Comparative Study Of Two Kinds Of Incisions On The Change Of Tear Film After Phacoemulsification

Objective: To compare and evaluate two kinds of incisions (scleral tunnelincision and clear corneal incision) on the changes of tear-film afterphacoemulsification.Methods: The data of106patients (146eyes) undergoing phacoemulsificationand foldable IOL implantation were collected in General Hospital of NingxiaMedical University from Oct.2012and Oct.2013.88patients (121eyes) withfull follow-up data were enrolled in this study and randomly divided into2groups according to the simplerandomization. Group A received scleral tunnelincision and Group B took clear corneal incision. Each group was furtherdivided into3subgroups according to Lens Opacities Classification System II,i.e. AⅡ, AⅢ, AⅣ and BⅡ, BⅢ, BⅣ. Score of dry eye symptoms (SDES）,Breaking up time (BUT）,score of cornea fluorescein staining (SCSF），(schirmerI test SIt),mean counjunctival goblet cells（MCGC），tears films height (TMH）,and topography were examined at1day before operation and at1,7,30or90days after operation.Results:1SDES: Compared with preoperative data, postoperative SDES at1day and7days in both of the2groups were increased. Postoperative SDES inBⅣ, SDES did not return to the preoperative level after30days of operation.There are statistical differences of SDES Between A Ⅲ-B Ⅲ and A Ⅳ-B Ⅳsubgroups after1day and7days of operation, and also between subgroup AⅣand BⅣ after30days of operation. 2.TMH: Compared with preoperative data, postoperative TMH at1day inBoth of the2groups were significantly increased. Postoperative TMH in BⅣ at7day were significantly increased compared with the preoperative level.There are statistical differences of TMH Between Group AⅡ-BⅡ and AⅢ-BⅢ after1day of operation, and also Between subgroup AⅣ and BⅣ after7days of operation.3BUT: Compared with preoperative data, postoperative BUT at1day and7days in both of the2groups were shorten. In B Ⅳ, BUT returned to thepreoperative level after30days of operation.There are statistical differences of BUT between A Ⅲ-B Ⅲ and A Ⅳ-B Ⅳsubgroups after1day of operation, and also between subgroup AⅣ and BⅣafter7days of operation.4SCSF: Compared with preoperative data, postoperative SCSF at1day and7days in both of the2groups were significantly increased. Postoperative SCSF inB Ⅳ subgroups at30days were significantly increased compared with thepreoperative level.There are statistical differences of SCSF between subgroup AⅢ and BⅢ after1day of operation, and also between subgroup AⅣ and BⅣ after7days ofoperation.5SIt: Compared with preoperative data, postoperative SIt at1day in both ofthe2groups were significantly increased. Postoperative Sit in AⅣ and BⅣsubgroups at7days were significantly increased compared with the preoperativelevel.There are statistical differences of SIt between subgroup AⅢ and BⅢ after1day of operation, and also between subgroup A Ⅳ and B Ⅳ after1day of operation, and still between subgroup AⅣ and BⅣ after7days of operation.6. Ast:Compared with preopertaion, corneal astigmatism values in group A andB increased after operation. In addition,there were statistically significant at7days after operation in group A and7days,30days and90days after operationin group B.Corneal astigmatism values at each time point in group B werehigher those in group A, and the difference was statistically significant.7. MCGC: Mean conjunctival goblet cells were not statistically significantbetween group A and B at all time points（p>0.05）.Conclusions:1Both scleral tunnel incision and clear corneal incision candamage the function of the tear film.2No significant differences are found onthe influence of the tear film between the two kinds of incisions using nuclearphacoemulsification surgery gradeⅡ;.3For those surgery gradeⅢ and Ⅳ, clearcorneal incision has more impact on the tear film,especially. Grade Ⅳ.