不同切口白內障超聲乳化及人工晶狀體植入術后淚膜穩定性觀察

【摘要】 目的 探討透明角膜切口與鞏膜隧道切口白內障超聲乳化及人工晶狀體植入術后淚膜穩定性的差異。

方法抽取擬行白內障超聲乳化術的老年性白內障患者60例68眼，隨機分為兩組，A組30例32眼，予透明角膜切口施術，B組30例36眼，予鞏膜隧道切口施術。檢測兩組術前1天，術后1、7、14、30天 的淚膜破裂時間（BUT）、基礎淚液分泌試驗（Sit）、角膜熒光素染色積分（FL）以及患者主觀干眼感覺癥狀。結果 A組術后第1天較術前BUT 明顯縮短，Sit、角膜熒光素染色積分明顯增高（P＜0.05或0.01）；第7天時Sit，第30天時 BUT、角膜熒光素染色積分恢復至術前水平(P＞0.05)。B組術后第１天BUT 明顯縮短，Sit明顯增高（P＜0.05或0.01），角膜熒光染色積分比較差異無統計學意義(P＞0.05)；術后第7、14、30天，BUT、Sit逐漸恢復至術前水平(P＞0.05)。兩組主觀干眼感覺癥狀，術后第1天均明顯增高（P＜0.05），14天后基本恢復到術前狀況(P＞0.05)。結論鞏膜隧道切口淚膜的穩定性較透明角膜切口白內障摘除術顯著降低，但主觀感覺無明顯差異。

【關鍵詞】 小切口白內障超聲乳化術；切口方式；淚膜；干眼

文章編號：1003-1383(2010)06-0678-03 中圖分類號：R 779.66 文獻標識碼：A

doi:10.3969/j.issn.1003-1383.2010.06.011

Observation on the tear film stability after different incision phacoemulsification and intraocular lens implantation

LIUWeihua

（Yixing City，Jiangsu Province People's Hospital of Ophthalmology，

Yixing， Jiangsu 214200）

【Abstract】 ObjectiveTo study the tear film stability after cataract extraction and intraocular lens implantation with different incision positions.

Methods 60 patients with 68 eyes scheduling for cataract extraction by phacoemulsification cataract surgery were randomly divided into two groups.Group A of 32 eyes of 30 patients were given the treatments to clear corneal incision，group B of 30 patients with 36 eyes were given the scleral tunnel incision surgery. Tear breakup time (BUT)， basal tear secretion test (Sit)，corneal fluorescein staining points(FL)，and patients with subjective symptoms of dry eye feeling were test on a day preoperative，the 1st，7th，14th，30th day postoperative.

Results The BUT of a day preoperative was shorter than that of the 1st day after operation in group A， the Sit and the FL was increased(P＜0.05 or 0.01);Sit on the 7th day and BUT，corneal fluorescein staining points on the 30th day returned to preoperative level(P＞0.05). The BUT of a day preoperative was shorter than that of the 1st day after operation in group B ，the Sit increased(P＜0.05 or 0.01)，no significant difference was found in corneal staining points(P＞0.05); the BUT，Sit gradually returned to the preoperative level on the 7th，14th，30thday after operation(P＞0.05). the feeling of dry eye symptoms got worse on the 1st day after operation in both groups(P＜0.05)，but returning to the preoperative status on the 14th day after operation(P＞0.05).

Conclusion The tear film stability of the surgery by the sclera tunnel incision is less than surgery by clear corneal incision，but no different is found in the subject sensation of dry symptoms.

【Key words】smallincision cataract extirpation;type of incision;tear film;dry eye

近年來，小切口白內障超聲乳化術被許多眼科醫生所接受，我科自2009年新開展了透明角膜切口白內障超聲乳化術，發現其術后切口愈合快、散光小，但術后部分患者出現明顯異物感、干澀等干眼癥表現，因此筆者對不同切口白內障超聲乳化術后患者淚膜的變化作了一些比較，結果如下。

對象和方法

1.對象 2009年2月至2010年2月間我科施行小切口白內障手術的白內障患者60例 68 眼，年齡55～9２歲，平均（67.3±11.2）歲，其中男31例，女29例，單眼52例，雙眼8例。……