·糖尿病视网膜病变·

　　【摘要】 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月及3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差异比较均无统计学意义(P>0.05);术后2周,两组各症状中干涩感、异物感、畏光、疼痛、眼红和流泪比较差异均有统计学意义(P<0.05);术后3个月,两组各症状、泪液总蛋白量、乳铁蛋白、溶菌酶及神经纤维密度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。

　　【关键词】 超声乳化白内障吸除术;糖尿病;角膜共焦显微镜;角膜知觉

The change of cornea and tear film after phacoemulsification surgery and IOL implantation with different incision for true cataract patients SHAO Yi, YU Yao ,WANG Le, et al. Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Nanchang 330006,China

Corresponding author: PEI Zhong-gang, E-mail: Freebee99@aliyun.com

　　【Abstract】 Objective To observe the symptom of ocular surface, corneal nerve fiber and tear protein of true diabetic cataract(TDC) patients after phacoemulsification surgery and IOL implantation with superior incision. Methods 56 TDC patients(56 right eyes) were randomly divided into two groups：(group A) superior corneal incision phacoemulsification surgery and IOL implantation ,versus (group B) temple incision phacoemulsification surgery and IOL implantation. The symptom of ocular surface, corneal perception and tear protein examination were performed at week 1, week 2, month 1 and month 3 postoperatively. Results There were no significant differences for the symptom score of ocular surface, tear proteins, lactoferrin, lysozyme, nerve fiber density and corneal perception were found between two groups preoperatively(P>0.05). There were statistically significant differences in dry and unsmooth sensation, foreign body sensation, photophobia, pain, red eye and tear at preoperation versus postoperative week 2 between both groups(P<0.05).There were statistically significance differences in corneal perception and the connective nervous of corneal incision at preoperation versus postoperation in both groups. Whereas ,there was no statistically significant difference in symptom score of ocular surface, tear proteins, lactoferrin, lysozyme and nerve fiber density at preoperative versus postoperative month 3 between both groups (P>0.05). The proportion difference of patients with an abnormal morphologic nerve fibers in corneal incision was significantly was greater in group B than in group A (P<0.05). Conclusion Phacoemulsification surgery and IOL implantation with superior incision is more favorable for TDC patients, which can ameliorate the corneal perception and corneal incision nerve injury，mitigate the symptom of ocular surface and therefore improve the visual quality.

　　【Key words】 Phacoemulsification surgery;Diabetes mellitus;Confocal microscope;Corneal perception