微创玻璃体视网膜手术后早期泪膜变化的临床观察  

Clinical studies of early changes in tear film after vitreous microsurgery

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

机构地区：[1]温州医学院眼视光学院,浙江温州325027

出　　处：《中华眼视光学与视觉科学杂志》2011年第4期300-303,共4页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的观察微创玻璃体视网膜手术后患者泪膜的早期变化及恢复情况，比较23-GfGauge）与25-G微创玻璃体视网膜手术对泪膜的影响。方法前瞻性系列病例研究。连续选取2009年3月至2009年7月间行单眼微创玻璃体视网膜手术的患者86例（86眼）．行23-G联合25．G手术者（A组）35例，仅行25-G手术者（B组）35例，单独行23-G手术者（C组）16例。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（BUT）、角膜荧光素染色（CFSl及基础泪液分泌试验（Schirmer I test，SIT）等检查，并以对侧未手术眼作为对照，数据采用Kruskal—Wallis检验、Wilcoxon秩和检验、单因素方差分析和独立样本t检验进行处理。结果术眼术后1d，10％患者出现疼痛、发痒、红肿及流泪；术后1、3dBUT值明显下降，术后10d好转，与术前1d相比差异均有统计学意义（P=0．001）；术后3dCFS评分较术前增加（Z=-3．782，P〈0．05）；术后1 d SIT值较术前增加（P=O．001），术后10d恢复至术前水平。对照眼术后未出现眼部不适感，与术前相比，术后10dBUT值较低（．P=0．001），CFS评分较高（Z=-3．597，P〈0．05）。术眼与对照眼比较，术后1、3d不适症状（Z=-5．470、-5．011，P〈0．05）、BUT值（t=-4．968、-5．184，P〈0．05）和SIT值（t=4．452、3．963，P〈0．05）差异均有统计学意义；CFS评分术后各时间点差异均有统计学意义（Z=-6．229、-5．780、-5．018、-4．379、-2．374，P〈0．05）。在手术前后的各个时间点，A、B、C3组间相互比较，各指标差异均无统计学意义。结论微创玻璃体视网膜手术早期可出现眼部不适。泪膜稳定性下降，术后10d时所有检查项目基本恢复正常，泪膜稳定性恢复快。23-G与25-G微创玻璃体切除术后泪膜的变化类似。Objective To investigate the early changes in tear film after vitreous microsurgery, to compare the postoperative impact of 23-gauge and 25-gauge vitreous microsurgery on tear film. Methods Eighty-six eyes of 86 patients who underwent 23-gauge or 25-gauge vitreous microsurgery monocularly between March 2009 and July 2009 were enrolled in this prospective case series study. The contralateral eyes were regarded as the control group. Among them, 35 eyes each underwent 25- combined 23-gauge surgery （group A）, another 35 eyes underwent 25-gauge vitrectomy （group B）, and another 16 eyes underwent 23-gauge vitrectomy （group C）. Symptoms of discomfort, break-up time （BUT）, Schirmer I test （SIT） and corneal fluorescein staining （CFS） were recorded before and after surgery in all patients （86 patients with 172 eyes）, and the data from all ophthalmologic examinations were collected. Data were analyzed with a Kruskal-Wallis, a Wilcoxon, an one-way ANOVA and an independent samples t test. Results Nine patients complained of foreign body sensation, burning, or lacrimation with significantly increased SIT （P=0.001） at day 1 and CFS scores （Z=-3.782, P〈0.05） at days 3 postoperatively. Obviously decreased BUT was recorded at day 1 and day 3 postoperatively, BUT recovered significantly 10 days postoperatively （P=-0.001）. In the subjective scores for symptoms of discomfort and SIT results in the contralateral eyes, no significant changes were found at any follow-up examination, the differences for CFS and BUT were significant 10 days after surgery. Compared to contralateral eyes, all dry eye test values were significantly worse at day 1 and days 3postoperatively in the surgical eyes （Z=-5.470, -5.011; t=-4.968, -5.184; t=4.452, 3.963; P〈O.05）. CFS values were different at each follow-up examination （Z=-6.229, -5.780, -5.018, -4.379, -2.374, P〈0.05）. There were no differences in tear film in both eyes between group A, group B and group C at any follow-up examination. Conehtsion T

关 键 词：玻璃体切除术 外科手术 微创 泪膜 干眼病 

分 类 号：R779.6[医药卫生—眼科]