不同方法矫治麻风性兔眼对视功能和眼组织损害的对比研究

Comparative study on effect of different surgeries for vision and ocular tissues in leprosy patients with lagophthalmos

摘要:

目的：探讨不同手术方法矫治麻风性兔眼所引起的术后并发症和对患者视觉质量的影响。

方法：回顾性临床对照研究。选择我院2007-05/2015-09采用不同方法矫治麻风性兔眼的患者68例97眼，包括尼龙线矫治术、眼睑缝合术、颞肌移位术。观察术后6mo的最佳矫正视力变化，对其术后并发症(溢泪、泪道损伤、睁眼困难、内外眦部感染和泪器组织的瘢痕化改变)的发生率进行组间比较。

结果：三种手术方法术后对患者视力的影响：尼龙线矫治术和眼睑缝合术患者手术前后视力差异具有统计学意义(Ζ=-4.193、-4.213，P<0.05)； 颞肌移位术患者手术前后视力变化的差异无统计学意义(Ζ=-1.532，P>0.05)。术后并发症：(1)溢泪：尼龙线矫治术占91%，眼睑缝合占89%，颞肌移位术占59%，三者比较差异具有统计学意义(χ²=12.198，P<0.05)；(2)泪器损伤：尼龙线矫治术占66%，眼睑缝合术占95%，颞肌移位占41%，三者比较差异具有统计学意义(χ²=22.415，P<0.05)；(3)睁眼困难：尼龙线矫治术占56%，眼睑缝合术占55%，颞肌移位术占22%，三者比较差异具有统计学意义(χ²=8.795，P<0.05)；(4)术后感染：尼龙线术占84%，眼睑缝合术占3%，颞肌移位占11%，三者比较差异具有统计学意义(χ²=60.858，P<0.05)。

结论：麻风性兔眼手术矫治虽有一定的临床效果，尤其是颞肌移位术后患者能主动闭眼，其视力、视觉质量无显著变化。提示该手术可预防角膜的暴露性损害。但手术造成的医源性损伤与其他组间患者的视觉质量下降和眼组织损害(溢泪、泪道损伤、内外眦部感染、泪器组织瘢痕化等)应引起足够的重视。

Abstract:

AIM:To study the effect of different surgeries for vision and postoperative complications in leprosy patients with lagophthalmos.

METHODS: A retrospective analysis. Totally 68 leprosy patients(97 eyes)with lagophthalmos were selected who treated with different surgeries during May 2007 to September 2015 in our sanatorium. The surgeries included nylon thread correction surgery, tarsorrhaphy, temporalis transposition surgery. We observed and compared the best corrected visual acuity(BCVA)and the rate of postoperative complications, such as epiphora, lacrimal duct injury, hard to open eyes, infection at the inner and lateral canthus and scar formation of lacrimal apparatus.

RESULTS: The effect on BCVA of patients treated with nylon thread correction surgery and tarsorrhaphy: the preoperative and postoperative BCVA was significantly different of the two groups(Z=-4.193, -4.213; P<0.05); the preoperative and postoperative BCVA was not significantly different of the patients underwent temporalis transposition surgery(Z=-1.532, P >0.05). The postoperative complications:(1)epiphora: there was 91% in patients underwent nylon thread correction surgery, 89% in patients underwent tarsorrhaphy, 59% in patients underwent temporalis transposition surgery, the difference was statistically significant(χ²=12.198, P<0.05);(2)lacrimal duct injury: there was 66% in patients underwent nylon thread correction surgery, 95% in patients underwent tarsorrhaphy, 41% in patients underwent temporalis transposition surgery, the difference was statistically significant(χ²=22.415, P<0.05);(3)hard to open eyes: there was 56% in patients underwent nylon thread correction surgery, 55% in patients underwent tarsorrhaphy, 22% in patients underwent temporalis transposition surgery, the difference was statistically significant(χ²=8.795, P<0.05);(4)infections: there was 84% in patients underwent nylon thread correction surgery, 3% in patients underwent tarsorrhaphy, 11% in patients underwent temporalis transposition surgery, the difference was statistically significant(χ²=60.858, P<0.05).

CONCLUSION: There are certain clinical efficacy for lagophthalmos caused by leprosy after surgery, especially patients after temporalis transposition surgery can close eyes by oneself. And their vision does not change significantly, which suggests that this surgery may prevent exposure injury for cornea. But the iatrogenic injury, the vision decrease in patients underwent other surgeries and the ocular tissue damage, such as epiphora, lacrimal duct injury, hard to open eyes, infection at the inner and lateral canthus and scar formation of lacrimal apparatus should be pay more attention to.