作者：程立波，刘庆淮
作者单位：1中国江苏省溧阳市中医院眼科；2中国江苏省南京市，南京医科大学附属第一临床医学院眼科
【摘要】 目的：探讨表面麻醉下白内障超声乳化摘除术对正常眼表的影响。
方法：对34例（40眼）行白内障超声乳化摘除合并人工晶状体植入术的患者, 观察术前、术后3，10d；1，3mo的干眼症状(干涩感、异物感、烧灼感) , 泪膜破裂时间(BUT) 、基础泪液分泌试验(Schinner′I试验) 、角膜荧光素染色, 并对数据进行统计学分析。
结果：白内障超声乳化术后10d内患者有明显的干眼症状, 术后3d和10d荧光素试验较术前明显增多;而且泪液分泌量术后10d较术前明显减少(P<0.05) ; 术后1～3mo接近术前水平( P>0.05) 。术后3，10d BUT均较术前明显缩短( P<0.05) ;1～3mo后接近术前水平( P>0.05) 。
结论：表面麻醉下超声乳化白内障摘除术对眼表具有一定程度的影响, 发生机制可能与多种因素有关，临床应积极采取预防、治疗措施。
【关键词】 白内障超声乳化摘除术;泪膜;眼表
Effect of phacoemulsification in surface anesthesia on normal ocular surface
LiBo Cheng1, QingHuai Liu2
1Department of Ophthalmology, Chinese Traditional Medicine Hospital of Liyang City, Liyang 213300, Jiangsu Province, China; 2Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
AbstractAIM: To study the effect of phacoemulsification in surface anesthesia on normal ocular surface.
METHODS: Forty eyes of 34 cases with agerelated cataract who underwent phacoemulsification were included in this study. The eyes were observed for subjective complaints of dry eye, tear break up time (BUT), Schirmers I test,corneal fluorescein staining preoperatively and 3 days, 10 days, 1 month, and 3 months postoperatively. The results were analyzed statistically.
RESULTS: The subjective complaints of dry eye were obvious within 10 days after surgery. Coneal fluorescein staining were concentrated at 3 and 10 days postoperatively, and the Schirmers I test result was lower at the 10th day (P<0.05). No significant changes in Schirmer's I test and BUT were found between preoperatively and 1 to 3 months postoperatively (P>0.05). There were clearly decrease in BUT at 3 and 10 days.
CONCLUSION: Phacoemulsification in surface anesthesia alters tear film of all patients in a short term postoperatively. There are some facts related with the mechanism, actively preventive and treatment measures should be taken clinically.
KEYWORDS: phacoemulsification; tear film; ocular surface
Cheng LB, Liu QH. Effect of phacoemulsification in surface anesthesia on normal ocular surface. Int J Ophthalmol(Guoji Yanke
Zazhi) 2008;8(11):23222323
0引言
白内障超声乳化摘除合并人工晶状体植入术的手术方法，已经成为目前治疗白内障的常规手术方法，而进行表面麻醉下白内障超声乳化手术，可以最小限度造成眼部的损伤和最大程度的提高视觉质量[1]。但是在临床工作中，很多患者在术后主诉眼部干涩感、异物感等干眼症状。根据干眼症诊断标准[2] ,即同时具备以下三条者诊断为干眼症:（1）Schirmer 试验≤10mm ,泪膜破裂时间(breakup time , BUT) ≤10s。（2）角膜荧光素染色积分≥1(角膜一个象限)。（3）有症状者。为此我们对白内障超声乳化手术患者术后眼表的变化情况进行了系列研究, 现将结果报告如下。
1对象和方法
1.1对象 收集200712/200805在本院接受白内障超声乳化摘除合并人工晶状体植入术的老年性白内障患者34例（40眼）。其中男14例（14眼），女20例（26眼），年龄55～81（平均67.5±8.4）岁。排除糖尿病、眼部其他病变、全身结缔组织病及严重自身免疫性疾病。术前、术后3，10d；1，3mo检查:常规检查裸眼视力,矫正视力,裂隙灯眼前节检查,超声角膜测厚,眼压测量及人工晶状体度数测量等。特殊检查包括泪膜稳定性检查和泪液分泌测定Schirmer′I、泪河高度、角膜荧光素染色,这3项检查安排在同一个安静检查室,由同一个有经验的医师操作检查。
1.2方法 术眼表面麻醉,作颞上或鼻上方3.2mm透明角膜切口，侧方2∶00作一角膜缘辅助切口,前房注入粘弹剂后连续环形撕囊、水分离,囊袋内原位劈裂法，对晶状体核行超声乳化,超声能量为55%～75%,平均68%,超声时间50～80（平均64）s。灌吸清除皮质后,囊袋内植入折叠式人工晶状体,术毕结膜囊涂典必殊眼膏。评分标准：(1)干眼症状:包括干涩感、异物感、烧灼感。采取检查时问诊并记录。(2)荧光素试验:随诊时检查，并排除术前阳性染色的病例，并将角膜分为四个象限,按象限记录。 (3)泪液分泌量:滤纸湿润长度15～30mm为正常,<10mm为泪液分泌减少。(4)泪膜破裂时间BUT:15～35s为正常;<10s为泪膜不稳定。术后3，10d；1，3mo复诊，观察指标和方法同术前。术后第1d起滴用典必殊眼液, 4次/d ,并美多丽眼药水散瞳连续2wk。
统计学处理：本研究数据均经SPSS 13.0统计学软件处理，BUT和泪液分泌量结果采用方差分析方法。
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