不同切口白内障联合青光眼手术对眼表的影响

Clinical observation of the ocular surface changes through one-site versus two-site phacotrabeculectomy

摘要:

目的：探讨单切口和双切口白内障超声乳化联合小梁切除术治疗闭角型青光眼合并年龄相关性白内障术后眼表的影响。

方法：随机抽取在我院行单切口和双切口白内障超声乳化吸除、人工晶状体植入联合小梁切除术患者各26例26眼，对临床资料进行回顾性分析。比较两组病例术前1d和术后1wk，1、3mo时的泪膜破裂时间(break up time，BUT)，泪液分泌试验Ⅰ(SchirmerⅠ time，SⅠt)，角膜荧光素染色程度(corneal fluorescein staining，FL)等，并对结果进行统计学分析。

结果：所有入选的病例均在局部麻醉下行手术治疗，术后随访3mo。两组患者术后1wk，1mo的BUT，FL，SⅠt指标数值与术前相比均有明显差异(P<0.01)，术后3mo基本恢复术前水平。术后1wk，1mo双切口组BUT，SⅠt均明显短于单切口组(P<0.05)； FL双切口组术后1wk明显高于单切口组(P<0.05)，而术后1mo两组差异无统计学意义(P>0.05)。术后3mo，两组患者的BUT，FL，SⅠt相比差异均无统计学意义(P>0.05)。

结论：单切口和双切口的白内障超声乳化联合显微小梁切除术术后均对术眼眼表有影响，双切口组影响更大，且相关指标异常的高峰期出现在术后1mo之内。

Abstract:

AIM: To compare the ocular surface changes of one-site versus two-site phacotrabeculectomy in angle-closure glaucoma associated with cataract.

METHODS: This retrospective, randomized study included 52 patients(52 eyes)with coexisting angle-closure glaucoma and cataract. The patients were randomly divided into 2 groups: one group had the phacotrabeculectomy in the superior quadrant through the same incision(one-site group; n=26), while the other group had the trabeculectomy through a superior quadrant incision, and the phacoemulsification through another separate, temporal, clear corneal incision(two-site group; n=26). In each group, the values such as tear break-up time(BUT), Schirmer I test(SⅠt), and corneal fluoresce(FL)in staining score were measured at 1d, 1wk, 1mo and 3mo postoperatively.

RESULTS: All patients were operated under local anesthesia and followed up for 3mo. The SⅠt of two-site group and one-site group 1wk and 1mo postoperatively were significantly shorter than those before the operation(P<0.01). The SⅠt of two-site group were significantly shorter than those of one-site group 1wk and 1mo postoperatively(P<0.05). The FL scores of two-site group were significantly higher than those of one-site group 1wk postoperatively(P<0.05). However, 1mo postoperatively, the FL scores of two groups were basically equal(P>0.05). Three months postoperatively,the BUT, SⅠt and FL were basically equal to the preoperative level(P>0.05).

CONCLUSION: Phacotrabeculectomy through two incisions is more likely to affect the ocular surface, and those abnormal related values appear in the early 1mo postoperatively.