目的：探讨原发性闭角型青光眼(PACG)合并白内障急性发作眼与对侧眼术后眼表变化。

方法：选取2021-01/2022-01于郑州大学附属郑州中心医院就诊的单眼发作的急性PACG合并白内障患者40例，急性发作眼行小梁切除术联合超声乳化白内障吸除人工晶状体植入术，对侧眼行超声乳化白内障吸除人工晶状体植入术，分别于术前、术后1、3、6mo行眼表疾病指数(OSDI)问卷调查及非侵入性首次泪膜破裂时间(NifBUT)、非侵入性平均泪膜破裂时间(NiaBUT)、泪河高度(TMH)检查。

结果：纳入患者术后1、3mo OSDI评分(14.72±3.07、11.39±2.24分)较术前(9.68±1.98分)明显升高(均P<0.0083)，术后6mo(10.18±1.84分)与术前无明显差异； 发作眼术后1、3mo NifBUT较术前明显降低，术后1、3、6mo NiaBUT较术前明显降低(均P<0.0083)； 对侧眼术后1mo NifBUT和NiaBUT较术前均明显降低(均P<0.0083)，术后3、6mo与术前无明显差异。手术前后纳入患者发作眼和对侧眼TMH均无差异(P>0.05)。

结论：PACG合并白内障术后泪膜稳定性下降，发作眼恢复需6mo甚至更长，对侧眼约需3mo。

METHODS: A total of 40 patients with monocular acute PACG combined with cataract who admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2021 to January 2022 were selected. Trabeculectomy combined with phacoemulsification and intraocular lens implantation was carried out in the acute attack eyes, and phacoemulsification and intraocular lens implantation were carried out in the contralateral eyes. The ocular surface disease index(OSDI)questionnaire, noninvasive first tear film break-up time(NifBUT), noninvasive average tear film break-up time(NiaBUT)and tear meniscus height(TMH)were assessed preoperatively and 1, 3 and 6mo postoperatively.

RESULTS: The OSDI scores of the included patients at 1 and 3mo postoperatively(14.72±3.07, 11.39±2.24)were significantly higher than those preoperatively(9.68±1.98; all P<0.0083), and there was no significant difference between 6mo postoperatively(10.18±1.84)and preoperatively. NifBUT of the acute attack eyes at 1 and 3mo postoperatively was significantly lower than that preoperatively, and NiaBUT of the acute attack eyes at 1, 3 and 6mo postoperatively was significantly lower than that preoperatively(all P<0.0083). The NifBUT and NiaBUT of the contralateral eyes at 1mo postoperatively were significantly lower than those preoperatively(all P<0.0083), and there was no significant difference between 3 and 6mo postoperatively and preoperatively. There was no significant difference in TMH of the attack eyes and the contralateral eyes postoperatively and preoperatively(P>0.05).

CONCLUSION: The stability of tear film after surgery of PACG and cataract is decreased. The acute attack eye needs 6mo or even longer to recover, while the contralateral eye needs roughly 3mo.