功能性溢泪糖尿病患者下睑松弛矫正术后泪膜和泪液蛋白的特点

Characteristics of tear film and tear protein after blepharoplasty for lower eyelid relaxation in diabetic patients with functional epiphora

目的探讨糖尿病功能性溢泪患者下睑松弛矫正术后眼表症状、泪膜和泪液蛋白的特点。方法下眼睑松弛导致的糖尿病功能性溢泪患者60例(右眼),随机分为两组:A组行外侧睑板条悬吊术;B组行常规Kuhnt睑板三角切除术,分别于术前、术后1周、1个月及3个月对患者行眼表症状评分、泪膜4项检查和泪液各蛋白测定。结果 A组总有效率为90.0%;B组总有效率为66.7%,两组比较差异有统计学意义(P<0.05);术前两组干眼各亚症状评分、眼表指数(OSDI)、泪膜破裂时间(BUT)、基础泪液分泌试验(ST)、泪河高度、角膜荧光素染色(FL)、泪液蛋白(TP)、乳铁蛋白(LF)、溶菌酶(LZM)和分泌型免疫球蛋白A(s Ig A)比较,差异无统计学意义(P>0.05);术后1周,两组患者ST、泪河高度、FL比较,差异均有统计学意义(P<0.05),但两组眼表各症状、OSDI、BUT、泪液总蛋白量、LF、LZM及s Ig A比较,差异无统计学意义(P<0.05);术后3个月,两组患者OSDI、BUT、ST、泪河高度、FL比较,差异有统计学意义(P<0.05),但两组眼表各症状、泪液总蛋白量、LF、LZM及s Ig A比较,差异无统计学意义。结论对于下眼睑松弛导致的糖尿病功能性溢泪患者,外侧睑板条悬吊术可以明显改善患者眼表症状和泪膜稳定性,升高泪液蛋白,提高患者的视觉质量。

[Objective] To observe the symptom of ocular surface, tear film and tear protein of the diabetic patients with functional epiphora after lower eyelid relaxation. [Methods] Sixty diabetic patients with functional epiphora caused by loose lower eyelid （60 right eyes） were randomly divided into two groups： group A with the lateral tarsal strip and group B receiving Kuhnt tarsal triangular resection. Scoring of the symptom of ocular surface, and examinations of tear film and tear protein were performed at 1 w, 1 m and 3 m after operation. [Results] The effective rate of the group A was 90.0%, and that of group B was 66.7%. The overall effective rate of the group A was significantly higher than that of the group B （P 〈 0.05）. There was no significant difference in the symptom score of ocular surface, ocular surface disease index （OSDI）, break up time （BUT）, Schirmer test （ST）, tear meniscus height, fluorescent staining （FL）, tear proteins, lactoferrin, lysozyme or sIgA between both groups before operation （P 〉 0.05）. One week after operation, there were statistical differences in ST, tear meniscus height and FL between both groups （P 〈 0.05）, whereas there was no significant difference in the symptom of ocular surface, OSDI, BUT, tear proteins, lactoferrin, lysozyme or slgA （P 〉 0.05）. Three months after operation, there were statistical differences in OSDI, BUT, ST, tear meniscus height and FL between both groups （P〈 0.05）, whereas there was no significant difference in the symptom of ocular surface, tear proteins, lactoferrin, lysozyme or sIgA （P 〉 0.05）. [ Conclusions ] The lateral tarsal strip is a more favorable solution for diabetic patients with functional epiphora caused by loose lower eyelid, which can ameliorate the symptom of ocular surface and tear film function, increase the tear proteins and therefore improve the visual quality.