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)(χ2 =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关因素.经ROC曲线分析得知,是否使用黏弹剂、术前眼压、术后BUT及术后TMH水平均对预测患者是否发生视觉质量的敏感度分别为 0.646、0.723、0.662、0.785,特异度分别为 0.555、0.643、0.698、0.538,各指标联合的AUC=0.847,敏感度0.846,特异度 0.736.结论 超声乳化白内障吸除术中应用黏弹剂对术后眼压影响较小,有利于提高泪膜稳定性,术后视觉质量与术中使用黏弹剂、术前眼压、术后BUT水平及术后TMH水平相关.
Abstract
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)points in the observation group.BUT,TMH and OSDI decreased in both groups at 28 d postoperatively compared with the preoperative period,but the BUT level in the observation group was higher than that in the control group at 28 d postoperatively(t=3.03,P=0.003),and the OSDI score was lower than that in the control group(t=2.51,P=0.013).The incidence of poor visual quality in the observation group was 18.55%(23/123),lower than the 34.15%(42/123)in the control group(χ2 =7.33,P=0.007).The results of logistic regression analysis showed that the absence of viscoelastic agent(OR = 2.14,P = 0.041),high intraocular pressure before surgery(OR = 1.61,P<0.001),low postoperative BUT level(OR= 0.48,P<0.001)and low postoperative TMH level(OR= 0.00,P<0.001)were all relevant factors affecting the poor visual quality of patients(P<0.05).According to ROC curve analysis,the sensitivity of whether viscoelastic agent was used,preoperative intraocular pressure,postoperative BUT and postoperative TMH level were 0.646,0.723,0.662 and 0.785,respectively,and the specificity was 0.555,0.643,0.698 and 0.538,respectively,and the combined AUC=0.847,sensitivity 0.846 and specificity of each index were 0.736.Conclusion Application of viscoelastic agents during phacoemulsification has little effect on postoperative intraocular pressure and is beneficial to improve tear film stability and visual quality.In addition,the visual quality after surgery may be related to factors such as the application of viscoelastic agents,preoperative intraocular pressure,postoperative BUT level and TMH level.
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