小梁切除术前后干眼的临床观察

Clinical observation of dry eye before and after trbeculectomy

目的探讨小梁切除术后干眼症的发病情况。方法对36例(40眼)原发性急性闭角型青光眼患者在小梁切除术前3d,术后1周、1个月和3个月行眼部检查。检查项目包括:裂隙灯显微镜观察眼表情况、角膜和结膜荧光素染色、泪液膜破裂时间(BUT)、Schirmer试验(STI)、结膜印迹细胞学(IC)检查。结果原发性急性闭角型青光眼患者经小梁切除术保持了良好的视功能,但术后部分患者出现顽固性干眼症状。小梁切除术后患者可出现泪河线变窄,BUT变短、STI泪液分泌减少、角膜荧光素染色加重。此现象可在术后1周出现,术后1个月时达明显状态,术后3个月部分患者的症状可有一定程度恢复。术后结膜杯状细胞的密度明显低于术前。结论小梁切除术后患者可能出现明显的干眼症状和体征,应及时给予干预和治疗。

Objective This study aimed to investigate dry eye in patients before and after trbeculectomy.MethodsThirty-six patients（40 eyes） with acute primary angle closure glaucoma were collected in this study.Slit lamp microscope examination,cornea and conjunctiva fluorescein staining,tear break-up time（BUT）,Schirmer test I（ST I）,impression cytology（IC） were carried out in 3 days before trabeculectomy,1 week,1 month and 3 months following trbeculectomy on the 40 eyes.ResultsThe tear stream was normal in 29 eyes and was less 0.3 mm in 11 eyes before trabeculectomy.However,the narrowing and disappear of tear stream were seen in 35 eyes in 1 month after trabeculectomy.The positive corneal and conjunctival fluorescine was seen in 5 eyes（1 week）,15 eyes （1 month） and 4 eyes（3 months） respectively after operation.The van Bijsterveld scoring was significantly higher after trbeculectomy than before operation with the peak in 1 month after operation（P〈0.05）.BUT value and ST I were significantly lower after operation in comparison with before operation（P〈0.05）.The value of conjunctival cell density was（461.47±226.32）/mm^2 before operation but the number was reduced to（344.16±234.91）/mm^2 3 months after operation,showing a significant difference between them（q=4.72,P〈0.01）.IC examination showed serious squamous metaplasia in epithelial layer of conjunctiva.ConclusionDry eye can be induced or deteriorated after trabeculectomy.More attentions should be paied to its prevention after trabeculectomy.