三联手术治疗青光眼合并白内障术后患者泪膜功能的临床分析

摘要

Objective: To explore the tear film function in glaucoma and cataract patients before and after phacotrabeculectomy. Methods:Thirty glaucoma and cataract patients (30 eyes) who underwent phacotrabeculectomy were enrolled in this study . One day before and 1 month ,3 and 6 month after surgery, the tear film break-up time(BUT), Schirmer I test, fluorescein staining(FL) as well as the examination of tear film interference image were examined, to evaluate the effects of tear function changes. Results:One day before surgery, patients with glaucoma and cataract had shorter BUT, lower SIt, higher FL score and lower proportion of normal tear film interference image than the opposite healthy eyes(P<0.05). One month after the surgery, the BUT shortened, SIt decreased, FL increased and the proportion of normal tear film interference image decreased compared with preoperation (P<0.05);Three months operation, the BUT and FL were still significantly different (P<0.05), but the SIt and the proportion of normal tear film interference image were not (P>0.05);Six months after the surgery, no significant difference was found in four tests when compared with the preoperation (P>0.05). Conclusion:In the short term,phacotrabeculectomy may affect the tear film function after the surgery.%目的：探讨小梁切除联合白内障超声乳化人工晶状体植入术治疗青光眼合并白内障手术前后对泪膜功能的影响。方法：选取青光眼合并白内障患者30例（30眼）为观察对象，以对侧健眼为对照，于术前1 d及术后1月、3月、6月分别记录泪膜破裂时间（BUT）、泪液分泌试验（SIt）、角膜荧光素染色（FL）及泪膜干涉图像检查结果，术前与健眼对照，术后不同时间结果与术前对照。结果：术前与健眼比较：患眼的BUT缩短（P＜0．05）、SIt减少（P＜0．05）、FL评分高于健眼（P＜0．05）、泪膜正常干涉图像比率低于健眼（P＜0．05）。患眼手术前后比较：术后1个月，BUT比术前缩短（P＜0．05），SIt比术前减少（P＜0．05），FL评分比术前增高（P＜0．05），泪膜正常干涉图像比率比术前减少（P＜0．05）；术后3个月，BUT及FL评分仍存在差异（P＜0．05），而SIt及泪膜正常干涉图像比率已接近术前水平（P＞0．05）；术后6个月，4项试验与术前比较均无统计学意义（P＞0．05）。结论：青光眼合并白内障患者术前已存在泪膜功能异常，三联手术后早期会对患者泪膜功能造成影响，降低泪膜的稳定性，远期泪膜功能会逐渐恢复到术前水平。