不同切口大小白内障超声乳化术对Ⅱ型糖尿病患者泪膜及角膜表面规则性的影响

摘要

目的比较1.8 mm和3.0 mm两种白内障手术切口在Ⅱ型糖尿病患者术后泪膜及角膜规则性的变化，以探讨不同切口大小对合并Ⅱ型糖尿病老年性白内障患者的干眼影响。方法选取合并Ⅱ型糖尿病老年性白内障患者48例55眼，根据患者对人工晶状体的选择分为A、B两组，A组23例26眼行1.8 mm透明角膜切口白内障超声乳化术；B组25例29眼行3.0 mm透明角膜切口白内障超声乳化术。观察两组术前及术后1 d、7 d、1个月、3个月的泪膜破裂时间（tear break-up time，BUT）、角膜荧光素染色（cornea fluorescein staining，FLS）、干眼主观症状评分、基础泪液分泌（schirmer I test，SIt）、角膜表面规则性指数（surface regularity index，SRI）及角膜表面非对称性指数（surface asymmetry index，SAI）情况。结果术前两组间BUT、FLS、干眼主观症状评分、SIt、SRI及SAI的比较，差异均无统计学意义。术后1 d、7 d，B组BUT、SIt明显低于A组（P<0.05），FLS值、干眼主观症状评分、SAI明显高于A组（P<0.05）。术后1 d、7 d、1个月、3个月，B组SRI明显高于A组，差异有统计学意义（P<0.05）。A组BUT、SIt、干眼主观症状评分于术后7 d恢复至术前水平（P>0.0125），FLS、SRI于术后1个月恢复至术前水平（P>0.0125），SAI于术后1 d恢复至术前水平（P>0.0125）。B组BUT、SIt、SRI、SAI于术后3个月恢复至术前水平（P>0.0125）， FLS、干眼主观症状评分于术后1个月恢复至术前水平（P>0.0125）。结论对于合并Ⅱ型糖尿病白内障拟行超声乳化术的患者，术后短期内1.8 mm切口较3.0 mm切口对泪膜功能及角膜规则性影响更小，患者干眼症状更轻，且恢复更快。%Objective To compare changes in tear film and corneal surface regularity of type Ⅱ diabetes patients after coaxial phacoemusification through 1.8 mm and 3.0 mm clear corneal incision, to explore effect of different incision size on dry eye in senile cataract patients with type Ⅱ diabetes.Methods 48 cases of senile cataract patients (55 eyes) with type type Ⅱ diabetes were selected, and were divided into 2 groups (A&B) according to their selection of intraocular lens. 23 patients (26 eyes) enrolled in group A were treated with coaxial phacoemusification through 1.8 mm clear corneal incision. And 25 patients (29 eyes) in group B were treated with coaxial phacoemusification through 3.0 mm clear corneal incision. Tear break time (BUT), cornea fluorescein staining (FLS), subjective symptom score of dry eye, schirmer I test (SIt), surface regularity index (SRI) and surface asymmetry index (SAI) of the two groups were evaluated before operation and 1 day, 7 days, 1 month and 3months after operation.Results Before operation, differences of BUT, FLS, subjective symptom score of dry eye, SIt, SRI and SAI between the two groups were not statistically significant. 1 day and 7 days after operation, BUT and SIt in group B were significantly lower than those in group A (P<0.05), and FLS, subjective symptom score of dry eye, SAI in group B were significantly higher than those in group A (P<0.05). SRI of group B were higher than group A at all time points after operation, the difference was statistically significant (P<0.05). In groupA, BUT, SIt and subjective symptom score of dry eye recovered to preoperative levels at 7 days after operation (P>0.0125), FLS and SRI recovered to preoperative levels at 1 month after operation (P>0.0125), and SAI recovered to preoperative level at 1 day after operation (P>0.0125). In group B, BUT, SIt, SRI and SAI recovered to preoperative levels at 3 months after operation (P>0.0125), FLS and subjective symptom score of dry eye recovered to preoperative levels at 1 month after operation (P>0.0125).Conclusions For cataract patients with type Ⅱdiabetes planning to accept phacoemulsification, compared with 3.0 mm clear corneal incision, 1.8 mm clear corneal incision has less effect on tear film function and regularity of cornea, patients’ dry eye symptoms are lighter, and will recover faster.