不同手术方式对青光眼合并白内障患者干眼症状的影响

doi:10.3760/cma.j.cn115909-20210810-00310

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摘要

目的：比较超声乳化白内障摘除术（Phaco-IOL）、超声乳化白内障摘除联合房角分离术（Phaco-IOLGSL）和超声乳化白内障摘除联合小梁切除术（Phaco-IOL-Trab）这3种术式对干眼症状的影响。方法：非随机回顾性平行对照研究。收集2019 年6 月至2020 年6 月在青岛市市立医院就诊并符合纳入标准的患者92例（118眼），按手术方式分为：A组：Phaco-IOL 32例（40眼），B组：Phaco-IOL-GSL 30例（38 眼），C组：Phaco-IOL-Trab 30例（40 眼）。采用Keratograph 5M眼表综合分析仪、Schirmer Ⅰ试验（SⅠT）、CochetBonnet角膜知觉计检测患者术前1 d及术后3 d、1周、1个月、3个月非侵入性首次泪膜破裂时间（NIF-BUT）、非侵入性平均泪膜破裂时间（NIA-BUT）、泪河高度（TMH）、睑板腺缺失评分、基础泪液分泌及角膜知觉（CP）并进行对比研究。定量资料符合正态分布采用重复测量方差分析，组内两两比较采用LSD-t检验，组间比较采用单因素方差分析。不符合正态分布数据多组间比较采用Kruskal-Wallis H检验。结果：术后3 d至3 个月，C组NIF-BUT和NIA-BUT较术前明显降低，且变化程度高于其他2 组（均P<0.05）。在A组和B组中，NIF-BUT和NIA-BUT在术后1 个月恢复至术前水平。术后3 d、1 周，C组TMH、基础泪液分泌量较术前升高（均P<0.05），术后1 个月恢复至术前水平。A组和B组术后各时间点TMH、基础泪液分泌量同术前相比差异均无统计学意义。C组在术后3 个月睑板腺缺失评分较术前增加（t=-9.48，P<0.001）。A组和B组术后各时间点睑板腺缺失评分同术前相比差异均无统计学意义。C组术后3 d至1 个月CP明显降低，变化程度高于其他2 组（均P<0.05），术后3个月恢复到术前水平。A组和B组CP在术后1个月恢复至术前水平。结论：超声乳化白内障摘除联合小梁切除术对眼表及CP影响较大，术后3 个月CP恢复正常，但泪膜稳定性仍有明显降低且开始出现明显睑板腺缺失。

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关键词 ：干眼, 泪膜破裂时间, 泪河高度, 睑板腺缺失评分, 基础泪液分泌试验, 角膜知觉, 超声乳化白内障摘除联合房角分离术, 超声乳化白内障摘除联合小梁切除术

Abstract：

Objective: To compare the effects on dry eye symptoms from phacoemulsification (phaco) combined

with intraocular lens (IOL) implantation, phaco-IOL-goniosynechialysis and phaco-IOL-trabeculectomy.

Methods: This was a retrospective control study. Ninety-two patients were recruited from June 2019

to June 2020 in the Department of Ophthalmology at Qingdao Municipal Hospital. Group A (40 eyes)

underwent phacoemulsification, group B (38 eyes) underwent phaco-IOL-goniosynechialysis, and group

C (40 eyes) underwent phaco-IOL-trabeculectomy. Noninvasive first tear film break-up time (NIFBUT),

noninvasive average tear film break-up time (NIA-BUT), tear meniscus height (TMH), meibomian

gland loss scores, basal tear secretion, and corneal perception were analyzed and compared at 1 day

preoperatively and 3 days, 1 week, 1 month, and 3 months postoperatively using the Oculus Keratograph

5M, SchirmerⅠ test (SⅠT) and Cochet-Bonnet Asthesiometer. Quantitative data consistent with normal

distribution were analyzed by repeated measures ANOVA. The LSD-t test was used for intra-group

comparison and one-way ANOVA was used for inter-group comparison. Kruskal-Wallis H test was used

to compare the data that did not conform to normal distribution. Results: From postoperative 3 days to 3

months, the NIF-BUT and NIA-BUT of group C dropped more significantly than those of the other two

groups (P<0.05). NIF-BUT and NIA-BUT both returned to preoperative levels at 1 month after surgery in

groups A and B. TMH and SⅠT in group C increased at 3 days and 1 week postoperatively (P<0.05), and

returned to preoperative levels at 1 month postoperatively. At each time point postoperatively, TMH and

SⅠT of groups A and B were not significantly different compared to baseline. At 3 months postoperatively,

meibomian gland loss scores increased significantly, and there was a statistically significant difference in

group C (t=-9.48, P<0.001). At each time point postoperatively, meibomian gland loss scores were not

significantly different compared to baseline between groups A and B. The corneal perception of each group

receded and the perception in group C was more serious and different than the other two groups from 3

days to 1 month postoperatively (P<0.05). At 3 months postoperatively, corneal perception in group C

returned to the preoperative level and there was no statistically significant difference. It was restored to the

preoperative level at 1 month postoperatively and there was no statistically significant difference between

group A and B. Conclusions: Phaco-IOL-trabeculectomy has a great influence on SⅠT and corneal

perception. Corneal perception recovered at 3 months postoperatively, but tear film stability and meibomian

gland loss was still lost.

Key words： dry eye tear film break-up time tear meniscus height meibomian gland loss scores Schirmer I test corneal perception phaco-IOL-goniosynechialysis phaco-IOL-trabeculectomy

收稿日期: 2021-08-10

基金资助:

通讯作者: 姜霄晖（ORCID：0000-0001-6747-5308），Email：ocularjxh@163.com

引用本文:

霍蒙蒙, 王琇, 高雪, 等.. 不同手术方式对青光眼合并白内障患者干眼症状的影响[J]. 中华眼视光学与视觉科学杂志, 2022, 24(2): 116-122. Mengmeng Huo, Xiu Wang, Xue Gao,et al. Effects of Different Surgical Methods on Dry Eye Symptoms in Patients with Glaucoma Complicated with Cataract. Chinese Journal of Optometry Ophthalmology and Visual science, 2022, 24(2): 116-122. DOI: 10.3760/cma.j.cn115909-20210810-00310

链接本文:

https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20210810-00310 或 https://www.cjoovs.com/CN/Y2022/V24/I2/116

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