干眼对白内障术后角膜散光的影响  

Effect of dry eye on postoperative corneal astigmatism after cataract surgery

作　　者：宋颖[1] 张琳[1] 周绍荣[1] 

机构地区：[1]上海第二医科大学附属仁济医院眼科,上海市200001

出　　处：《眼科新进展》2005年第6期553-555,共3页Recent Advances in Ophthalmology

摘　　要：目的了解干眼与白内障手术的关系,术前干眼对术后角膜散光的影响,以及术后干眼的发生与转归。方法将84例96眼患者随机分成2组,为44例51眼和40例45眼,分别行白内障囊外摘出术(I组)和小切口囊外摘出术(II组),并植入人工晶状体。所有患者于术前进行干眼检查,按积分分级,分别列入A、B、C3组,并于术后1月、3月随访远视力、干眼状况、角膜散光、轴位及非球面指数等指标。结果在I组中,C组术后1月角膜散光值为2·41±1·23,术后3月为2·12±0·89,与A组(1·94±1·01,1·51±0·72)和B组(2·03±1·08,1·60±0·75)角膜散光值的差异均有显著性意义(P<0·01);在II组中,C组术后1月角膜散光值为1·90±0·83,术后3月为1·12±0·71,与A组(1·28±0·62,0·82±0·54)和B组(1·34±0·64,0·86±0·55)角膜散光值的差异也均有显著性意义(P<0·01);而2组中A组和B组之间差异无显著性意义(P>0·05)。在I组和II组中,术前、术后1月、3月,角膜非球面指数值在各组患者中差异均有统计学意义(P<0·01)。I组中,术后1月、3月C组视力分别为0·43±0·30、0·54±0·33,较A组(0·62±0·24、0·70±0·28)和B组(0·58±0·21、0·65±0·26)低(P<0·01);II组中,术后1月、3月,C组视力分别为0·65±0·32、0·76±0·30,亦较A组(0·85±0·26、0·90±0·29)和B组(0·84±0·24、0·88±0·25)低(P<0·01);而A组和B组之间差异无显著性意义(P>0·05)。2组中术后1月C组患者数均较术前增加,术后3月则基本恢复至术前水平,且I组术后发生中重度干眼的比率高于II组。结论白内障术前干眼的程度与术后角膜散光、角膜非球面指数及术后视力的恢复都存在正相关,术前中重度干眼的存在及术后干眼的发生直接影响患者的手术效果。治疗术前干眼及预防术后干眼对提高手术预后都是至关重要的。Objective To research the effect of dry eye on postoperative corneal astigmatism after cataract surgery. Methods Ninty-six eyes of eightyfour patients were divided randomly into two groups according to the method of cataract surgery （group Ⅰ, extracapsular cataract extraction; group Ⅱ, small-incision extracapsular cataract extraction）. Each group was divided into three subgroups （A, B, C） according to the degree of dry eye preoperatively .All eyes were examined visual acuity, corneal astigmatism with axis and aspherical index by corneal topography before operation as well as at 1 month and 3 months after cataract surgery. Results In group Ⅰ, mean corneal astigmatism In subgroup C was 2.41 ± 1.23 at 1 month and 2.12 ± 0.89 at 3 months postoperatively, significantly greater than that in subgroups A （1.94 ± 1.01, 1.51 ±0.72） and 13 （2.03± 1.08,1.60±0.75） （P〈0.01）; In group Ⅱ, mean corneal astigmatism in subgroup C was 1.90±0.83 at 1 month and 1.12±0.71 at 3 months postoperatively, also significantly greater than that in subgroups A （ 1.28 ± 0.62,0.82 ± 0.54） and B （ 1.34 ± 0.64,0.86± 0.55 ） （P （ 0.01 ） ; At one time there were no statistic differences in subgroups A and B （P〉0.05） .In both group Ⅰ and group Ⅱ, the number of eyes Increased In subgroup C at 1 month after surgery,and returned to their preoperative values at 3 months. The ratio of moderate and severe dry eye producing postoperative was higher in group Ⅰ than in group Ⅱ.Conclusion Postoperative corneal astigmatism,aspherical index,and recovery of visual acuity all has positive correlation with the degree of dry eye preoperatively.Existing of moderate and severe dry eye preoperatively and producing of dry eye postoperatively both affect cataract surgery directly. It is important to treat preoperative dry eye and prevent postoperative dry eye in order to improve the prognosis of cataract surgery.

关 键 词：干眼 角膜散光 白内障囊外摘出术 小切口 

分 类 号：R776.1[医药卫生—眼科] R777.2[医药卫生—临床医学]