青光眼小梁切除术对眼表结构影响的研究

Study of the Ocular Surface Structure of Glaucoma Trabeculoctomy

目的探讨青光眼小梁切除手术对眼表结构及泪膜的影响。方法选择66例80只急性闭角型青光眼行小梁切除的患者,观察术前及术后6个月的角膜表面规则指数(SRI)、角膜表面非对称性指数(SAI)、角膜荧光素染色及虎红染色、基础泪液分泌试验(Schirmer I test)、泪膜破裂时间(BUT),并对数据进行统计学分析。结果小梁切除术前,术后1周、1个月、3个月和6个月的SRI为(0.26±0.11)、(0.65±0.30)、(0.53±0.25)、(0.45±0.17)和(0.28±0.12),SAI为(0.42±0.22)、(0.78±0.23)、(0.68±0.26)、(0.60±0.22)、(0.46±0.21),术后3个月内的SRI及SAI明显增加,术后1周最明显,与术前相比差异有统计学意义(P<0.05),术后6个月SRI及SAI与术前相比差异无统计学意义(P>0.05);术后1周、1个月、3个月角膜荧光素染色及虎红染色点增多,泪液分泌量明显减少、BUT明显缩短,与术前相比差异有统计学意义(P<0.05),术后6个月角膜荧光素染色、虎红染色、SIt及BUT恢复至术前水平,与术前比差异无统计学意义(P>0.05)。结论青光眼小梁切除术对眼表结构和泪膜具有一定程度的影响,这可能与多种因素有关,应积极采取预防措施。

Objective To evaluate the effects of trabeculectomy in glaucoma on eye surface structures and tear iflm. Methods 80 eyes of 66 cases with acute angle-closure glaucoma were studied. The symptoms and signs were observed preoperatively and 6 months postoperatively, such as surface regularity index （SRI）, surface asymmetry index （SAI）, lfuorescein staining of corneal and rosebengal staining , Schirmer I test （SIt） and tear break up time（BUT）. The results were all analyzed. Results Before surgery, 1 weeks, 1 months, 3 months and 6 months after trabeculectomy. The SRI’ scores were （0.26±0.11）, （0.65±0.30）, （0.53±0.25）, （0.45±0.17）, （0.28 ±0.12）, the SAI’ scores were （0.42±0.22）, （0.78±0.23）, （0.68±0.26）, （0.60±0.22）, （0.46±0.21）, respectively. SRI and SAI were significantly increased in 3 months postoperation compared with preoperation （P〈0.05）, espically in 1 week postoperation, while there were no signiifcant difference between 6 months postoperation and preoperation （P〉0.05）. FSC’ and SC’ scores were signiifcant increased in 1 week, 1 month, 3 months postoperation compared with preoperation （P〈0.05）. SIt’ scores and BUT’ times were all signiifcantly decreased in 3 months postoperation compared with preoperation. All of the signs were no signiifcant difference between 6 months postoperation and preoperation （P〉0.05）. Conclusion Trabeculectomy in glaucoma does have some effects on the ocular surface structures and tear iflm, which is related to multi-factors. Clinical preventions should be taken.