目的：探讨射频微创治疗结膜松弛引起溢泪的手术效果和眼表微环境变化。

方法：收集以溢泪为主诉的结膜松弛患者。所有患者结膜松弛分级程度均≥Ⅱ级，且前期经过药物治疗症状未明显改善，给予射频微创矫正结膜松弛，术后联合人工泪液点眼、抗炎治疗、眼表修复治疗。所有患者术前，术后8 wk进行眼表疾病指数(OSDI)评分、眼红分析、泪液分泌、非侵袭性泪膜破裂时间、脂质层厚度、泪液蕨类试验、结膜印迹细胞检查并进行术前术后的比较，观察患者治疗效果和眼表微环境变化。

结果：本研究共纳入以溢泪为主诉的结膜松弛患者43例43眼。其中男23例，女20例； 平均年龄64.69±3.36岁。术后8 wk随访43眼的手术总有效率达到91%。与术前相比较，术后8 wk的OSDI评分降低，非侵袭性泪膜破裂时间延长(均P<0.05)，而脂质层厚度、泪液分泌与术前比较无差异(均P>0.05)。氯霉素尝味试验的正常率从术前21%提高到术后63%，眼红分析的正常率从术前的40%提高到70%，泪液蕨类分级的正常率从术前的30%到达63%，结膜印迹细胞的分级正常率从21%提高到74%。

结论：射频微创治疗结膜松弛具有明确的治疗效果，且手术操作简便。结膜松弛患者除结膜松弛外，还合并有其他眼表问题，如泪液分泌不足、脂质层厚度低等干眼问题，治疗时需重视眼表泪液动力学的整体观念。

METHODS: Patients with epiphora primarily caused by conjunctivochalasis were enrolled. All patients had conjunctivochalasis of ≥grade II, and their symptoms showed no significant improvement after previous pharmacological treatment. All patients underwent radiofrequency minimally invasive correction of conjunctivochalasis, supplemented with artificial tears, anti-inflammatory therapy, and ocular surface repair treatment postoperatively. At 8 wk post-surgery, the ocular surface disease index(OSDI), eye redness, tear secretion, non-invasive tear break-up time, lipid layer thickness, tear ferning test, and conjunctival impression cytology were assessed to compare treatment efficacy and observe changes in the ocular surface microenvironment.

RESULTS: A total of 43 cases(43 eyes)of conjunctivochalasis and with a main complaint of epiphora were included, including 23 males and 20 males, with a mean age of 64.69±3.36 years. The total effective rate of surgery was 91% at 8 wk postoperatively. Compared with preoperative values, the OSDI scores significantly decreased and the non-invasive tear break-up time was prolonged at 8 wk post-surgery(all P<0.05). No statistically significant differences were observed in lipid layer thickness or tear secretion at 8 wk postoperatively(all P>0.05). The normal rate of chloramphenicol taste test increased from 21% preoperatively to 63% postoperatively; the normal rate of eye redness increased from 40% to 70%; normal rate of tear ferning grading improved from 30% to 63%; and normal conjunctival impression cytology grading increased from 21% to 74%.

CONCLUSION: Radiofrequency minimally invasive treatment is effective for conjunctivochalasis and is straightforward to perform. Patients with conjunctivochalasis often present with other ocular surface issues beyond conjunctivochalasis itself, such as insufficient tear secretion, reduced lipid layer thickness, and other dry eye-related problems. Therefore, a comprehensive approach emphasizing tear dynamics should be adopted during treatment.