白内障手术切口对矫正角膜原有散光和泪膜稳定性的影响

Effect of cataract surgical incision on original astigmatism and tear film stability of corrected cornea

摘要:

目的：探讨白内障手术切口大小对矫正角膜原有散光、泪膜稳定性的影响。

方法：收集我院2014-07/2016-07接诊的白内障患者92例92眼，随机分为对照组和观察组，各46例46眼。两组均行透明角膜隧道切口白内障乳化超声术联合折叠人工晶状体植入术，对照组为3.0mm透明角膜切口，观察组为1.8mm透明角膜切口。检测术前及术后1d，1wk，1、3mo裸眼视力、角膜散光度、基础泪液分泌(schirmer Ⅰ test，SⅠt)、泪膜破裂时间(break-up time，BUT)，记录术后1d，1wk，1、3mo术源性散光(surgery induced astigmatism，SIA)。

结果：两组术后1、3mo裸眼视力与术前比较差异有统计学意义(P<0.05)，但两组手术前后不同时间比较差异无统计学意义(P>0.05)； 两组术后1、3mo角膜散光与术前比较无明显变化，差异有统计学意义(P<0.05)，两组手术前后各时间点比较差异无统计学意义(P>0.05)； 两组术后1wk，1、3mo SIA均不断减小，且观察组术后1d，1wk，1mo SIA明显低于对照组，差异有统计学意义(P<0.05)。两组术后1wk SⅠt、BUT少于术前，差异有统计学意义(P<0.05)，术后1、3mo与术前比较差异无统计学意义(P>0.05)； 观察组术后1wk SⅠt、BUT高于对照组，差异有统计学意义(P<0.05)，但术后1、3mo比较，差异无统计学意义(P>0.05)。

结论：与3.0mm标准切口相比，1.8mm透明角膜切口可减少SIA，缩短角膜稳定性恢复时间。

Abstract:

AIM:To investigate the effect of the size of cataract surgical incision on original astigmatism and tear film stability of corrected cornea.

METHODS: Totally 92 cataract patients(92 eyes)who were admitted to our hospital from July 2014 to July 2016 were randomly divided into the control group and the observation group, 46 cases(46 eyes)in each group. Both groups were treated by clear corneal tunnel incision phacoemulsification combined with intraocular lens implantation. The incision of the control group was 3.0mm while of the observation group was 1.8mm. The uncorrected visual acuity, corneal astigmatism, Schirmer I test(SⅠt)and break-up time(BUT)were detected before surgery and at 1d, 1wk, 1mo and 3mo after surgery. The surgery induced astigmatism(SIA)was recorded at 1d, 1wk, 1 and 3mo after surgery.

RESULTS: There were significant differences in the uncorrected visual acuity between the two groups at 1 and 3mo before surgery(P<0.05), but there were no significant differences at different time points before and after surgery(P>0.05). At 1wk, 1 and 3mo after surgery, SIA of two groups decreased continuously, and the SIA of the observation group was significantly lower than that of the control group at 1d, 1wk and 1mo after surgery(P<0.05). At 1wk after surgery, SⅠt and BUT in the two groups were less or shorter than those before surgery(P<0.05), but there were no significant differences at 1mo, 3mo after surgery, compared with those before surgery(P>0.05). SⅠt and BUT in the observation group were less or shorter than those in the control group at 1wk after surgery(P<0.05)but there were no significant differences at 1 and 3mo after surgery(P>0.05).

CONCLUSION: Compared with 3.0mm standard incision, 1.8mm clear corneal incision can reduce SIA and shorten the time for corneal stability recovery.