穿透性角膜移植术后泪膜稳定性的临床观察

Clinical observing on the Tear Film Stability alter Penetrating Keratoplasty Qi Chaoxiu, Li Qigen, Wang tao, Dong lijie, Zhu chunlan.

目的探讨穿透性角膜移植术后泪膜稳定性的变化规律。方法对20例行部分穿透性角膜移植术后的患者分别观察术后6、9、12个月主观感觉、泪膜破裂时间（BUT）、泪液分泌值、泪河高度值、角膜荧光素染色，并与健眼对照观察。将结果作统计学分析。结果穿透性角膜移植术后12个月内，术眼泪膜破裂时间低于健眼（P〈0．01），但患者无明显眼部干涩等症状；泪液分泌值在6个月时，比较健眼有统计学意义（P〈0．01），9、12个月时与健眼相比无统计学意义（P〉0．05）；泪河高度值在6个月时比较健眼有统计学意义（P〈0．01），9、12个月时术眼与健眼无统计学意义（P〉0．05）；荧光素染色在6个月时评分为7．89，与健眼比较有统计学意义（P〈0．01），9、12月时评分为4．62、3．03，与健眼比较无统计学意义（P〉0．05）。结论穿透性角膜移植术后6～12月的时间内，术眼的泪膜稳定性仍未恢复到正常水平，特别是泪膜破裂时间的缩短较健眼有显著差异（P〈0．01），提示穿透性角膜移植术后12个月时间内，存在泪膜不稳定和干眼症，需要定期复查泪膜变化，根据情况使用不含防腐剂的人工泪液和角膜营养，神经营养药物。

Objective To investigate tear fill changes after penetrating keratoplasty. Methods Twenty cases （20eyes）after penetrating keratoplasty were examined. We observed subjective symptom, tear fill bread-up time, Schirmer Test I with anaesthesia, the height of tear meniscus and corneal fluorescein staining. On both operative eye and healthy eye of the patients at 6m,9m, 12m after penetrating keratoplasty. Then the results were analysis in statistics.Results During 6m after penetrating keratoplasty the data of tear fill break-up time of the operative eye was less than the healthy eye（P 〈0.01 ）. But the patients didn＇t feel dull and dry; the data of Schirmer Test I with anaesthesia of the operative eye was significantly different from the healthy eye at 6m after penetrating keratoplasty （P 〈0.01 ）. There was no significant difference between operative eye and healthy eye at 9m and 12m （P 〉0.05 ）. FL scored at 7.89 in operative eye at 6m was significantly different from FL in healthy eye （P 〈 0.01 ）. FL scored at 4.62,3.03 in operative eye at 9m and 12m wasn＇t different from FL in healthy eye （P 〉 0.05 ）. Conclusions During the time from 6 months to 12 months after penetrating keratoplasty, the tear fill stability does not get resume, especially the shorten of tear fill break-up time had significant difference between operation eye and healthy eye （P 〈0.01 ）Indicating instability of tear fill and transient dry eye was existed during one year after penetrating keratoplasty.Patients should examine the change of tear fill regularly, use artificial tears without antiseptics and medcime with conneal nutrition and nerve nutrition.