两种复合式小梁切除术对泪膜的影响

Changes of tear film functions in trabeculectomy with human amniotic membrane or mitomycin C

目的:观察两种复合式小梁切除术中使用羊膜和丝裂霉素C对泪膜的影响。方法:采用随机对照的方法,将36例44眼青光眼患者分为HAM组和MMC组,各22眼,分别施行小梁切除联合羊膜植入及可调节缝线术、小梁切除联合术中使用丝裂霉素及可调节缝线术。分别于术前1d、术后1,3mo行角膜荧光染色(fluorescence integral,FI)、泪膜破裂时间(tearbreak-up time,BUT)、泪液分泌试验(SchirmerⅠtest,SⅠt)检查。结果:在术后1mo,两种手术方式均可引起泪膜功能的下降,与术前相比,差异具有统计学意义(P<0.05)。但两组之间无显著差异。术后3mo,使用羊膜组的泪膜功能基本恢复。使用丝裂霉素C组泪膜的损害程度明显高于使用羊膜组,差异具有统计学意义(P<0.05)。结论:施行小梁切除联合羊膜植入及可调节缝线术式比施行小梁切除联合术中使用丝裂霉素C及可调节缝线的术式对术后的泪膜功能的影响更小,是一种更安全、有效的手术方法。

·AIM：To observe the changes of tear film functions in trabeculectomy by using human amniotic membrane（HAM）or mitomycin C（MMC）.·METHODS：In a randomized control clinical trial,44 eyes 36 patients were divided randomly into two groups,and each group had 22 eyes.The former was underwent trabeculectomy with HAM transplanted and adjustable suture line,and the later was administrated intra-operatively with MMC and adjustable suture line.Slit-lamp microscope examination,cornea fluorescence integral（FI）staining,tear break-up time（BUT）and Schirmer Ⅰ test（SⅠt）were carried out 1 day before,1 month and 3 months after operation in the 44 eyes.·RESULTS：Compared with the data before operation,all of the cornea FI scores,SⅠt and BUT were statistically significant 1 month after operation（P〈0.05）,but there was no statistical significance between the two groups.3 months after operation,all of the data returned to their preoperative values in HAM group,but the tear film functions were significantly decreased in MMC group,there was statistical significance between the two groups（P〈0.05）.·CONCLUSION：The changes of tear film functions in the combined trabeculectomy with HAM and adjustable suture line are smaller than those in the MMC group.It is a safe and effective method for treatment of glaucoma.·