结膜松弛症手术前后眼表泪液动力学的变化

Tear dynamic changes before and after the surgery for conjunctivochalasis

目的探讨结膜松弛症(CCh)患者眼表泪液特征及手术前后的变化。方法对Ⅲ级以上A组单纯CCh患者11例(21眼)和B组伴有水性泪液缺乏的CCh患者4例(6眼)进行结膜半月形切除,检测手术前后的临床症状、泪河线高度及形态、泪膜破裂时间(BUT)、SchirmerⅠ试验、荧光素活体染色(FL)、氯霉素尝味试验,并进行比较。结果术前两组患者的主要临床症状均有刺激感或异物感、视物模糊及分泌物增多,干涩、泪溢是A组患者的常见症状,泪河线均异常,氯霉素尝味试验大部分异常,BUT、FL评分均明显异常,B组SchirmerⅠ试验异常。手术后3个月A组各症状及B组刺激感或异物感症状明显改善(P<0.05),BUT、FL评分两组均改善(P<0.05),A组泪河线及氯霉素尝味试验大部分恢复正常(P<0.01),B组无变化,但泪河线形态恢复;两组SchirmerⅠ试验无变化。结论CCh明显影响眼表泪液,松弛结膜新月形切除能缓解或消除CCh的临床症状及眼表损害。

Objective Conjunctivoehalasis is a common ocular surface disease. It results in tear alteration and therefore many clinical symptoms. Present study was to discuss the ocular surface lacrimology changes before and after the surgery for conjunctivochalasis. Methods A total of 27 eyes from 15 conjunctivochalasis patients with（21 eyes, group A） or without（6 eyes,group B） dry eye underwent the operating procedure for conjunctivoehalasis. Ocular subjective symptoms and ocular surface lacrimology changes including tear meniscus, break up time （BUT）, Schirmer Ⅰ test （ST）, corneal fluorescein staining and chloramphenieol gustation test were examined before and 3 months after operation. Results The number of eyes and percentage with irritation or foreign body sensation,lacrimation, blurry vision or discharge and dryness were significantly less in group A after operation than before operation（P 〈 0. 05 -0. 01 ）. However,only irritation or foreign body sensation got improvement in group B in 3 months after operation （ P = 0. 04）. BUT, tear meniscus, chloramphenicol gustation test and corneal fluorescein staining score were obviously improved after the operation in group A in comparison with before operation（P 〈0.05 -0. 01 ） ;while only BUT and fluoreseein staining score were significantly improved in group B after operation （P 〈 0. 05 ）. The shapes of tear meniscus retauned to normal at 3 months after operation in 85.72% in group A and only 16.67% in group B. The Schirmer test did not show a significant change before and after the operation in both groups（P 〉 0.05）. Conclusion This study suggests that conjunctivoehalasis has a great impact on the ocular surface lacrimology. It is very effective in resolving patient＇ s complaints and ocular surface damage in conjunctivochalasis with or without dry eye following resection of redundant conjunctival tissue.