穿透性角膜移植术后干眼的分析

Dry eye syndrome after penetrating keratoplasty

目的探讨穿透性角膜移植术后泪液的变化情况。方法穿透性角膜移植术25例（25眼），以自体健眼作为对照组。分别于术前3天，术后1周、1个月、3个月及6个月行干眼调查问卷、泪膜破裂时间（BUT）、基础泪液分泌试验（sIt）、角膜荧光素染色（FL）检查，对两组指标进行比较。结果术眼组术后各时间点干眼症状评分、FL评分均明显高于术前（P=0．029，P=0．018），术眼组术后各时间点干眼症状、FL评分重于健眼组（P=0．013，P=0．006）。术后各时间点BUT较术前均缩短（P=0．036）。术眼组术后各时间点BUT值短于健眼组（P=0．017）。术眼组术后1周sIt值增加，术后6个月时低于术前水平，与术前相比差异均无统计学意义（P〉0．05）。结论了解穿透性角膜移植术后泪膜的变化规律对术后合理用药和视功能恢复有重要的临床意义。

Objective To study postoperative tear changes after penetrating keratoplasty. Methods Penetrating keratoplasty was done in 25 cases （ 25 eyes ）, with the healthy eye served as a control group. Dry eye questionnaire, tear break-up time （BUT）, basal tear secretion test （Sit）, corneal fluorescein staining （FL） examination were observed 3 days before surgery, and 1 week, 1 month, 3 months and 6 months after surgery. Comparison was done between the two groups. Results At each time point after operation, dry eye symptom score, FL score were significantly higher than that before operation （ P = 0. 029, P = 0. 018）. And the symptoms of dry eye and FL score was higher in the surgery group than that in the control group at each timpoint （P = 0. 013, P = 0. 006）. At each time point after operation, the BUT was shorter than that before operation （P = 0. 036） , the BUT in surgery group was shorter than the control group （P = 0. 017 ）. The Sit values increased in the surgery group one week postoperatively. It was lower than the preoperative level in 6 months, but the difference were not statistically significant compared with preoperative one （P 〉 0.05 ）. Conclusion Understanding tear film changes after penetrating keratoplasty has important clinical significance on postoperative rational medicine treatment and recovery of visual function.