陈　洁,章峥嵘,陈　炜



青光眼白内障联合手术对眼表泪膜功能的影响

陈洁,章峥嵘,陈炜

Department of Ophthalmology, the First Hospital of Jiaxing City, Jiaxing 314000, Zhejiang Province, China

Correspondence to:Jie Chen. Department of Ophthalmology, the First Hospital of Jiaxing City, Jiaxing 314000, Zhejiang Province, China. 20679549@qq.com

Received：2016-03-30Accepted：2016-07-11

•AIM:To evaluate the effect of combined glaucoma and cataract surgery on the function of eye surface and tear film.

•METHODS:This clinical trial involved 75 patients (75 eyes) with glaucoma complicated with cataract undergoing combined glaucoma and cataract surgery. All the eyes were divided into surgical group (the eyes undergoing operation) and control group (the other eyes).The symptoms and signs of dry eye disease, Schirmer’s I test, break-up time (BUT), corneal fluorescein staining were tested and marked 1mo after operation. Comparison of the results was made between two groups.

•RESULTS: The average intraocular pressure was 16.25±0.46mmHg at 1mo after operation, compared with 45.29±4.39mmHg at 3d before surgery, the difference was statistically significant (P<0.05). Preoperative average visual acuity was 0.08±0.06, corrected visual acuity was <0.05 in 23 eyes, ≥0.05 to <0.1 in 16 eyes, ≥0.1 to <0.3 in 36 eyes. Postoperatively 1mo, corrected visual acuity: <0.05 for 7 eyes (9%), ≥0.05 to <0.1 for 11 eyes (15%), ≥0.1 to <0.3 for 38 eyes (51%), ≥0.3 to <0.5 for 11 eyes (15%) , ≥0.5 for 8 eyes (11%), postoperative visual acuity was 0.15±0.1, which was significantly higher than before surgeries (P<0.05). The postoperative dry eye symptoms of surgical group was higher, compared with that of control group, and the differences of diagnosis of dry eye test indicators between the two groups were statistically significant(P<0.05).

•CONCLUSION: Combined cataract and glaucoma surgery may affect postoperative ocular surface and tear film function, make the tear film stability damaged and lead to dry eye disease.

Citation:Chen J, Zhang ZR, Chen W. Effect of combined cataract and glaucoma surgery on function of eye surface and tear film.GuojiYankeZazhi(IntEyeSci) 2016;16(8):1584-1587

摘要

目的：探讨青光眼白内障联合手术中眼表及泪膜功能的变化。

方法： 选取施行青光眼白内障联合手术的患者75例75眼，以手术眼为手术眼组，以未手术眼为对照眼组。于术后1mo对干眼相关症状、泪液分泌试验(Schirmer Ⅰ test, SⅠt)、泪膜破裂时间(break-up time, BUT)、角膜荧光素染色、眼压、视力等项目进行检查评分，并比较两组间各项结果差异。

结果：患者术后1mo的平均眼压为16.25±0.46mmHg，与术前3d的眼压45.29±4.39mmHg相比较，差异性具有统计学意义(P<0.05)。术前平均视力0.08±0.06，术前矫正视力：<0.05为23眼，≥0.05～<0.1为16眼，≥0.1～<0.3为36眼。术后1mo矫正视力：<0.05者7眼(9%)，≥0.05～<0.1者11眼(15%)，≥0.1～<0.3者38眼(51%)，≥0.3～<0.5者11眼(15%)，≥0.5者8眼(11%)，术后平均视力0.15±0.1。患者术眼视力与术前相比有明显提高，差异有统计学意义(P<0.05)。两组间术后的术眼干眼症状与对照组眼相比均呈增高趋势，干眼症诊断性试验各项指标与对照眼组相比，差异具有统计学意义(P<0.05)。

结论：青光眼白内障联合手术可在术后对眼表和泪膜功能造成影响，使泪膜稳定性受到破坏而产生干眼症。

关键词：青光眼合并白内障；超声乳化；小梁切除；干眼症；泪膜

引用：陈洁,章峥嵘,陈炜.青光眼白内障联合手术对眼表泪膜功能的影响.国际眼科杂志2016;16(8):1584-1587

0引言

青光眼合并有白内障目前多采用青-白联合性手术[1]，并且在临床上已应用多年。其术后不仅在眼压控制，延缓视神经进一步损伤等方面有积极的作用，还可以解决术前患者存在的视物模糊等症状，但是术后有一部分患者会出现眼部干涩、眼部不适等症状。因青-白联合性手术时间均较单纯手术方式时间长等因素[2-3]，故术后更易出现干眼症。随着许多学者对此研究的不断深入，促使医生不仅对疾病本身重视，同样对术后出现的眼表症状也逐渐加以重视，并逐步解决眼表症状[4-5]。基于上述因素故对此进行进一步研究。……