不同切口超声乳化术对糖尿病合并白内障患者角膜神经和泪液蛋白的影响研究  

The influence of different incision on cornea nerve and tear protein under phacoemulsification surgery and IOL implantation in type 2 diabetic patients with age-related cataract

作　　者：邵毅[1] 裴重刚[1] 王乐[2] 余瑶[3] 涂萍[3] 陈乐磊[2] 陈素芳[1] 黄歆[1] 

机构地区：[1]南昌大学第一附属医院眼科,江西南昌330006 [2]厦门大学附属厦门眼科中心,福建厦门361001 [3]南方医科大学附属南昌第三医院内分泌科,江西南昌330009

出　　处：《中国现代医学杂志》2013年第31期52-57,共6页China Journal of Modern Medicine

基　　金：国家自然科学基金(No:81160118);全国临床医药研究专项基金(No:L2012052);江西省科技支撑计划项目(No:20111BBG70026-2);江西省自然科学基金(No:20114BAB215029);江西省卫生厅科技计划面上项目(No:20121026);江西省教育厅青年科学基金项目(No:GJJ12158);福建省卫生厅科研基金资助项目(No:2011-2-79)

摘　　要：目的探讨年龄相关性白内障糖尿病患者超声乳化术后眼表症状,角膜神经和泪液蛋白的特点。方法年龄相关性白内障糖尿病患者64例(64眼,均为右眼),随机分为A、B组。A组采用上方透明角膜切口行超声乳化白内障吸除联合人工晶状体(IOL)植入术,B组在颞侧透明角膜切口行超声乳化白内障吸除联合IOL植入术,分别于术前、术后1周、2周、1个月及3个月对患者行眼表症状评分、泪液蛋白测定、角膜知觉计检查和共聚焦显微镜检查。结果术前两组干眼各亚症状评分、泪液蛋白、乳铁蛋白、溶菌酶、神经纤维密度及角膜敏感度差异无显著性(P>0.05)。术后2周,两组患者各症状中干涩感、异物感、畏光、疼痛、眼红和流泪比较,差异均有显著性(P<0.05);术后3个月,两组患者各症状间差异无显著性(P>0.05)。术后3个月,两组患者泪液总蛋白量,乳铁蛋白,溶菌酶及神经纤维密度差异无显著性(P>0.05),但角膜敏感度、角膜切口连接型神经比较差异有显著性(P均<0.05)。结论年龄相关性白内障糖尿病患者行上方切口超声乳化联合IOL植入术可以明显改善角膜知觉,减轻角膜切口神经损伤,提高患者的视觉质量。【Objective】To observe the symptom of ocular surface, corneal nerve fiber and tear protein of type 2 diabetic patients with age-related cataract after phacoemulsification surgery and IOL implantation with superior incision. 【Methods】Sixth-four cataract patients（64 right eyes） were randomly divided into two groups：（group A） superior corneal incision phacoemulsification surgery and IOL implantation,（group B） temple incision phacoemulsification surgery and IOL implantation. The symptom of ocular surface, corneal perception and tear protein were examined at 1 week, 2 week, 1 months and 3 months postoperatively. The cornea was scanned with Confoscan 4.0. The images of subbasal nerve plexus and stromal nerves were analyzed. 【Results】There were no significant difference for the symptom score of ocular surface, tear proteins, lactoferrin, lysozyme, nerve fiber density and corneal perception were found between two groups preoperatively（P 0.05）. There were statistically significance for dry and unsmooth sensation, foreign body sensation, photophobia, pain, red eye and tear at preoperative compared with the postoperative week 2 in both groups（P 0.05）. There were statistically significance for corneal perception and the connective nervous of corneal incision at preoperative compared with the postoperative in both groups, whereas no statistically significance for symptom score of ocular surface, tear proteins, lactoferrin, lysozyme and nerve fiber density at preoperative compared with the postoperative month 3 in both groups（P 0.05）. 【Conclusion】Phacoemulsification surgery and IOL implantation with superior incision is a more favorable solution for type 2 diabetic patients with age-related cataract, which can ameliorate the corneal perception and corneal incision nerve injury,mitigate the symptom of ocular surface and therefore improve the visual quality.

关 键 词：超声乳化白内障吸除术 泪液蛋白 糖尿病 角膜共焦显微镜 角膜知觉 年龄相关性白内障 

分 类 号：R776.1[医药卫生—眼科] R77[医药卫生—临床医学]