小梁切除术后远期泪膜和眼表上皮改变及其影响因素研究

Studies of long-term changes of tear film and ocular surface epithelium after trabeculectomy

目的探讨青光眼患者小梁切除术后远期泪膜和眼表上皮的情况及其影响因素。方法对103例（139只眼）小梁切除术后6个月以上的患者进行眼表泪膜检查和结膜印迹细胞学检查，分析术后远期薄壁滤过泡的发生率与术中使用丝裂霉素C（MMC）的关系，分析术后远期泪膜和眼表上皮改变与术中使用MMC及术后滤过泡形态的相关关系。结果小梁切除术后患眼与正常对照组相比，泪膜破裂时间缩短，眼表活体染色增多，结膜上皮鳞状化生改变明显。高浓度MMC组术后薄壁滤过泡的发生率明显高于低浓度MMC组和空白对照组。术后远期眼表上皮杯状细胞密度（GCD）与术中MMC的使用及术后滤过泡的形态呈负相关。结论小梁切除术后远期患眼存在干眼表现。术中使用高浓度MMC可增加术后远期薄壁滤过泡的发生率。术后远期结膜上皮杯状细胞密度的降低与MMC的使用及隆起于眼表的滤过泡有关。

Objective To investigate the long-term changes of tear film and ocular surface epithelium after trabeculectomy and the influential factors, especially the effects of mitomycin-C（MMC）and bleb shape on ocular surface of glaucoma patients.Methods One hundred and three patients （139 eyes）underwent tra beeulectomy more than 6 months ago were included.Routine ocular examinations and ocular surface examina- tions, including Schirmer I test （ S I t）, break-up time （ BUT ）, fluorescein staining, rose bengal staining, and conjunctival impression cytology （CIC）,were conducted.The precidence of thin-wall bleb in different MMC groups was analyzed.The effects of intraoperative use of MMC and postoperative bleb shape on the tear film and ocular surface epithelium of the patients were analyzed.Results Compared with normal controls,the BUT value was significantly lowerened, ocular surface vital staining was increased, with marked conjtmcfival epithelial squamous metaplasia of CIC in glaucoma patients.The precidence of thin-wall bleb was significantly higher in high-concentration MMC group than low-concentration MMC group and blank control group.The goblet cell density（GCD ）of conjunctival epithelium was significantly related to the intraoperative use of MMC and postoperative bleb shape.Conclusions Dry eye conditions existed in the glaucoma patients long after tra- beculectomy.Intraoperative use of high-concentration-MMC may increase the precidence of thin-wall bleb after trabeculectomy.Decrease of conjunctival GCD in the long term after the operation was related to use of MMC and the elevated conjunctival bleb.