同轴微切口白内障超声乳化术后泪膜及角膜规则性的研究

目的　比较１．８ｍｍ和３．０ｍｍ两种白内障手术切口术后泪膜及角膜规则性的变化。方法　选取２０１４年１１月至２０１５年１０月行白内障超声乳化吸出术的年龄相关性白内障患者４８例（６２眼），根据患者对人工晶状体的选择分为:Ａ组２４例（３０眼）行１．８ｍｍ透明角膜微切口白内障超声乳化术，Ｂ组２４例（３２眼）行３．０ｍｍ透明角膜切口白内障超声乳化术。比较术前及术后１ｄ、７ｄ、１个月、３个月的泪膜破裂时间（ｂｒｅａｋ-ｕｐｔｉｍｅ，ＢＵＴ）、基础泪液分泌（ＳｃｈｉｒｍｅｒⅠ ｔｅｓｔ，ＳⅠｔ）、角膜荧光素染色评分（ｃｏｒｎｅａｆｌｕｏｒｅｓｃｅｉｎｓｔａｉｎｉｎｇ，ＦＬＳ）、干眼主观症状评分、角膜表面规则性指数（ｓｕｒｆａｃｅｒｅｇｕｌａｒｉｔｙｉｎｄｅｘ，ＳＲＩ）及角膜表面非对称性指数（ｓｕｒｆａｃｅａｓｙｍｍｅｔｒｙｉｎｄｅｘ，ＳＡＩ）。结果　术后１ｄ、７ｄＢ组ＢＵＴ均短于Ａ组（均为Ｐ＜０．０５）。术后１ｄＢ组ＳⅠｔ低于Ａ组（Ｐ＜０．０５）。术后１ｄ、７ｄ、１个月Ｂ组ＦＬＳ均高于Ａ组（均为Ｐ＜０．０５）。术后１ｄ、７ｄＢ组干眼主观症状评分均高于Ａ组（均为Ｐ＜０．０５）。术后１ｄ、７ｄ、１个月Ｂ组ＳＡＩ、ＳＲＩ均高于Ａ组（均为Ｐ＜０．０５）。Ａ组ＢＵＴ、ＦＬＳ、干眼主观症状评分、ＳＡＩ于术后１个月恢复至术前状态，ＳⅠｔ和ＳＲＩ于术后７ｄ恢复至术前状态；Ｂ组各项结果均于术后３个月恢复至术前状态。结论　１．８ｍｍ切口较３．０ｍｍ切口白内障超声乳化术后干眼症状更轻，泪膜功能及角膜规则性恢复更快。

Changes in tear film and corneal surface regularity after coaxial micro-incision phacoemulsification

Objective To compare the changes in tear film and corneal surface regularity after l. 8 mm coaxial micro-incision phacoemulsification and 3. 0 mm incision coaxial phacoemulsification. Methods From November 2014 to October 2015 ,48 patients (62 eyes) with age-related cataract were divided int0 2 groups according to the IOL selection. Group A ( 24 patients, 30 eyes) received l. 8 mm coaxial micro-rncision phacoemulsification, and group B ( 24 patients , 32 eyes) took 3. 0 mm incision coaxial phacoemulsification. Tear break-up time ( BUT) ,Schirmer I test ( sit) ,comea fluorescein staining scores ( FLS ) , subjective score for dryness , surface regularity index ( SRI) and surface asymmetry index ( SAI) were evaluated preoperatively and I day , 7 days , I month and 3 months postoperatively. Results At I day, 7 days postoperatively, the mean BUT of group B reduced greatly than group A. At I day postoperatively , the mean SIt of group B was lower than group A(P < 0. 05 ) . At I day ,7 days and I month postoperatively , the mean FLS of group B were higher than group A ( all P < 0. 05 ) . At I day ,7 days postoperatively , the mean subjective score for dryness of group B were higher than group A ( all P < 0. 05 ) . At I day ,7 days and I month postoperatively ,the mean SAI and SRI of group B were both higher than group A. In group A, BUT, FLS, subjective score for dryness and SAI recovered to preoperative levels at I month postoperatively , and SIt and SRI in group A recovered at 7 days. In group B, all of observing indexes recovered to preoperative levels at 3 months postoperatively. Conclusion l. 8 mm coaxial micro-incision phacoemulsification has the slighter dry eye symptom ,faster recovery of tear film and corneal surface regularity than 3. 0 mm incision coaxial phacoemulsification.