巩膜扣带术后早期泪膜变化的临床研究  

Clinical study on early changes of tear film after scleral buckling surgery

作　　者：陈春丽[1] 宋宗明[1] 郑景伟[1] 王瑞华[1] 柯治生[1] 李明翰[1] 

机构地区：[1]温州医学院附属眼视光医院,浙江省温州市325027

出　　处：《眼科新进展》2011年第8期754-757,共4页Recent Advances in Ophthalmology

摘　　要：目的观察巩膜扣带术后早期泪膜变化的临床特征及其规律。方法收集2009年3月至7月行巩膜扣带术的裂孔源性视网膜脱离的连续临床病例36例(36眼)。于术前1d,术后1d、3d、10d、1个月及3个月进行症状评分、泪膜破裂时间(break-up time,BUT)测定、角膜荧光素染色(corneal fluorescein staining,CFS)及基础泪液分泌试验(Schirmer I test,SIT)等检查,以对侧眼作为自身对照,根据临床检查结果进行评分并进行统计学分析。结果术眼:术后1d、3d,70%患者术眼出现疼痛、发痒、红肿及流泪等不适症状;BUT术后10d与术前相比平均增加5.35s,差异有显著统计学意义(P=0.001),术后3个月时80%患者泪膜趋于正常;CFS评分在术后1d减少最明显,与术前1d比较差异有显著统计学意义(Z=-4.038,P=0.001);SIT术后1d增加最明显(P=0.001),50%患者泪液分泌量大于30mm,70%患者泪液分泌量大于25mm,术后10d恢复至术前水平。对照眼:术后未出现眼部不适症状;BUT术后10d、1个月、3个月分别为(8.33±5.45)s、(8.44±4.70)s、(8.75±3.71)s,与术前比较,差异均有统计学意义(均为P<0.05);SIT术后1d,17%患者泪液分泌量大于25mm,与术前比较,差异有统计学意义(P<0.05)。术眼与对照眼组间比较,干眼不适症状、BUT和SIT在术后1d、3d差异均有统计学意义(均为P<0.05),CFS评分术前1d、术后1d、3d、10d差异均有统计学意义(Z=-4.247、-3.174、-2.528、-1.555,均为P<0.05)。结论巩膜扣带术后早期可出现明显眼表不适症状,并影响泪液分泌及泪膜稳定性,术后3个月时术眼眼表及泪膜基本趋于稳定。Objective To investigate the early changes of tear film after the scleral buckling surgery.Methods Thirty-six eyes of 36 patients with rhegmatogenous retinal detachment underwent scleral buckling surgery from March to July 2009 were enrolled in this consecutive study.The contralateral eyes were regarded as control group.Uncomfortable symptoms score,break-up time（BUT）,Schirmer I test（SIT） and corneal fluorescein staining（CFS） were recorded 1 day before surgery and 1 day,3 days,10 days,1 month and 3 months after surgery,the data were statistical analyzed.Results The surgical eyes：70% patients complained of foreign body sensation,burning or lacrimation at 1 day and 3 days after surgery;BUT gradually increased 5.35 s at 10 days after surgery compared with before surgery,there was significant difference（P=0.001）,and the tear film recovered to preoperative baseline at 3 months after surgery;CFS scores decreased most at 1 day after surgery,there was significant difference compared with 1 day before surgery（Z=-4.038,P=0.001）.SIT increased most at 1 day after operation（P=0.001）,however,the SIT values of 80% patients were more than 30 mm and 70% patients more than 25 mm,recovered to the preoperative baseline at 10 days after surgery.The control eyes：No uncomfortable syndrome appeared;Compared with before surgery,there were statistical differences in BUT at 10 days,1 month,3 months after surgery（all P0.05）;SIT values in 17% patients were more than 25 mm,there was statistical difference compared with before surgery（P0.05）.Compared between the surgical eyes and control eyes,there were statistical differences in DES,BUT and SIT at 1 day,3 days after surgery（all P0.05）,statistical differences in CFS scores at 1 day before surgery and 1 day,3 days,10 days after surgery（Z=-4.247,-3.174,-2.528,-1.555,all P0.05）.Conclusion The tear film stability can be affected at early postoperative period after scleral buckling surgery,and the tear secretion and tear film stability also be affected,the

关 键 词：泪膜 巩膜扣带术 裂孔源性视网膜脱离 

分 类 号：R774.1[医药卫生—眼科]