20G玻璃体视网膜手术对糖尿病患者泪膜功能的影响

Changes in tear film after 20-gauge vitrectomy in patients with diabetes

目的观察糖尿病患者经20G玻璃体视网膜切除手术前后泪膜变化。方法前瞻性病例系列研究。自2012年5月至2013年2月间于我院行20G玻璃体视网膜切除手术的连续病例132例(132只眼)纳入研究。其中伴有II型糖尿病的63例(63只眼)作为A组,无糖尿病的69例(69只眼)作为B组,对侧眼为对照眼。所有患者均于术前1 d,术后1、3、7 d,1个月及3个月行泪膜破裂时间(BUT)、基础泪液分泌试验(SIT)、角膜荧光素染色(CFS)及干眼不适症状(DES)评分等检查。分析比较手术前后患者泪膜的变化,以及两组患者术后泪膜的变化。结果与术前1 d相比,术后1、3 d患者均感到术眼明显不适,DES评分差异有统计学意义(Z=-3.771、-3.452,P<0.05);43%患者主诉患眼有轻度异物感及红肿流泪;与术前1 d相比,术眼术后1、3、7 d BUT值差异均具有统计学意义(t=-3.473、-3.218、-4.121,P<0.05),且A组(糖尿病组)泪膜稳定性恢复慢;术眼术后1,3d CFS评分差异有统计学意义(Z=-3.375,P<0.05),且在术后3 d时评分最高,术后10 d恢复至术前水平;术后1 d及3 d术眼SIT值差异有统计学意义(t=4.312、3.814,P<0.05),术后7 d恢复至术前水平,随后变化不大。结论糖尿病患者本身的泪膜稳定性差,20G玻璃体切除术影响泪膜的稳定性,糖尿病患者经20G玻璃体视网膜切除手术后早期可出现泪膜的异常改变,尤其表现为泪膜稳定性下降和泪液分泌量的下降,且术后泪膜恢复较无糖尿病患者恢复慢。

Objective To evaluate the changes in tear film after 20-gange vitrectomy and the recovery of tear film in patients with type 2 diabetes. Methods Totally 132 patients （63 with type 2 diabetes, group A, and 69 without type 2 diabetes, group B） who underwent 20-gauge vitrectomy between May 2012 and February 2013 were enrolled in this pro- spective case-controlled study. The fellow eyes were used as control group. Break-up time （ BUT）, Schirmer I test （ SIT}, uncomfortable symptoms score and corneal fluorescein staining （CFS） were recorded 1 day before surgery and ld, 3d, 7d, 1mo, and 3too after surgery in all patients. Data from all ophthalmologie examinations were collected. Results Patients complained uncomfortable at Id and 3d postoperatively, and the DES scores were different compared to preoperative meas- urements significantly （Z = -3. 771 and - 3. 452 respectively, P 〈0.05 ）. Forty three percent patients complained of mild pain and red eye. BUT scores of operated eyes in two groups at 1st, 3rd, and 7th postoperative days were significantly different from preoperative BUT scores （ t = -3. 473, -3. 218 and -4. 121, P 〈 0.05 ）. There was significant peri - surgical difference in CFS scores in treated eyes at the 1st and 3rd day in both groups. Highest CFS score was found on the 3rd day, and on the 10th day it returned to normal level. At 1 and 3 days after surgery the secretion of tear of both groups werehigher （t =4.312,3.814, P 〈0.05）, and in the 7th day it returned to the preoperativelevel. Conclusions The stability of tear film of type 2 diabetes patients is poorer than normal patients and is more vulnerable at the early period after vitreous microsurgery owing. The secretion of the tear in diabetes patients is declined and the tear film recovers slowly after the surgery.