Effects Of Different Clear Corneal Incision In Cataract Phacoemulsification On The Postoperative Tear Film

ObjectiveTo observe and compare the effects of different clear corneal incision in cataract phacoemulsification on the postoperative tear film. The obvervational index included preoperative and postoperative uncorrected visual acuity(UCVA); non Invasive Tear Break Up Time(NIBUT); tear meniscus height(TF-NIKTMH); conjunctival hyperemia scoring(R-Scan); dry eye symptoms(DES), etc.MethodNinety eyes (age 60-80) from August 2015 to March 2016 were diagnosed aged-related cataract in outparent department of AIER OPHTHALMOLOGY hospital in Foshan, guangdong province, which were randomized divided into 3 groups according to the condition of the corneal curvature. Astigmatism was greater than 1.00 D, the incision did in the maximum refractive power of the cornea radial axial transparent angle;astigmatism was less than 1.00 D, did in temporal incision;other situations or the maximum refractive power of the cornea radial axial transparent angle at the superior,did in superior transparent cornea. Finally, grouping according to the orientation of the incision.The group A with 27 eyes were treated using the maximum refractive power of the cornea radial axial transparent angle incision (do not include the 180°and 90°incision) in cataract phacoemulsification and aspheric intraocular lens implantion;The group B with 31 eyes were treated using the superior transparent cornea (90°incision);The group C with 32 eyes were treated using the temporal clear cornea(180°incision). The UCVA、NIBUT、 TF-NIKTMH、R-Scan and DES were examined at preoperation and the first postoperative day、the 7th postoperative day、the 30th postoperative day by the ocular surface analyzer (OCULUS Keratograph).ResultsThrough the observation we found that, (1)Uncorrected visual acuity (UCVA):there has the statistical significant difference (P＜0.05) by comparing the UCVA of preoperative and the first postoperative Day of three groups, it explained that the UCVA on the first postoperative Day was increased in three groups; To compare the UCVA had increased at the 30th postoperative day in three groups, it was no statistical significant difference(P＞0.05). (2) Non Invasive Tear Break Up Time at the first time (NIBUTf):There has the statistical significant difference(P＜0.05) by comparing the NIBUTf of preoperative and the first postoperative Day of three groups, it displayed that the NIBUTf of the first postoperative Day was lower than the preoperative in group A and group C, but the NIBUTf of the first postoperative Day was higher than the preoperative in group B;There has the statistical significant difference (P＜0.05) by comparing the NIBUTf of preoperative and the 7th postoperative day of three groups, it explained that the NIBUTf of the 7th postoperative day was lower than the preoperative in three groups;But to compare the NIBUTf of the 7th postoperative day of three groups, it was no statistical significant difference(P＞0.05);To compare the NIBUTf of preoperative and the 30th postoperative day of three groups,it was no statistical significant difference(P＞0.05). To compare the NIBUTf of the 30th postoperative day of three groups, it was no statistical significant difference(P＞0.05). (3) Non Invasive Tear Break Up Time at the average time (NIBUTav):There has the statistical significant difference(P＜0.05) by comparing the NIBUTav of preoperative and the first postoperative Day in group C, the NIBUTav was lower than preoperative; There has the statistical significant difference (P＜0.05) by comparing the NIBUTav of the first postoperative Day in three groups,it explained that The NIBUTav is inconsistent, among them, the group A compared with group B, there has the statistical significant difference(P＜0.05), the group C compared with group B,there has the statistical significant difference(P＜0.05), the group A compared with group C, it was no statistical significant difference(P＞0.05), it explained that the NIBUTav of group B was higher than other groups, and the NIBUTav of group C were lower than other groups;To compare the NIBUTav of preoperative and the first postoperative Day of group A and group B, it was no statistical significant difference(P＞0.05);To compare the NIBUTav of preoperative and the 7th postoperative day in three groups, it was no statistical significant difference(P＞0.05);To compare the NIBUTav of preoperative and the 30th postoperative day in three groups, it was no statistical significant difference (P＞0.05); To compare the NIBUTav of the 7th postoperative day in three groups.it was no statistical significant difference (P＞0.05);To compare the NIBUTav of the 30th postoperative day in three groups, it was no statistical significant difference (P＞0.05). (4) Tear meniscus height (TF-NIKTMH):There has the statistical significant difference(P＞0.05) by comparing the TF-NIKTMH of preoperative and the first postoperative Day of three groups, it displayed that tear meniscus height was higher than preoperative; There has the statistical significant difference (P＞0.05) by comparing the TF-NIKTMH of preoperative and the 30th postoperative day in three groups, it explained that the TF-NIKTMH in group C was lower than preoperative;To compare the TF-NIKTMH of preoperative and the 7th postoperative day in three groups, it was no statistical significant difference (P＞0.05); To compare the TF-NIKTMH of the first postoperative day in three groups, it was no statistical significant difference(P＞0.05); To compare the TF-NIKTMH of the 7th postoperative day in three groups, it was no statistical significant difference(P＞0.05). (5)Conjunctival hyperemia scoring (R-Scan):To compare the conjunctival hyperemia scoring of preoperative and the first postoperative day in three groups, it was no statistical significant difference(P＞0.05); To compare the conjunctival hyperemia scoring of preoperative and the the 7th postoperative day in three groups, it was no statistical significant difference(P＞0.05); To compare the conjunctival hyperemia scoring of preoperative and the 30th postoperative day in three groups, it was no statistical significant difference (P＞0.05); To compare the conjunctival hyperemia scoring at same time in three groups, it was no statistical significant difference (P＞0.05). (6) The corneal of all patitents with postoperative was clear;there was no obvious inflammation in anterior chamber;the intraocular pressure was normal;the location of aspheric intraocular lens was entopic and no serious complications. Patients did not complained about dessry eyes, burning seoperansation, foreign body sensation, fatigue sensation and vision fluctuation after operation.ConclusionThere is a certain impact of different clear corneal incision in cataract phacoemulsification on the postoperative tear film, the temporal clear cornea incision significantly affects the stability of the tear film, their impact is:temporal clear cornea incision (180°incision)> maximum refractive power of the cornea radial axial transparent angle incision (do not include the 180° and 90° incision)> superior transparent cornea incision (90° incision).