玻璃体视网膜手术对泪膜的影响  

The effect of vitreoretinal surgery on tear film

作　　者：张君敏[1] 李虹霓[1] 张少冲[2] 黄奕霞[1] 

机构地区：[1]广东省汕头市中心医院眼科,515031 [2]中山大学中山眼科中心眼科学国家重点实验室

出　　处：《中华眼底病杂志》2010年第6期528-531,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的 观察玻璃体视网膜手术对泪膜的影响.方法 97例视网膜脱离患者的97只眼纳入研究.所有患者均接受玻璃体切割手术、巩膜加压手术、巩膜环扎手术等治疗.于手术前3 d,手术后2 d、2周,1、2、3、6个月询问患者是否存在不适症状,同时行角膜荧光素染色、泪膜破裂时间、泪液分泌试验、泪河宽度测定.随机选取其中30例患者于手术前和手术后1、2、3、6个月行结膜印迹细胞学检查.结果 手术后2 d、2周、1个月,患者的不适症状增多,角膜染色评分增加,泪膜破裂时间缩短,与手术前比较,差异有统计学意义（t=-25.082,-9.966,-4.718 -6.244,-3.716,-4.683 9.960,5.627,4.953 P均＜0.01） 手术后2 d、2周,泪液分泌试验和泪河宽度增加,与手术前比较,差异有统计学意义（t=-25.931,-5.839 -25.345,-3.873 P均＜0.01） 手术后1个月,结膜杯状细胞数量减少,与手术前比较,差异有统计学意义（t=2.259,P＜0.05）.手术后2个月,泪膜各项功能检查基本恢复至手术前水平.结论 玻璃体视网膜手术影响手术后早期泪膜的稳定性,手术后2个月内泪膜功能基本恢复.Objective To evaluate the effect of vitreoretinal surgery on tear film. Methods Ninetyseven patients （97 eyes） of retinal detachment undergoing surgical therapy including vitrectomy, scleral buckling or scleral encircling were included in this study. Uncomfortable eye symptoms were inquired and tear break-up time （BUT）, Schirmer Ⅰ test （S Ⅰ t）, corneal fluorescein staining （CFS）, tear meniscus height （TMH） were measured at three days before surgery and at six time-points after surgery （two, 14 days and one, two, three, six months）. Thirty patients were randomly chosen to receive impression cytology of conjunctiva at three days before surgery and at four time-points after surgery （one, two, three,six months）. Results Comparing with the preoperative results, at the first three time-points after surgery （two, 14 days, one month）, uncomfortable symptoms （t=-25.082, -9.966, -4.718, P〈0.01） and CFS scores （t= -6. 244, -3. 716, -4. 683, P〈0.01） increased, tear break-up time （BUT） shortened greatly （t= 9. 960, 5. 627, 4. 953 P〈 0. 01）. S Ⅰ t and TMH increased significantly （t= -25. 931,-5. 839 -25. 345, -3. 873 P〈0. 01） at two and 14 days after surgery. The number of conjunctival goblet cell decreased significantly at one month after surgery （t= 2. 259, P〈 0. 05）. All those tear film parameters returned to preoperative level at two months after surgery. Conclusion Vitreoretinal surgery influences tear film stability transiently, and the tear film function tends to restore in two months after the operation.

关 键 词：玻璃体切除术/副作用 眼泪/代谢 

分 类 号：R779.6[医药卫生—眼科] R777.2[医药卫生—临床医学]