滤过泡形态对青光眼患者眼表结构和舒适度的影响  

The effect of the filtering bleb morphology on the ocular surface and comfort in patients with glaucoma

作　　者：辛晨[1] 王宁利[2] 乔利亚[2] 

机构地区：[1]首都医科大学附属北京安贞医院眼科,100029 [2]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室

出　　处：《眼科》2010年第1期19-24,共6页Ophthalmology in China

摘　　要：目的探讨不同形态滤过泡对青光眼患者眼表结构和舒适度的影响。设计前瞻性病例系列。研究对象滤过性手术成功并完成术后6个月随访的青光眼患者44例。方法采用手术前后的自身对照方法,通过问卷调查、眼表结构检查及裂隙灯显微镜滤过泡照相,比较滤过泡的存在及其不同形态引起青光眼患者眼表结构和舒适度的变化。主要指标问卷调查、角膜荧光素染色、结膜虎红染色、泪液分泌试验(Schirmer值)、泪膜仪脂质层测量、泪膜破裂时间(BUT)、角膜对称性指数(SRI)、角膜不规则指数(SAI)和角膜潜在视力(PUV)。结果滤过泡眼眼部畏光感和干涩感的发生明显增高(P=0.02,0.000),眼部不适感评分显著升高(P=0.000),荧光素染色、虎红染色、泪膜仪分级、SRI和SAI均较术前显著增高(P值均=0.000),PUV和BUT较术前显著减小(P=0.000),Schirmer值无显著变化(P=0.417)。患者年龄和性别与术后滤过泡形态及眼表结构和舒适度的变化程度无显著相关性。薄壁滤过泡组患者畏光感加重明显(P=0.002),厚壁滤过泡组患者干涩感加重突出(P=0.003)。薄壁滤过泡组术后虎红染色评分、泪膜仪评级增加程度及BUT缩短程度均较厚壁滤过泡组明显(P=0.046,P=0.032,P=0.024),而厚壁滤过泡组则以Schirmer值减小更为显著(P=0.027)。结论滤过术后晚期,滤过泡的存在破坏眼表结构,引起患眼明显的不适症状。薄壁滤过泡主要引起眼部刺激症状及角结膜组织结构的损害,厚壁滤过泡主要引起眼部干涩感及泪液量的减少。Objective To detect the effect of filtering bleb with different morpha on the ocular surface structures and comfort in patients with glaucoma. Design Prospective case series. Participants 44 glaucoma patients with successful filtering surgeries and six months follow-up. Methods By questionnaire, examination of ocular surface structures and photographs of bleb with slit-lamp microscopy, we compared the changes of ocular surface structures and comfort in virtue of blebs by a self-control method and compared the different effects between thick-wall bleb and thin-wall bleb. Main Outcome Measures Questionnaire, ocular surface dyeing, the scale of lacrimal film, BUT, SRI, SAI and PUV. Results The positive rates of ocular dryness and photophobia in patients with blebs were much higher than that of preoperation （P=0.02, 0.000）. And scores for comfortlessness, ocular surface dyeing, the scale of lacrimal film, SRI and SAI dramatically increased in the group with blebs （P=0.000）. Meanwhile the PUV and BUT dramatically decreased （P=0. 000） and Schirmer test kept stable （P=0.417）. There was no relationship between the change degree of the ocular surface structure and sensation and the area or the angle of the blebs. The incidence of photophobia dramatically increased in the group with thin-wall blebs（P=0. 002） and the incidence of dryness mainly demonstrated in the thick-wall group （P=0.003）. Concerning the ocular structures the score for eye dyeing, the scale for lacrimal film, and the BUT changed dramatically in thin-wall bleb group （P=0.046, 0.032, 0.024）, while Schirmer test changed greatly in thick-wall group（P=0.027）. Conclusion Blebs destroy the ocular surface structures and comfort. What＇s more, thin-wall blebs induce the irritation and damage the corneal and conjunctiva structure. Thick-wall blebs induce the dryness and decrease the amount of lacrima.

关 键 词：青光眼/外科学 滤过泡 眼表 眼部舒适度 

分 类 号：R779.6[医药卫生—眼科]