鼻泪道阻塞患者逆行置管手术前后泪膜及睑板腺功能变化的临床研究  

Changes of tear film and meibomian gland function before and after retrograde intubation in patients with nasolacrimal duct obstruction

作　　者：马子伟 陈洪[1] 杨卫华[1] 潘雪峰[1] 刘云芳[1] 洪佳旭 MA Ziwei;CHEN Hong;YANG Weihua;PAN Xuefeng;LIU Yunfang;HONG Jiaxu(Department of Ophthalmology,Huzhou First People’s Hospital,Huhzou 313000,China;Department of Ophthalmology,Eye?ENT Hospital,Fudan University,Shanghai 200031,China)

机构地区：[1]浙江省湖州市第一人民医院眼科,湖州 313000 [2]复旦大学附属眼耳鼻喉科医院眼科,上海 200031

出　　处：《中国眼耳鼻喉科杂志》2020年第5期364-368,共5页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的应用Karetograph 5M眼表综合分析仪探讨鼻泪道阻塞患者逆行置管手术前后眼表参数的变化。方法本研究为前瞻性研究。选取2018年1~6月在湖州市第一人民医院行逆行置管的鼻泪道阻塞患者,选取同期性别、年龄匹配的健康志愿者作为对照组,利用Karetograph 5M眼表综合分析仪对鼻泪道阻塞患者术前、术后1个月及对照组进行泪河高度、非侵入性泪膜破裂时间测量,脂质层评级、睑板腺评分,采用眼表疾病指数(OSDI)问卷进行症状评分。结果鼻泪道阻塞患者42例(42眼)及对照组21例(42眼)纳入研究。鼻泪道阻塞患者术前OSDI评分(17.6±2.8)分,术后(10.0±4.0)分,两者差异有统计学意义(P<0.001);对照组OSDI评分(8.0±2.4)分,与鼻泪道阻塞患者术前(P<0.001)及术后(P=0.007)相比差异均有统计学意义。逆行置管成功患者术前泪河高度显著高于术后及对照组,差异均有统计学意义(P值均<0.001);术后脂质层评级显著高于术前及对照组,差异均有统计学意义(P值均<0.001)。鼻泪道阻塞患者术前、术后及对照组非侵入性泪膜破裂时间(包括首次和平均)比较差异均无统计学意义(P值均>0.05)。结论鼻泪道阻塞逆行置管成功患者眼表泪河高度降低、不适症状改善,但评分仍高于正常人。置管术后泪膜脂质层厚度增加,有助于维持眼表泪膜的稳定性。Objective To investigate the changes of tear film and meibomian gland function before and after retrograde intubation in patients with nasolacrimal duct obstruction(NDO)by using Karetograph 5M.Methods This is a prospective study.Patients with nasolacrimal duct obstruction undergoing retrograde intubation in our hospital from January to June in 2018 were enrolled.Age-and sex-matched subjects were selected as the control.Karetograph 5M was performed before and after the surgery.Tear menisci,non-invasive tear film breakup time(NI-BUT),lipid layer rating,meibomian gland score,and ocular surface disease index(OSDI)questionnaire were obtained and analyzed.Results Forty-two NDO cases(42 eyes)and 21 normal subjects(42 eyes)were enrolled in our study.The preoperative(17.6±2.8)and postoperative(10.0±4.0)OSDI score were significantly different(P<0.001)in NDO patients.The OSDI score(8.0±2.4)in normal control was better than the values of NDO patients at baseline(P<0.001)and at postoperative follow-up time point(P=0.007).The height of tear menisci was significantly higher in the NDO patients before the surgery than that in patients post-operatively and the normal control(all P<0.001).Similarly,the lipid layer rating was significantly higher in the NDO patients before the surgery(all P<0.001).There was no statistical difference of NI-BUT(including the first and average NI-BUT)between three group(P>0.05).Conclusions The height of tear menisci decreased and the symptoms of discomfort improved after retrograde intubation in the NDO patients.However,their OSDI score was still higher than normal control even after the surgery.The thickness of lipid layer increased after intubation,which was helpful to maintain the tear film stability.

关 键 词：鼻泪道阻塞 逆行置管 眼表综合分析仪 

分 类 号：R779.6[医药卫生—眼科]