论文部分内容阅读
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-IOL-GSL）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-n 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 n H检验。n 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n 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n 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（n t=-9.48，n 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n 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。n 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。“,”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 (NIF-BUT), 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-n t test was used for intra-group comparison and one-way ANOVA was used for inter-group comparison. Kruskal-Wallis n H test was used to compare the data that did not conform to normal distribution.n 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 (n 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 (n 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 (n t=-9.48, n 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 (n 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.n 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.