超声乳化白内障吸除术中应用黏弹剂对泪膜及眼压的影响  

Effect of application of viscoelastic agents on tear film and intraocular pressure during phacoemulsification

作　　者：庞彦利 陈瑞强 汪雪婷 Pang Yanli;Chen Ruiqiang;Wang Xueting(Department of Glaucoma,the Second People’s Hospital of Puyang,Puyang Eye Hospital,Puyang 457000,China)

机构地区：[1]濮阳市第二人民医院青光眼科,濮阳市眼科医院,濮阳457000

出　　处：《中华眼外伤职业眼病杂志》2024年第3期219-226,共8页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的分析超声乳化白内障吸除术中应用黏弹剂对泪膜及眼压的影响。方法回顾性病例对照研究。纳入2019年1月至2023年6月濮阳市第二人民医院白内障患者247例(354眼)。患者均行超声乳化白内障吸除术治疗,并根据术中是否应用黏弹剂分为观察组及对照组。观察组123例(177眼)术中应用黏弹剂,对照组124例(177眼)术中应用平衡盐溶液。术后随访28 d,比较两组患者眼压变化、泪膜破裂时间(BUT)、泪河高度(TMH)及眼表疾病指数量表(OSDI),采用Logistics回归分析影响患者视觉质量的相关因素,制作受试者工作曲线(ROC),并以曲线下面积(AUC)分析各指标对患者术后视觉质量的预测价值。结果对照组术前、术后1 d、7 d、14 d、28 d的眼压分别为(14.60±2.21)、(16.60±1.54)、(17.05±1.90)、(16.32±1.71)、(14.71±1.63)mmHg(1 mmHg=0.133 kPa),观察组术前、术后1 d、术后7 d、术后14 d、术后28 d的眼压分别为(15.00±2.04)、(17.11±1.88)、(18.32±1.45)、(16.74±1.59)、(14.60±1.72)mmHg;观察组术后1 d(F=5.41,P=0.021)、术后7 d(F=34.82,P<0.001)及术后14 d(F=3.95,P=0.048)眼压均高于对照组。术前,对照组BUT为(12.11±1.95)s、TMH为(0.20±0.05)mm及OSDI为(28.71±5.33)分,观察组BUT为(12.19±2.05)s、TMH为(0.21±0.06)mm及OSDI为(28.98±6.16)分;术后28 d,对照组BUT为(10.58±1.34)s、TMH为(0.18±0.08)mm及OSDI为(19.23±7.03)分,观察组BUT为(11.09±1.31)s、TMH为(0.19±0.08)mm及OSDI为(17.14±6.04)分;两组患者术后28 d BUT、TMH及OSDI均较术前下降(均P<0.05),但术后28 d观察组BUT水平高于对照组(t=3.03,P=0.003),OSDI评分低于对照组(t=2.51,P=0.013)。观察组视觉质量较差者23例(18.55%,23/123),低于对照组42例(34.15%,42/123)(χ^(2)=7.33,P=0.007)。Logistic回归分析结果显示,未使用黏弹剂(OR=2.14,P=0.041)、术前眼压较高(OR=1.61,P<0.001)、术后BUT水平较低(OR=0.48,P<0.001)及术后TMH水平较低(OR=0.00,P<0.001)均为影响患者视觉质量较差的相�Objective To analyse the effect of viscoelastic agents applied during phacoemulsification on the tear film and intraocular pressure.Methods This was a retrospective case series study.Total of 354 eyes of 247 cases of cataract from Jan.2019 to Jun.2023 in the Second People’s Hospital of Puyang were included,and the patients were treated with phacoemulsification,they were divided into the observation group and the control group based on whether or not the viscoelastic agent was applied intraoperatively.In the observation group,123 cases(177 eyes)were treated with viscoelastic agent,and in the control group,124 cases(177 eyes)were treated with balanced salt solution.Intraocular pressure,breakup time of tear film(BUT),tear meniscus height(TMH)and OSDI were compared between the two groups,and the relevant factors affecting the visual quality of patients were analyzed by Logistics regression.The working curve(ROC)of subjects was made,and the area under the curve(AUC)was used to analyze the predictive value of each index on postoperative visual quality.Results Intraocular pressure preoperatively,and 1 d,7 d,14 d,28 d postoperatively in the control group were(14.60±2.21),(16.60±1.54),(17.05±1.90),(16.32±1.71),and(14.71±1.63)mmHg(1 mmHg=0.133 kPa),respectively,and in the observation group were(15.00±2.04),(17.11±1.88),(18.32±1.45),(16.74±1.59),and(14.60±1.72)mmHg,respectively.The intraocular pressure was higher in the observation group than in the control group at 1 d postoperatively(F=5.41,P=0.021),7 d postoperatively(F=34.82,P<0.001)and 14 d postoperatively(F=3.95,P=0.048).Preoperatively,the BUT was(12.11±1.95)s,TMH was(0.20±0.05)mm and OSDI was(28.71±5.33)points in the control group,and the BUT was(12.19±2.05)s,TMH was(0.21±0.06)mm and OSDI was(28.98±6.16)points in the observation group;at 28 d postoperatively,in the control group,the BUT was(10.58±1.34)s,TMH was(0.18±0.08)mm and OSDI was(19.23±7.03)points in the control group,and BUT was(11.09±1.31)s,TMH was(0.19±0.08)mm and OSDI was(17.14±6.04

关 键 词：超声乳化白内障吸除术 黏弹剂 泪膜稳定性 眼压 

分 类 号：R779.66[医药卫生—眼科]