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目的探讨真性糖尿病性白内障(TDC)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 TDC患者56例(右眼),随机分为两组,A组采用上方透明角膜切口,B组采用颞侧透明角膜切口,均行超声乳化白内障吸除联合人工晶状体(IOL)植入术,分别于术前、术后1周、2周、1个月及3个月行眼表症状评分、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眼表症状评分、泪液蛋白、乳铁蛋白、溶菌酶、神经纤维密度及角膜敏感度比较,差异均无统计学意义(P>0.05);术后2周,两组干涩感、异物感、畏光、疼痛、眼红和流泪症状比较,差异均有统计学意义(P<0.05);术后3个月,两组各症状和泪液总蛋白量、乳铁蛋白、溶菌酶及神经纤维密度比较,差异均无统计学意义(P>0.05),但角膜敏感度、角膜切口连接型神经比较,差异有统计学意义(P<0.05)。角膜切口中形态异常的神经纤维在B组中出现的几率高于A组(P<0.05)。结论对于TDC,上方切口行超声乳化联合IOL植入术可以改善角膜知觉,减轻角膜切口神经损伤,提高患者的视觉质量。
Objective To investigate the ocular surface features, corneal nerves and tear proteins after phacoemulsification in patients with true diabetic cataract (TDC). Methods Fifty-six patients (right eye) with TDC were randomly divided into two groups. Group A received upper clear corneal incision and group B received temporal corneal incision. Phacoemulsification combined with intraocular lens (IOL) Preoperative, postoperative 1 week, 2 weeks, 1 month and 3 months were ocular surface score, tear protein, corneal sensitometer and confocal microscopy. Results There was no significant difference in ocular surface symptom score, tear protein, lactoferrin, lysozyme, nerve fiber density and corneal sensitivity between the two groups before operation (P> 0.05) The symptoms of dryness, foreign body sensation, photophobia, pain, jealous and tearing were statistically significant (P <0.05). After 3 months, the symptoms and the total tear protein, lactoferrin, Lysozyme and nerve fiber density, the difference was not statistically significant (P> 0.05), but corneal sensitivity, corneal incision junctional nerve comparison, the difference was statistically significant (P <0.05). The incidence of morphologically abnormal nerve fibers in the corneal incision was higher in group B than in group A (P <0.05). Conclusion For TDC, phacoemulsification combined with IOL implantation at the top incision can improve corneal sensation, reduce corneal incision nerve injury and improve visual quality of patients.