小梁显微切除术对泪膜及眼表上皮细胞影响的初步研究  

Primary research on the influence of trabeculectomy on tear film and epithelial cells of ocular surface

作　　者：钟毅敏[1] 刘杏[1] 毛真[1] 林健贤[1] 黄晶晶[1] 王涛[1] 李媚[1] 曾阳发[1] 肖辉[1] 

机构地区：[1]中山大学中山眼科中心眼科学国家重点实验室,广州市510060

出　　处：《中华显微外科杂志》2007年第5期344-347,共4页Chinese Journal of Microsurgery

基　　金：广东省科技计划项目(2003C32725);广州市科技计划项目(2005JI-C0101)

摘　　要：目的初步探讨复合式小梁显微切除术对泪膜及眼表上皮细胞的近期影响。方法收集2006年3月到2007年5月施仃小梁显微切除术联合巩膜瓣可调整缝线、结膜巩膜瓣下选择性放置丝裂霉素C(MMC)的26例(36眼)青光眼患者,分别在术前和术后1个月作常规眼科检查和眼表检查,包括泪液分泌试验(Sh)、泪膜破裂时间J(BUT)、角膜荧光素染色(FL)、眼表七皮虎红染色(RB),及球结膜上皮印迹细胞学检查,记录结膜上皮细胞的Nelson分级及杯状细胞密度,并与正常组进行比较。结果与正常对照组相比,青光眼患者术前及术后1个月BUT均日月显缩短,FL和RB值增加,结膜上皮Nelson等级增高,杯状细胞密度降低;Sit值与正常组的差异无统计学意义青光眼患者术后1个月的Slt、BUT、FL、RB值与术前相比,差异无统计学意义;结膜上皮Nelson分级明显高于术前,杯状细胞密度较术前明显降低。术中使用0.25 mg/ml MMC组与未使用MMC组(对照组)相比,术前、术后SIt、BUT、Nelson分级、杯状细胞密度差异无统计学意义,术后对照组FL和RB评分显著高于MMC组。结论复合式小梁显微切除术对泪膜的稳定性及眼表上皮细胞存在一定影响,术后1个月表现为泪膜不稳定,伴有角结膜上皮细胞的染色,结膜上皮的鳞状化生和杯状细胞数量的减少这种改变暂未发现与术中使用低浓度的MMC有关。Objective To investigate the early influence of trabeculectomy on tear film and epithelial cells of ocular surface. Methods Twenty-six patients （36 eyes） with glaucoma underwent trabeculectomy with adjustable suture, and with or without use of intraoperative mitomycin-C （MMC） under conjunctiva and sclera were included from March 2006 to May 2007. Routine ocular examinations and ocular surface examinations, including Schirmer I test, break-up time, fluorescein staining, rose bengal staining, and conjunctival impression cytology, were conducted preoperatively and 1 month postoperatively. Results Compared with normal controls, both postoperative and preoperative BUT were significantly shortened, and FL, RB scores, conjunctival Nelson classification significantly higher, and goblet cell density was significantly decreased in glaucomatous patients. No statistically significant difference of Sit were observed between the patients and the normal controls. There were no statistically significant difference of Sit, BUT, FL and RB scores between preoperation and 1 month postoperation. Postoperative conjunctival Nelson classification was significantly higher than preoperative level, and goblet cell density was significantly lowered. There were no significant difference of Sit, BUT, Nelson classification and goblet cell density between 0. 25 mg/ml MMC group and the control preoperatively and 1 month postoperatively. The FL and RB scores of the control group were significantly higher than MMC group postoperatively. Conclusion There may be some influence of trabeculectomy on tear film stability and ocular surface epithelium, which is manifested by teat film unstability, epithelial staining, conjunctival squamous metaplasia, and goblet cell density decrease 1 month postoperatively. These may not be related to use of low concentration of MMC in operation.

关 键 词：青光眼 小梁显微切除术 丝裂霉素 杯状细胞 

分 类 号：R779.6[医药卫生—眼科]