中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2013年
6期
597-601
,共5页
张振佳%王丽娅%王静%余晓菲
張振佳%王麗婭%王靜%餘曉菲
장진가%왕려아%왕정%여효비
三叉神经痛%射频温控热凝术%角膜神经%眼表%共焦显微镜
三扠神經痛%射頻溫控熱凝術%角膜神經%眼錶%共焦顯微鏡
삼차신경통%사빈온공열응술%각막신경%안표%공초현미경
Trigeminal neuralgia%Radiofrequency thermocoagulation%Corneal nerve%Ocular surface%Confocal microscopy
背景 射频温控热凝术是目前普遍认同的治疗三叉神经痛最为有效的方法之一,是一种微创伤性神经损毁疗法.眼表的大多数感觉神经纤维来自三叉神经眼支,对维持眼表功能的完整性起重要作用.三叉神经痛患者用射频温控热凝术治疗后对眼表的影响尚不清楚. 目的 观察和分析三叉神经痛患者行射频温控热凝术后眼表感觉和功能的变化. 方法 对28例28眼三叉神经痛患者行三叉神经半月节射频温控热凝术,术前1d、术后3d、术后1个月进行眼部检查.检查项目包括:角膜知觉敏感度检查、泪液分泌试验I(SIt)、泪膜破裂时间(BUT)测定、角膜荧光素染色评分和共焦显微镜观察角膜上皮下神经.均以未行手术侧的眼作为对照. 结果 术前三叉神经半月节射频热凝术组与对照组的角膜知觉敏感度、泪液分泌量、BUT、角膜荧光素染色评分和角膜上皮下神经纤维的密度比较,差异均无统计学意义(Z=-1.511、-1.119、-0.428、-0.378、-0.854,P=0.131、0.263、0.669、0.705、0.393).术后3d三叉神经半月节射频热凝术组与对照组相比BUT无明显变化,泪液分泌量稍有增加,角膜荧光素染色数量增加,但差异均无统计学意义(Z=-0.620、-0.315、-1.732,P=0.535、0.753、0.083)；角膜知觉敏感度相比下降,上皮下神经纤维数量减少,差异均有统计学意义(Z=-2.708、-2.813,P=0.007、0.005).术后1个月三叉神经半月节射频热凝术组与对照组的角膜知觉敏感度、泪液分泌量、角膜荧光素染色评分和角膜上皮下神经纤维的密度比较,差异均有统计学意义(Z=-3.888、-2.373、-3.311、-2.535,P=0.000、0.018、0.001、0.011).三叉神经半月节射频热凝术组术后角膜上皮下神经纤维与术前相比明显稀疏、纤细、连续性差；部分患者可见树突状细胞浸润.结论 三叉神经痛患者行射频温控热凝术后泪膜稳定性及泪液分泌量下降,可出现明显的干眼症状,角膜知觉敏感性与角膜上皮下神经纤维的数量也有不同程度的减少,术后应给予干预和治疗.
揹景 射頻溫控熱凝術是目前普遍認同的治療三扠神經痛最為有效的方法之一,是一種微創傷性神經損燬療法.眼錶的大多數感覺神經纖維來自三扠神經眼支,對維持眼錶功能的完整性起重要作用.三扠神經痛患者用射頻溫控熱凝術治療後對眼錶的影響尚不清楚. 目的 觀察和分析三扠神經痛患者行射頻溫控熱凝術後眼錶感覺和功能的變化. 方法 對28例28眼三扠神經痛患者行三扠神經半月節射頻溫控熱凝術,術前1d、術後3d、術後1箇月進行眼部檢查.檢查項目包括:角膜知覺敏感度檢查、淚液分泌試驗I(SIt)、淚膜破裂時間(BUT)測定、角膜熒光素染色評分和共焦顯微鏡觀察角膜上皮下神經.均以未行手術側的眼作為對照. 結果 術前三扠神經半月節射頻熱凝術組與對照組的角膜知覺敏感度、淚液分泌量、BUT、角膜熒光素染色評分和角膜上皮下神經纖維的密度比較,差異均無統計學意義(Z=-1.511、-1.119、-0.428、-0.378、-0.854,P=0.131、0.263、0.669、0.705、0.393).術後3d三扠神經半月節射頻熱凝術組與對照組相比BUT無明顯變化,淚液分泌量稍有增加,角膜熒光素染色數量增加,但差異均無統計學意義(Z=-0.620、-0.315、-1.732,P=0.535、0.753、0.083)；角膜知覺敏感度相比下降,上皮下神經纖維數量減少,差異均有統計學意義(Z=-2.708、-2.813,P=0.007、0.005).術後1箇月三扠神經半月節射頻熱凝術組與對照組的角膜知覺敏感度、淚液分泌量、角膜熒光素染色評分和角膜上皮下神經纖維的密度比較,差異均有統計學意義(Z=-3.888、-2.373、-3.311、-2.535,P=0.000、0.018、0.001、0.011).三扠神經半月節射頻熱凝術組術後角膜上皮下神經纖維與術前相比明顯稀疏、纖細、連續性差；部分患者可見樹突狀細胞浸潤.結論 三扠神經痛患者行射頻溫控熱凝術後淚膜穩定性及淚液分泌量下降,可齣現明顯的榦眼癥狀,角膜知覺敏感性與角膜上皮下神經纖維的數量也有不同程度的減少,術後應給予榦預和治療.
배경 사빈온공열응술시목전보편인동적치료삼차신경통최위유효적방법지일,시일충미창상성신경손훼요법.안표적대다수감각신경섬유래자삼차신경안지,대유지안표공능적완정성기중요작용.삼차신경통환자용사빈온공열응술치료후대안표적영향상불청초. 목적 관찰화분석삼차신경통환자행사빈온공열응술후안표감각화공능적변화. 방법 대28례28안삼차신경통환자행삼차신경반월절사빈온공열응술,술전1d、술후3d、술후1개월진행안부검사.검사항목포괄:각막지각민감도검사、루액분비시험I(SIt)、루막파렬시간(BUT)측정、각막형광소염색평분화공초현미경관찰각막상피하신경.균이미행수술측적안작위대조. 결과 술전삼차신경반월절사빈열응술조여대조조적각막지각민감도、루액분비량、BUT、각막형광소염색평분화각막상피하신경섬유적밀도비교,차이균무통계학의의(Z=-1.511、-1.119、-0.428、-0.378、-0.854,P=0.131、0.263、0.669、0.705、0.393).술후3d삼차신경반월절사빈열응술조여대조조상비BUT무명현변화,루액분비량초유증가,각막형광소염색수량증가,단차이균무통계학의의(Z=-0.620、-0.315、-1.732,P=0.535、0.753、0.083)；각막지각민감도상비하강,상피하신경섬유수량감소,차이균유통계학의의(Z=-2.708、-2.813,P=0.007、0.005).술후1개월삼차신경반월절사빈열응술조여대조조적각막지각민감도、루액분비량、각막형광소염색평분화각막상피하신경섬유적밀도비교,차이균유통계학의의(Z=-3.888、-2.373、-3.311、-2.535,P=0.000、0.018、0.001、0.011).삼차신경반월절사빈열응술조술후각막상피하신경섬유여술전상비명현희소、섬세、련속성차；부분환자가견수돌상세포침윤.결론 삼차신경통환자행사빈온공열응술후루막은정성급루액분비량하강,가출현명현적간안증상,각막지각민감성여각막상피하신경섬유적수량야유불동정도적감소,술후응급여간예화치료.
Background Radiofrequency thermocoagulation is one of the effective therapies for trigeminal neuralgia.Corneal nerve is important substance of radiofrequency thermocoagulation ocular surface,which support the normal structure and function of cornea.Most of corneal nerves come from ophthalmic branch of trigeminal nerve.However,the change of ocular surface microenvironment following radiofrequency thermocoagulation treatment in the patient with trigeminal neuralgiais unclear.Objective This study was to analyze ocular surface change after radiofrequency thermocoagulation therapy in patients with trigeminal neuralgia.Methods Twenty-eight eyes of 28patients with trigeminal neuralgia underwent radiofrequency thermocoagulation therapy were enrolled in this study.The contralateral eyes were regarded as the control group.The central corneal sensitivity,function of lacrimal secretion (Schiemer 1 test),tear break-up time(BUT),corneal fluorescence staining and laser scanning confocal microscopic examination were performed before and after surgery in operative eyes and compared with the fellow eye.Informed consent was obtained before any relevant medical procedure from each patient.Results No significant differences was found before surgery in the central corneal sensitivity,the Schiemer Ⅰ test,BUT,corneal fluorescence staining and densities value of corneal subepithelial nerve plexus between the treating eyes and fellow eyes(Z =-1.511,-1.119,-0.428,-0.378,-0.854; P =0.131,0.263,0.669,0.705,0.393).1n the third day after radiofrequencythermocoagulation therapy,compared with pre-treatment,no significant differences were seen in BUT result,Schirmer Ⅰ test and the score of ocular surface fluorescence staining (Z =-0.620,-0.315,-1.732;P =0.535,0.753,0.083).Corneal sensitivity and subbasal nerve density were lowed 3 days after surgery (Z =-2.708,-2.813 ; P =0.007,0.005).One month after treatment,differences of all indexes mentioned above showed statistical significance between treating eyes and fellow eyes(Z=-3.888,-2.373,-3.311,-2.535 ; P =0.000,0.018,0.001,0.011).The corneal subepithelial nerve was thinner and sparse and dendritic cells on the cornea were found in the eyes received radiofrequency thermocoagulation therapy.Conclusions The secretion of tears and the stability of tear film are poorer and the corneal sensitivity and subbasal nerve density are affected in a certain extent in the eye received radiofrequency thermocoagulation therapy.
