糖尿病性白内障超声乳化术后泪膜稳定性的动态变化

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。

Tear film stability change after phacoemulsification for diabetic cataract

Objective To evaluate the tear film stability at different 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-related cataract with type Ⅱ diabetes mellitus(experimental group) and 80 age-related cataract(control group).All patients underwent phacoemulsification through clear 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 difference of SIt and BUT between two groups preoperatively were significant(P<0.01),and tear film stability of experimental group was worse comparatively.At 1 day postoperatively in two groups,BUT reduced greatly and SIt value increased greatly.Corneal fluorescein staining showed negative(+).There was corneal edema at the incision.Compared with that of control group,these measurement values reduced greatly(BUT P< 0.05;SIt P<0.001).SIt value at 7 days in two groups returned to their preoperative values and there existed significant difference between two groups(P<0.01).In the recovering time of BUT between experimental group(P<0.01) and control group(P<0.05),there existed significant difference(P<0.05).The recovering time difference between two groups was not significant,and that of experimental group recovered 30 days postoperatively.Conclusion For the patients with diabetes mellitus tear film stability in experimental group is worse preoperatively,decreases greatly,and recovers slowly after surgery.Some diabetic patients may experience dry eye after surgery,so SIt,BUT and the corneal fluorescien staining should be measured preoperatively for them.These are helpful to diagnose and cure dry eye earlier.