Effect Of Phacoemulsification Cataract Surgery On Cornea And Tear Film And Clinical Outcomes Of Chinese Herbal Medicine On Them

Purpose:To observe the effect of phacoemulsification cataract surgery on cornea and tear film and clinical outcomes of Chinese herbal medicine on them.Methods:This prospective,randomized,controlled study was conducted from October 2019 to January 2020 in Ineye Hospital of Chengdu University of TCM.The patients after phacoemulsification and intraocular lens implantation were divided into two groups according to the random number method.One group was treated with conventional eyedrops as the control group.The other group was treated with conventional eyedrops combined with the agreed prescription for perioperative cataract surgery(Referred to as “agreed prescription”)as the experimental group.Corneal fluorescein staining scores(CFS),central corneal thickness(CCT),corneal endothelial cell density(ECD),corneal biomechanical parameters(corneal hysteresis,CH,corneal resistance factor,CRF),tear break-up time(BUT),Schirmer test ? value(S?t),Mc Monnies Questionnaire(MQ),and corrected distance visual acuity(CDVA)were evaluated preoperatively and postoperatively at 1 day,7 days and 15 days.SPSS 26.0 statistical software was used for statistical analysis of the data.Results:A total of 63 eyes(31 eyes in the test group and 32 eyes in the control group)were included in this study.All the operations went well,no adverse events occurred,and no serious postoperative complications occurred.(1)The corneal fluorescein staining scores in both groups were significantly increased(P<0.001)1 day postoperatively and gradually decreased in both groups.The decrease was faster in the experimental group,which was lower than the control group 7 days postoperatively and 15 days postoperatively(P=0.004<0.05,P=0.007<0.05),and the experimental group had decreased to the preoperative level 15 days postoperatively(P=0.423>0.017).(2)The central cornea in both groups significantly thickened(P<0.001)1 day after surgery,and then gradually recovered(thinned),but the recovery was faster in the experimental group.CCT of the experimental group was lower than that of the control group 7 days postoperatively(P=0.043>0.05),and the CCT of the experimental group returned to the preoperative level at 15 days postoperatively(P=0.102>0.017).(3)The corneal endothelial cell density in both groups significantly decreased on the 1 day postoperatively(P<0.001)and then continued to decrease.There was no statistical difference between the two groups at each checkpoint throughout the follow-up(P=0.320>0.05,P=0.264>0.05,P=0.286>0.05).(4)The cornea biomechanical properties include CH and CRF were significantly decreased in both groups 1 day after surgery(P<0.001),followed by an increasing trend of CH in both groups.But the experimental group recovered faster than the control group(7d postoperatively,P=0.046<0.05).CRF in both groups continued to decline after surgery,there are no significant difference between the two groups at each checkpoint throughout the follow-up(P=0.794>0.05,P=0.596>0.05,P=0.377>0.05).(5)BUT in both groups was significantly shortened 1 day after surgery(P<0.001),and then gradually extended.The recovery was faster in the experimental group.BUT in the experimental group had recovered to the preoperative level at 15 days after surgery(P=0.654>0.017),with statistically significant difference compared with the control group(P=0.038<0.05).(6)S ? t value in both groups was significantly increased 1 day after surgery(P<0.001),the S ? t value of the both group returned to the preoperative level at 7 days postoperatively(P = 0.118>0.017,P=0.863>0.017),Subsequently,the experimental group increased slightly,but the control group continued to decline,and was significantly lower than the preoperative level at 15 days after surgery(P<0.001).There was no statistical difference between the two groups at each checkpoint throughout the follow-up(P=0.650>0.05,P= 0.635>0.05,P=0.099>0.05).(7)The MQ scores in both groups were significantly higher after the operation(all P<0.001).The scores of the experimental group gradually decreased,and were lower than the control group at 15 days postoperatively(P=0.003<0.05).(8)The CDVA in both groups was significantly improved(all P<0.001)(log MAR was decreased numerically),and CDVA in the experimental group was better than that in the control group 7 days postoperatively(P=0.007<0.05),and there was no statistical difference between the two groups on 15 days postoperatively(P=0.135>0.05),indicating that the visual acuity of the experimental group reached a better level earlier.Conclusions:(1)Phacoemulsification cataract surgery will cause corneal tissue damage in many aspects,including central corneal thickness increased,corneal epithelial loss,corneal endothelial cell decreased,and corneal biomechanical parameters changed.(2)Phacoemulsification cataract surgery alter the tear film instability significantly,including BUT shorten,S ? t value fluctuation,which exacerbate discomfortable symptoms of the patients.(3)Postoperative intervention with the the agreed prescription can promote the recovery of corneal and tear film in many ways,including promoting corneal epithelial repair,accelerating the recovery of central corneal thickness,promoting the recovery of cornea biomechanical,prolonging the tear film break-up time,reducing the discomfort of patients,and reaching better visual acuity level earlier.