方法：将2012-02/2015-06在我院进行白内障手术的患者94例126眼纳入本研究。随机均衡分为研究组和对照组，研究组(A组)46例63眼，行巩膜隧道切口； 对照组(B组)48例63眼，行透明角膜隧道切口。参考白内障LOCS Ⅱ核硬度分级标准细分为：AⅡ组、BⅡ组； AⅢ组、BⅢ组； AⅣ组、BⅣ组。患者在术前1d和术后1、7、30、90d进行主观干眼症状问卷评分(subjective symptoms of dry eye questionnaire scores，SDES)，同时测定患者泪膜破裂时间(break-up time，BUT)、角膜荧光素钠染色评分(staining scores of sodium fluorescein，SCSF)、泪液分泌试验(Schirmer Ⅰ test，SⅠt)，对比不同手术切口对患者泪膜影响。

结果：研究组和对照组患者术前泪膜功能指标进行比较，无统计学差异(P>0.05)； 术后第1、7d，研究组和对照组患者泪膜功能指标与术前1d比较，差异均有统计学意义(P<0.05)； 术后第30d，仅BⅣ组泪膜功能指标与术前1d有统计学差异(P<0.05)； AⅢ组患者在术后第1d时SDES、SCSF、SⅠt低于BⅢ组； AⅣ组在术后第1、7d时在SDES、SCSF指标方面低于BⅣ组患者，差异均有统计学差异(P<0.05)。

结论：在进行白内障超声乳化摘除术时，Ⅲ级和Ⅳ级核白内障采用透明角膜隧道切口进行手术，能够加重对患者泪膜功能损伤，手术效果比巩膜隧道切口方式差，尤其Ⅳ级核中更为明显。因此，可以在Ⅳ级核进行白内障超声乳化摘除手术治疗时选择巩膜隧道切口。

METHODS:Ninety-four patients(126 eyes)who underwent cataract surgery from February 2012 to June 2015 in our hospital were selected in this study. They were divided into research group(group A)with 46 cases(63 eyes)underwent surgery though scleral tunnel incision, and the control group(group B)with 48 cases(63 eyes)through clear corneal tunnel incision. According to referencing cataract LOCS Ⅱ nuclear hardness classification standard, patients in the two groups were subdivided into AⅡgroup, BⅡ group, A Ⅲ group, B Ⅲ group, A Ⅳ group and B Ⅳ group. On preoperatively 1d, postoperatively 1, 7, 30 and 90d, subjective symptoms of dry eye questionnaire scores(SDES), break-up time(BUT), staining scores of sodium fluorescein(SCSF), and Schirmer I test(SⅠt)were determinate to analyze the influence on tear film by different incisions.

RESULTS:There were no statistically significant differences on preoperative tear film function between the two groups(P>0.05); there were statistically significant differences on tear film function of the two groups on preoperatively 1d with postoperatively 1 and 7d(P<0.05). On postoperatively 30d, only the tear film function of BⅣ group had significant difference with that on preoperatively 1d(P<0.05). SDES, SCSF and SⅠt of AⅢ group on postoperatively 1d were significantly lower than those of BⅢ group(P<0.05). SDES and SCSF of AⅣ group on postoperatively 1 and 7d were lower than those of BⅣ group(P<0.05).

CONCLUSION:In the phacoemulsification, cataract with Ⅲ and Ⅳ nuclear through clear corneal tunnel incision, can sharpen tear film function damage, surgery effect was worse than through sclera tunnel incision, especially in Ⅳ level nuclear. Therefore, scleral tunnel incision can be selected in grade Ⅳ nuclear cataract in phacoemulsification.