CAJ | 학술논문

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.
목적 관찰파리체시망막수술대루막적영향.방법 97례시망막탈리환자적97지안납입연구.소유환자균접수파리체절할수술、공막가압수술、공막배찰수술등치료.우수술전3 d,수술후2 d、2주,1、2、3、6개월순문환자시부존재불괄증상,동시행각막형광소염색、루막파렬시간、루액분비시험、루하관도측정.수궤선취기중30례환자우수술전화수술후1、2、3、6개월행결막인적세포학검사.결과 수술후2 d、2주、1개월,환자적불괄증상증다,각막염색평분증가,루막파렬시간축단,여수술전비교,차이유통계학의의(t=-25.082,-9.966,-4.718;-6.244,-3.716,-4.683;9.960,5.627,4.953;P균＜0.01);수술후2 d、2주,루액분비시험화루하관도증가,여수술전비교,차이유통계학의의(t=-25.931,-5.839;-25.345,-3.873;P균＜0.01);수술후1개월,결막배상세포수량감소,여수술전비교,차이유통계학의의(t=2.259,P＜0.05).수술후2개월,루막각항공능검사기본회복지수술전수평.결론 파리체시망막수술영향수술후조기루막적은정성,수술후2개월내루막공능기본회복.
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.