额肌瓣悬吊术后眼表的改变和影响其恢复的临床因素分析

Clinical analysis of the ocular surface change and restoration after frontalis suspension

目的探讨额肌瓣悬吊术后眼表的改变和影响其恢复的临床危险因素。方法对2007年1月至2007年4月在中山眼科中心住院的22例(32只眼)先天性上睑下垂行额肌瓣悬吊术的患者,随机平分为术后加用局部用药组(A组,11例16只眼)和术后不加用局部用药组(B组,11例16只眼),观测两个组手术后2、5、7d和2周患者泪液的分泌、泪膜破裂时间、结膜充血、角膜荧光染色、睑板腺功能、瞬目次数、睑睫毛角度和眼睑闭合情况,并分析各个观察结果是否有统计学差异。结果2例(占总例数9.1%)患者3只眼(占总眼数9.4%)因角膜上皮水肿缺损需加用促角膜上皮生长药物退出本研究,其中1例(4.5%)(2只眼)因倒睫较严重并引起角膜溃疡需行缝线调整术,其余所有患者的眼表检测项目结果均显示不同程度的改变,但是随着术后炎症的逐渐消退,这些受影响的眼表异常均会逐渐恢复正常。泪液分泌量、泪膜破裂时间、结膜充血、瞬目次数、睑板腺功能、睫毛角度和眼睑闭合情况的影响在两个组之间均没有统计学差异(P>0.05);角膜荧光素染色在两个组之间有统计学差异(P<0.05)。结论额肌瓣悬吊术会引起患者眼表各个因素的不同程度的改变,局部用药只能改善角膜荧光素染色异常,对眼表恢复并非必要。睫毛角度异常是引起角膜损害最危险的因素。

ObJective To investigate ocular surface change and analyze the clinical factors of influencing its restoration after frontalis suspension. Methods 22 patients （ 32 eyes ） with congenital ptosis hospitalized in Zhong Shan Ophthalmic Center and received frontalis suspension from January to April in 2007 were randomly divided into two groups as with （group A, 16 eyes in 11 cases） or without （group B, 16 eyes in 11 cases） post surgery ophthalmic medication. Schirmer test, （tear film） break-up time, conjunctiva congestion, cornea fluorescent pigmentation, tarsal gland function, winking frequency, angle of eyelash and eyelid closure were all observed and statistically analyzed in two groups, at 2 days, 5 days, 7 days, 2 weeks after surgery. Results Except 3 eyes （ 9.4% of all eyes ） in 2 patients （ 9.1% of all cases ） needed advanced ophthalmic medicine, one of which （4.5 % ） was with corneal ulceration and needed another surgery, all the others were observed and resulted in that all ocular surface items were all altered in varied degree and gradually returned to normality as the inflammation caused by surgery recovered. Schirmer test, （tear film ）break-up time, conjunctiva congestion, winking frequency, tarsal gland function, angle of eyelash and eyelid closure were not statistically different between two groups （ P 〉 0.05 ） ; cornea fluorescent pigmentation was statistically different between two groups （ P 〉 0. 05 ）. Conclusion Frontalis suspension could alter all the ocular surface factors in varied degree, and ophthalmic medication post surgery could only ameliorate cornea fluorescent pigmentation but not necessarily to restoration of normal ocular surface. Abnormality of eyelash angle was the most dangerous factor to cornea injury.