不同切口白内障超声乳化手术对糖尿病患者术后泪膜功能的影响

2016-09-09左建霞邵丽静

河北医科大学学报 2016年8期

关键词：功能手术

赵　娴，刘　婕，左建霞，邵丽静

(河北省石家庄市第一医院眼科，河北石家庄 050011)

·论著·

不同切口白内障超声乳化手术对糖尿病患者术后泪膜功能的影响

赵娴，刘婕，左建霞，邵丽静

(河北省石家庄市第一医院眼科，河北石家庄 050011)

目的比较透明角膜切口与巩膜隧道切口白内障超声乳化手术对糖尿病患者术后泪膜功能的影响。方法选取糖尿病性白内障患者78例(90眼)，随机分为2组，每组45眼，A组行透明角膜切口白内障超声乳化手术，B组行巩膜隧道切口白内障超声乳化手术。分别观察术前3 d及术后1周、1个月、3个月角膜荧光素染色(conjunctive fluorescein staining,CFS)、基础泪液分泌试验(Schirmer Ⅰ test,SⅠt) 和泪膜破裂时间(tear break-up time,BUT) 3个指标，以测定患者的泪膜功能变化。结果2组CFS评分均在术后1周升高，随后逐渐下降，A组升高和下降幅度较大(P<0.05)；2组SⅠt和BUT均在术后1周下降，随后逐渐升高，A组下降和升高幅度较大(P<0.05)；术后3个月2组CFS、 SⅠt 、BUT数值基本恢复至术前水平。结论巩膜隧道切口较透明角膜切口白内障超声乳化手术对糖尿病性白内障患者术后泪膜功能影响小。

白内障；超声乳化术；糖尿病

10.3969/j.issn.1007-3205.2016.08.016

[Abstract]ObjectiveTo investigate the influence of phacoemulsificaiton with the clear corneal incision and the scelrotic tunnel incision on tear film of diabetic patients. MethodsSeventy-eight cataract patients(90 eyes) with diabetes were divided into two groups randomly:group A(45 eyes) with clear corneal incision phacoemulsification and group B(45 eyes) with sclerotic tunnel incision. Cornea fluorescein(CFS), Schirmer Ⅰ test(SⅠt) and tear break-up time(BUT) were observed at 3 d preoperatively and 1 week, 1 month and 3 months postoperatively to evaluate the changes of tear film. ResultsThe CFS scores of two groups were obviously increased at 1 week postoperatively, and then gradually decreased. The increase and decrease in the clear corneal incision group were larger(P<0.05). The SⅠt and BUT of two groups were both obviously lower at 1 week postoperatively than preoperatively(P<0.05), and then gradually increased. The increase and decrease in the clear corneal incision group were larger (P<0.05). There were no significant difference of CFS, SⅠt and BUT between two groups at 3 months postoperatively(P>0.05). ConclusionCompared with clear corneal incision, the changes of tear film in sclerotic tunnel incision was slighter after phacoemulsification in cataract patients with diabetes.

随着白内障手术由单纯的复明手术向屈光手术的发展，白内障患者对术后视觉质量及舒适度的追求越来越高，而患者常在术后出现眼睛干涩、烧灼感等干眼不适症状，在一定程度上影响了患者的视觉质量，尤其是糖尿病患者白内障术后的干眼症状比普通老年性白内障患者更加明显。已有研究表明，手术对眼表的生理状态会产生不同程度的破坏，其中以泪膜功能的改变较为明显[1]。本研究对不同切口白内障超声乳化术后患者的眼表状态改变进行观察，以了解并探讨糖尿病患者白内障术后泪膜功能的改变。现报告如下。