糖尿病性白内障超声乳化术后泪膜稳定性的动态变化  

Tear film stability change after phacoemulsification for diabetic cataract

作　　者：李颖[1] 张林[2] 王从毅[1] 吴利安[2] 邢咏新[2] 倪伟[1] 喻磊[1] 

机构地区：[1]西安市第四医院眼科,陕西西安710004 [2]西安交通大学第一医院眼科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2005年第6期590-592,共3页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：陕西省卫生厅科研基金资助项目(No.04D17)

摘　　要：目的观察糖尿病性白内障术后泪膜稳定性的变化规律,了解糖尿病患者术后泪膜功能的改变及其影响因素。方法设计自身配对研究。选2型糖尿病性白内障患者(随机检查48例48只眼),无糖尿病者设为对照组(随机检查80例90只眼)。采取透明角膜切口超声乳化白内障吸除及折叠式后房型人工晶体植入术,术前、术后1 d、7 d、1月、3月依次行Schirmer试验(Sit)、泪膜破裂时间(BUT)、角膜荧光素染色并对其泪膜稳定性的变化进行分析。结果术前两组SIt、BUT有明显差异(P<0.001),其中糖尿病组的患者泪膜稳定性较差。与术前相比,术后1 d两组BUT均明显缩短,Schirmer-I值明显增加,角膜荧光素染色为(+);与对照组相比,糖尿病组下降明显(BUT:P<0.05;Schirmer-1P<0.001)。两组Schirmer-I值术后7d恢复至术前水平,两组恢复有显著性差异(P<0.001)。对照组BUT术后1个月恢复至术前水平(P>0.001),糖尿病组BUT术后3个月恢复至术前水平(P<0.05),两组恢复程度有明显差异(P<0.05)。术前两组的角膜荧光素染色为阴性^+,无显著性差异;术后1 d两组亦无显著性差异。与对照组相比,糖尿病组角膜荧光素染色术后1个月恢复至术前水平。结论糖尿病患者泪膜稳定性较差,术后其泪膜稳定性较对照组下降明显,恢复较慢,部分患者术后出现眼干涩、畏光、视力波动等。术前应常规检查SIt、BUT、角膜荧光素染色,有助于早期发现、及时治疗。Objective To evaluate the tear film stability at differcnt time after phacoemulsifacation for diabetic cataract, and to estimate the tear film function and relative affective factors. Methods This randomized study involved two groups： 48 age-rclated cataract with type Ⅱ diabetes mcllitus （experimental group） and 80 agerelated cataract （control group）. All paticnts underwent phacoemulsification through clcar corneal combined with foldable intraocular lens（IOL） implantation; Schirmer Ⅰ test（Sit）, breakup time（BUT）, corneal fluorescein staining were measured preoperatively and 1 day, 7, 30, 90 days postoperatively. Results The diffcrcnce of Sit and BUT between two groups preoperatively were significant （P〈0.01）, and tcar film stability of experimental group was worse comparatively. At 1 day postopcrativcly in two groups, BUT reduced greatly and Sit valuc increased greatly. Corneal fluorescein staining showed negative （ ＋ ）. Thcrc was corneal cdema at the incision. Compared with that of control group, these measurement values reduced greatly （BUT P〈 0.05; Sit P〈0.001）. Sit valuc at 7 days in two groups returned to their preoperative values and therc existcd significant difference between two groups （ P〈0.01 ）. In the recovering timc of BUT betwcen experimcntal group （P〈0.01） and control group （P〈0.05）, there cxisted significant differencc （P〈0.05）. Thc recovering timc difference between two groups was not significant, and that of experimental group recovercd 30 days postoperatively. Conclusion For thc patients with diabetes mellitus tear film stability in experimental group is worse preoperatively, decreases greatly, and recovcrs slowly after surgery. Some diabetic patients may experience dry eye after surgery, so Sit, BUT and the corneal fluorescicn staining should be measured preoperatively for them. Thcse arc hclpful to diagnose and cure dry cyc carlicr.

关 键 词：糖尿病性白内障 手术 泪膜稳定性 

分 类 号：R775[医药卫生—眼科]