Objective To observe and compare the effects of different clear corneal incisions during cataract phacoemulsification on postoperative tear film.Methods 75 patients (age 60~80) diagnosed with age related cataract (n=90 eyes) were enrolled from Aier Eye Hospital in Foshan between August 2015 to March 2016.Patients were divided into 3 groups according to corneal curvature.In group A (n=27 eyes) corneal incisions were made along the axis with maximum refractive power (not including 180° or 90°).Patients were then implanted with aspheric intraocular lenses.Group B patients (n=31 eyes) were treated with superior transparent corneal incision (i.e., incision at 90°).Patients in group C (n=32 eyes) received corneal incision at temporal (0° or 180°).Uncorrected visual acuity (UCVA), first noninvasive tear break up time (NIBUTf), tear meniscus height (TF-NIKTMH) were examined before surgery and up to 30 days after surgery, using ocular surface analyzer (OCULUS Keratograph).Results We found that 1) UCVA significantly improved start day 1 after surgery (P<0.05) in all patients.2) NIBUTf was lower in group A and C patients but not in group B patients at PD1.But at PD7, NIBUTf were significantly lower in all groups (P<0.05).3) TF-NIKTMH increased in all groups at PD1 (P<0.05).This increase last to 30 days in group C patients.Conclusions Temporal corneal incision significantly affects the stability of the tear film.Comparison between the three incision locations showed that superior incisions has the least effects on tear film.%目的 探究不同方位透明角膜切口白内障超声乳化手术对泪膜变化的影响.方法 纳入2015年8月至2016年3月在广东省佛山爱尔眼科医院门诊确诊的75例(90只眼)老年性白内障(年龄60~80岁)患者,结合散光和角膜曲率的情况,分成A、B、C 3组,A组27只眼,B组31只眼,C组32只眼.其中A组予行透明角膜陡峭轴切口(不包含180°切口和90°切口)白内障超声乳化手术并植入非球面人工晶状体;B组予行透明角膜上方切口(切口定位于90°);C组予行透明角膜颞侧切口(切口定位于0°或180°).采用OCULUS Keratograph眼表综合分析仪客观定量检查3组术前及术后第1天、第7天、第30天的第1次泪膜破裂时间(NIBUTf)、泪河高度及裸眼视力的改变情况.结果 (1)裸眼视力:术后第1天,3组裸眼视力较术前提高,其差异有显著性(P<0.05).(2)NIBUTf:术后第1天,A组和C组NIBUTf较术前并较B组低,而B组较术前并较其它组高,其差异有显著性(P<0.05);术后第7天,3组NIBUTf较术前低,其差异有显著性(P<0.05).(3)泪河高度:术后第1天,3组泪河高度较术前高,术后第30天,C组泪河高度较术前并且较其它组低,其差异有显著性(P<0.05).结论 不同方位透明角膜切口白内障超声乳化术后对泪膜存在一定的影响,以颞侧透明角膜切口为显著,其影响力为:颞侧透明角膜切口>陡峭轴透明角膜切口>上方透明角膜切口.
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