ;Ftime = 868. 364 ,P= 0. 000 ;S I t value ： Fgroup = 2. 848 ,P= 0. 095 ;Ftime = 564. 017 ,P=0. 000）. FL scores of 2 groups were significantly higher in postoperation than those in preoperation （P〈0. 05） ,and those of diabetic cataract group were significantly higher than only cataract group（P〈0.05 ） , but no significant difference was found between postoperation 3 months and preoperation （ P〉0.05 ）. BUT was shorter in postoperation than that in preoperation in the diabetic cataract group（P〈0.05）, S I t values in postoperative 1 day and 1 week were significantly lower than in preoperation in both groups（P〈0.05 ）. However, S I t values returned to normal from 1 month through 3 months in both groups（P〉0.05）. Conclusions Tear film dysfunction occurs after operationin cataract patient with type 2 diabetes. It is thought that cataract patient with diabetes is susceptible population of dry eye. Dry eye appears more early and severer in diabetes patients after phacoemulsification combined with IOL implantation.