切开式重睑术后眼表泪膜变化的研究

Study on ocular surface and tear film changes after double eyelid operation with incision method

摘要:

目的：探讨切开式重睑术前后眼表泪膜的变化。

方法：该研究为前瞻性研究。选取2017-10/2018-07在我科行切开式重睑术者17例34眼，分别于术前和术后1、7、14d，1、3mo行眼表疾病指数问卷调查(OSDI)、基础泪液分泌试验(SⅠt)、泪膜破裂时间(BUT)、角膜荧光素染色、泪液羊齿状结晶试验(TFT)、结膜印迹细胞学检查，以评价患者手术前后的眼表泪膜功能。

结果：患者术后1、7、14d眼部不适感较术前加重，OSDI评分高于术前(P<0.001)，术后1、3mo眼部不适感较术后1、7、14d明显缓解，OSDI评分与术前无明显差异(P>0.05)； 术后1d角膜荧光素染色点明显增多(P=0.008)，术后7、14d，1、3mo角膜荧光色染色与术前无差异(P>0.05)； 术后1、7、14d时SⅠt值明显增高(P<0.001)，术后1、3mo时SⅠt值与术前无差异(P>0.05)； 术后1d结膜杯状细胞个数较术前下降(P<0.001)，余各时间点结膜杯状细胞数无明显差异，而术后BUT、TFT值与术前无差异(P>0.05)。

结论：切开式重睑术后早期患者出现明显的不适感和刺激症状，角膜、结膜上皮受到损害，拆除缝线后，随着眼表微环境的重新建立，术后1mo各项指标恢复至术前水平。

Abstract:

AIM: To investigate the changes of ocular surface and tear film before and after double eyelid operation with incision method.

METHODS: Ocular surface disease index questionnaire survey, S I t, break-up time of tear film(BUT), corneal fluorescein staining, tear fern test(TFT)and conjunctive impression cytology were examined at 17 patients(34 eyes)to evaluate function of ocular surface and tear film before and after the double eyelid operation with incision method.

RESULTS: There was significant difference in ocular surface disease index questionnaire survey scores before and after surgery(P<0.001). The score increased within 2wk postoperatively. There was significant difference in corneal fluorescein staining scores before and after surgery(P=0.008). The corneal epithelial staining spots increased within one day postoperatively. There was significant difference in S I t result before and after surgery(P<0.001)and it increased within 2wk postoperatively. There was significant difference in conjunctive impression cytology before and after surgery(P<0.001). Conjunctival goblet cells reduced within 1d postoperatively. There was no significant difference statistically in BUT of tear film and TFT before and after surgery(P>0.05).

CONCLUSION:In the early stage after surgery, patients showed obvious discomfort and irritation symptoms, and the corneal and conjunctival epithelium was slightly damaged. With the reconstruction of the ocular surface microenvironment and removal of sutures, all test results recovered to the preoperative level.