山东大学耳鼻喉眼学报 ›› 2022, Vol. 36 ›› Issue (6): 1-6.doi: 10.6040/j.issn.1673-3770.0.2022.381

• 白内障手术质量的规范管理——述评 •    下一篇

干眼对屈光性白内障手术的影响

段练,孟凡兰,党光福   

  1. 山东省千佛山医院)眼科, 山东 济南 250013
  • 发布日期:2022-12-07
  • 通讯作者: 党光福. E-mail:dangguangfu@sdhospital.com.cn

Effect of dry eye on refractive cataract surgery

DUAN Lian, MENG FanlanReview,DANG GuangfuGuidance   

  1. Department of Ophthalmology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250013, Shandong, China
  • Published:2022-12-07

摘要: 干眼是一类由多种因素引起的以泪膜稳态失衡为特点的眼表疾病,同时伴有泪膜不稳定、泪液渗透压升高、眼表炎性损伤以及眼表神经感觉异常导致的眼表症状。近年来随着环境污染、视频终端普及和生活方式的改变,干眼已成为临床最常见的眼科疾病之一,严重影响患者的视觉健康和生活质量,且发病有逐年增高和年轻化的趋势。虽然随着白内障手术技术和人工晶状体设计的不断进步,屈光性白内障手术已经被越来越多的医生和患者接受并取得了满意的效果,然而在临床实践中仍有部分患者未达到期望值,干眼是造成这类患者满意度降低的重要且常见的原因之一。屈光性白内障手术患者在围手术期不同的干眼干预措施,直接影响人工晶状体测算的准确性和术后屈光状态的稳定性。述评干眼在白内障患者中的发病率、白内障患者干眼的危险因素、术前干眼对屈光性白内障手术的影响、围手术期干眼干预对屈光性白内障手术的影响、屈光性白内障患者术后干眼的治疗,提出了重视干眼在屈光性白内障手术中的影响并科学合理地干预,是提高屈光性白内障手术安全性、准确性和患者满意度的重要措施。

关键词: 干眼, 屈光性白内障手术, 人工晶状体, 睑板腺功能障碍

Abstract: Dry eye is an ocular surface disease characterized by tear film homeostasis imbalance due to various factors. Dry eye is often accompanied by tear film instability, elevated tear osmolality, ocular surface inflammatory damage, and ocular surface nerve sensory abnormalities. With the environmental pollution, the popularity of video terminals, and the change in lifestyle, dry eye has become one of the most common ophthalmic diseases in clinical practice significantly affecting the visual health and quality of life. The incidence of dry eye has increased annually, and more commonly affects the younger population. With the continuous development in cataract surgery technology and intraocular lenses, refractive cataract surgery has been accepted by more doctors and patients and has achieved satisfactory results. However, in clinical practice, there are still some disgruntled patients. Dry eye is an important and common reason for the reduction in satisfaction. Different interventions for dry eye in the perioperative period of patients undergoing refractive cataract surgery directly affect the accuracy of intraocular lens measurement and the stability of the postoperative refractive state. This paper reviews the incidence of dry eye in cataract patients, the risk factors for dry eye, the impact of dry eye on refractive cataract surgery, the impact of preoperative dry eye intervention on refractive cataract surgery, and therapy for postoperative patients with dry eye. This study highlights the importance of dry eye in refractive cataract surgery and the scientific and reasonable way of dealing with this condition. It is an efficient measure to improve the safety, accuracy, and patient satisfaction of refractive cataract surgery.

Key words: Dry eye, Refractive cataract surgery, Intraocular lens, Meibomian gland dysfunction

中图分类号: 

  • R777.34
[1] 亚洲干眼协会中国分会, 海峡两岸医药卫生交流协会眼科学专业委员会眼表与泪液病学组, 中国医师协会眼科医师分会眼表与干眼学组. 中国干眼专家共识:定义和分类(2020年)[J]. 中华眼科杂志, 2020, 56(6): 418-422. doi:10.3760/cma.j.cn112142-20200316-00190.
[2] 中华医学会眼科学分会白内障及人工晶状体学组. 中国白内障围手术期干眼防治专家共识(2021年)[J]. 中华眼科杂志, 2021, 57(1): 17-22. doi:10.3760/cma.j.cn112142-20201013-00680.
[3] 王玮, 徐雯. 《ASCRS屈光性手术前眼表疾病诊疗临床路径》解读[J]. 中华实验眼科杂志, 2020, 38(7): 614-620. doi:10.3760/cma.j.cn115989-20200108-00013.?倓 WANG Wei, XU Wen. Interpretation of ASCRS algorithm for the preoperative diagnosis and treatment of ocular surface disorders[J]. Chinese Journal of Experimental Ophthalmology, 2020, 38(7): 614-620. doi:10.3760/cma.j.cn115989-20200108-00013.
[4] 俞阿勇. 屈光性白内障手术的若干挑战[J]. 中华眼视光学与视觉科学杂志, 2017(2): 65-70. doi: 10.3760/cma.j.issn.1674-845X.2017.02.001. YU AYong. Challenges of refractive cataract surgery[J]. Chinese Journal of Optometry & Ophthalmology, 2017(2): 65-70. doi: 10.3760/cma.j.issn.1674-845X.2017.02.001.
[5] Periman LM, Perez VL, Saban DR, et al. The immunological basis of dry eye disease and current topical treatment options[J]. J Ocul Pharmacol Ther, 2020, 36(3): 137-146. doi:10.1089/jop.2019.0060.
[6] Gupta PK, Drinkwater OJ, VanDusen KW, et al. Prevalence of ocular surface dysfunction in patients presenting for cataract surgery evaluation[J]. J Cataract Refract Surg, 2018, 44(9): 1090-1096. doi:10.1016/j.jcrs.2018.06.026.
[7] Stapleton F, Alves M, Bunya VY, et al. TFOS DEWS II epidemiology report[J]. Ocul Surf, 2017, 15(3): 334-365. doi:10.1016/j.jtos.2017.05.003.
[8] Lemp MA, Crews LA, Bron AJ, et al. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study[J]. Cornea, 2012, 31(5): 472-478. doi:10.1097/ICO.0b013e318225415a.
[9] Cochener B, Cassan A, Omiel L. Prevalence of meibomian gland dysfunction at the time of cataract surgery[J]. J Cataract Refract Surg, 2018, 44(2): 144-148. doi:10.1016/j.jcrs.2017.10.050.
[10] Trattler WB, Majmudar PA, Donnenfeld ED, et al. The Prospective Health Assessment of Cataract Patients' Ocular Surface(PHACO)study: the effect of dry eye[J]. Clin Ophthalmol, 2017, 11: 1423-1430. doi:10.2147/opth.s120159.
[11] Clayton JA. Dry Eye[J]. N Engl J Med, 2018, 378(23):2212-2223. doi: 10.1056/NEJMra1407936.
[12] Shah S, Jani H. Prevalence and associated factors of dry eye: our experience in patients above 40 years of age at a Tertiary Care Center[J]. Oman J Ophthalmol, 2015, 8(3): 151-156. doi:10.4103/0974-620x.169910.
[13] Belmonte C, Nichols JJ, Cox SM, et al. TFOS DEWS II pain and sensation report[J]. Ocul Surf, 2017, 15(3): 404-437. doi:10.1016/j.jtos.2017.05.002.
[14] Sullivan BD, Whitmer D, Nichols KK, et al. An objective approach to dry eye disease severity[J]. Invest Ophthalmol Vis Sci, 2010, 51(12): 6125-6130. doi:10.1167/iovs.10-5390.
[15] 孙一宁, 陈蔚. 关注白内障术后干眼[J]. 中华眼视光学与视觉科学杂志, 2021, 23(7): 486-490. doi:10.3760/cma.j.cn115909-20201020-00401. SUN Yining, CHEN Wei. Focus on dry eye after cataract surgery[J]. Chinese Journal of Optometry Ophthalmology and Visual Science, 2021, 23(7): 486-490. doi:10.3760/cma.j.cn115909-20201020-00401.
[16] Tomlinson A, Khanal S, Ramaesh K, et al. Tear film osmolarity: determination of a referent for dry eye diagnosis[J]. Invest Ophthalmol Vis Sci, 2006, 47(10): 4309-4315. doi:10.1167/iovs.05-1504.
[17] 晋秀明, 徐雯. 图解干眼诊疗[M]. 北京: 人民卫生出版社, 2020.
[18] Alves M, Fonseca EC, Alves MF, et al. Dry eye disease treatment: a systematic review of published trials and a critical appraisal of therapeutic strategies[J]. Ocul Surf, 2013, 11(3): 181-192. doi:10.1016/j.jtos.2013.02.002.
[19] Portal C, Gouyer V, Gottrand F, et al. Ocular mucins in dry eye disease[J]. Exp Eye Res, 2019, 186: 107724. doi:10.1016/j.exer.2019.107724.
[20] Tibrewal S, Sarkar J, Jassim SH, et al. Tear fluid extracellular DNA: diagnostic and therapeutic implications in dry eye disease[J]. Invest Ophthalmol Vis Sci, 2013, 54(13): 8051-8061. doi:10.1167/iovs.13-12844.
[21] 狄宇, 李莹. 干眼炎症反应机制及抗炎治疗的研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(2): 144-150. doi:10.6040/j.issn.1673-3770.0.2020.484. DI Yu, LI Ying. Research progress in the inflammatory reaction and anti-inflammatory treatments in dry eye[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(2): 144-150. doi:10.6040/j.issn.1673-3770.0.2020.484.
[22] Coursey TG, Bohat R, Barbosa FL, et al. Desiccating stress-induced chemokine expression in the epithelium is dependent on upregulation of NKG2D/RAE-1 and release of IFN-γ in experimental dry eye[J]. J Immunol, 2014, 193(10): 5264-5272. doi:10.4049/jimmunol.1400016.
[23] 中华医学会眼科学分会角膜病学组.干眼临床诊疗专家共识(2013年)[J].中华眼科杂志,2013,49(1):73-75. doi: 10.3760/cma.j.issn.0412-4081.2013.01.020.
[24] He X, Huang AS, Jeng BH. Optimizing the ocular surface prior to cataract surgery[J].Curr Opin Ophthalmol, 2022, 33(1): 9-14. doi: 10.1097/ICU. 0000000000000814.
[25] Hovanesian JA, Epitropoulos A, Donnenfeld ED. The effect of lifitegrast on refractive accuracy, higher order aberrations, and symptoms in dry eye patients undergoing cataract surgery[J]. Clin Ophthalmol, 2020, 16(14):2709-2716. doi: 10.2147/OPTH.S264520. eCollection 2020.
[26] Mills EC, Zarei-Ghanavati M, Liu Christopher SC. Immediate sequential bilateral cataract surgery: The rationale, implementation, and beliefs of ophthalmic surgeons across Europe[J]. J Cataract Refract Surg, 2019, 45(12):1725-1731. doi: 10.1016/j.jcrs.2019.07.027.
[27] Song P, Sun Z, Ren SW, et al. Preoperative management of MGD alleviates the aggravation of MGD and dry eye induced by cataract surgery: a prospective, randomized clinical trial[J]. Biomed Res Int, 2019: 2737968. doi:10.1155/2019/2737968.
[28] Jiang XD, Deng AH, Yang JR, et al. Pathogens in the Meibomian gland and conjunctival sac: microbiome of normal subjects and patients with Meibomian gland dysfunction[J]. Infect Drug Resist, 2018, 11: 1729-1740. doi:10.2147/idr.s162135.
[29] Labetoulle M, Rousseau A, Baudouin C. Management of dry eye disease to optimize cataract surgery outcomes: two tables for a daily clinical practice[J]. J Français D'ophtalmologie, 2019, 42(8): 907-912. doi:10.1016/j.jfo.2019.03.032.
[30] 中华医学会眼科学分会白内障及人工晶状体学组. 中国多焦点人工晶状体临床应用专家共识(2019年)[J]. 中华眼科杂志, 2019, 55(7): 491-494. doi:10.3760/cma.j.issn.0412-4081.2019.07.003.
[31] Khalifa YM, Mifflin MD. Keratitis and corneal melt with ketorolac tromethamine after conductive keratoplasty[J]. Cornea, 2011, 30(4): 477-478. doi:10.1097/ICO.0b013e3181ef6ec7.
[32] Cho YK, Kim MS. Dry eye after cataract surgery and associated intraoperative risk factors[J]. Korean J Ophthalmol, 2009, 23(2): 65-73. doi:10.3341/kjo.2009.23.2.65.
[33] Park Y, Hwang HB, Kim HS. Observation of influence of cataract surgery on the ocular surface[J]. PLoS One, 2016, 11(10): e0152460. doi:10.1371/journal.pone.0152460.
[34] Han KE, Yoon SC, Ahn JM, et al. Evaluation of dry eye and meibomian gland dysfunction after cataract surgery[J]. Am J Ophthalmol, 2014, 157(6): 1144-1150.e1. doi:10.1016/j.ajo.2014.02.036.
[35] Fiona S, Monica A, Vatinee YB, et al. TFOS DEWS II epidemiology report[J]. Ocul Surf, 2017, 15(3): 334-365. doi: 10.1016/j.jtos.2017.05.003.
[36] Mason L, Jafri S, Dortonne I, et al. Emerging therapies for dry eye disease[J]. Expert Opin Emerg Drugs, 2021, 26(4): 401-413. doi:10.1080/14728214.2021.2011858.
[37] Maria M, Takenori I, Masahiro N, et al. Prevalence and characteristics of dry eye disease after cataract surgery: a systematic review and meta-analysis[J]. Ophthalmol Ther, 2022, 11(4):1309-1332. doi: 10.1007/s40123-022-00513-y.
[38] Kasetsuwan N, Satitpitakul V, Changul T, et al. Incidence and pattern of dry eye after cataract surgery[J]. PLoS One, 2013, 8(11): e78657. doi:10.1371/journal.pone.0078657.
[39] Eguchi A, Inomata T, Nakamura M, et al. Heterogeneity of eye drop use among symptomatic dry eye individuals in Japan: large-scale crowdsourced research using DryEyeRhythm application[J]. Jpn J Ophthalmol, 2021, 65(2): 271-281. doi:10.1007/s10384-020-00798-1.
[40] Han KE, Yoon SC, Ahn JM, et al. Evaluation of dry eye and meibomian gland dysfunction after cataract surgery[J]. Am J Ophthalmol, 2014, 157(6): 1144-1150.e1. doi:10.1016/j.ajo.2014.02.036.
[41] Jun I, Choi S, Lee GY, et al. Effects of preservative-free 3% diquafosol in patients with pre-existing dry eye disease after cataract surgery: a randomized clinical trial[J]. Sci Rep, 2019, 9(1): 12659. doi:10.1038/s41598-019-49159-0.
[42] Na KS, Han K, Park YG, et al. Depression, stress, quality of life, and dry eye disease in Korean women: a population-based study[J]. Cornea, 2015, 34(7): 733-738. doi:10.1097/ICO.0000000000000464.
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