Change of the Tear Film Instability and Subjective Symptoms after Small-Incision Cataract Surgery

Abstract

Purpose: To investigate corneal surface changes and subjective symptoms after small incision cataract surgery and to compare the changes between clear corneal incision and corneoscleral incision.

Methods: The present prospective randomized study included 18 eyes of 18 patients with corneoscleral incision (Group 1) and 25 eyes of 25 patients with clear corneal incision (Group 2). All patients were examined for tear break-up time (BUT), Schirmer test, cornea and conjunctiva fluorescein staining, and dry eye symptoms using the Ocular Surface Disease Index (OSDI). All values were compared before surgery and at one day, one week, four weeks, and seven weeks after surgery.

Results: BUT decreased significantly (p < 0.05) and fluorescein staining scores increased significantly (p < 0.05) at postoperative day 1. The values of BUT and fluorescein staining returned to the preoperative level at postoperative week 3 in Group 1. In Group 2, fluorescein staining scores returned at one week and BUT returned to the preoperative level at postoperative week 3. Postoperative Schirmer test results were unchanged compared to preoperative values, and there was no difference between the two groups. OSDI scores significantly improved compared to preoperative scores at postoperative one week. In Group 1, the scores improved at postoperative one week (p < 0.05) compared to those in Group 2 at postoperative three weeks (p < 0.05).

Conclusions: Phacoemulsification with a small incision induced transient corneal surface changes and tear film instability, but the changes returned to the preoperative level at postoperative three weeks. Dry eye symptoms also improved at postoperative one week. The changes lasted longer with clear corneal incision than with corneoscleral incision but returned to the preoperative level at postoperative three weeks in both groups.

목적: 백내장 수술 후 각막표면 및 건성안과 관련된 자각증상의 변화와 절개법에 따른 차이를 비교해 보고자 하였다.

대상과 방법: 각공막절개술(1군, 18명 18안) 또는 투명각막절개술(2군, 25명 25안)후 초음파유화흡인술을 무작위배정으로 시행 받은 환자를 대상으로 술 전, 술 후 1일, 1주, 4주, 7주에 눈물막파괴시간, 쉬르머검사, 각막표면 형광염색검사를 시행하고, Ocular surface disease index (OSDI)를 이용한 자각증상을 조사하였다.

결과: 술 후 1일째 눈물막파괴시간이 감소하였고, 각막표면 형광염색정도가 증가하였다(p＜0.05). 두 검사 모두 2군에서는 술 후 3주째 회복되었으며, 1군에서는 눈물막파괴시간은 술 후 3주째, 형광염색정도는 1주째 회복되었다. 쉬르머검사는 수술 후 유의한 변화 및 절개법에 따른 차이를 보이지 않았다. 자각증상은 2군에서 술 후 3주째, 1군에서 1주째부터 호전되었다(p＜0.05).

결론: 백내장 수술 후 일시적인 각막표면의 변화와 눈물층의 불안정이 관찰되나, 술 후 3주 이내에 호전되며, 주관적 증상 역시 1주 이내 호전된다. 특히 투명각막절개술인 경우 각공막절개술보다 위의 변화가 더 오래 지속되나, 3주째에는 회복된다.