角膜绷带镜在结膜瓣以穹窿为基底的小梁切除术中的临床效果观察

The clinical applications and effects of bandage contact lens in fornix-based-flap trabeculectomy in Glaucoma

目的观察角膜绷带镜在结膜瓣以穹窿为基底的小梁切除术中的适应症、应用时机与方法以及临床效果，从而评估角膜绷带镜在青光眼疾病中的治疗价值。方法收集2015年3月至2015年9月江苏省徐州市第一人民医院眼科收治的32例（38只眼）青光眼患者的临床资料，进行回顾性分析。患者在接受结膜瓣以穹窿为基底的小梁切除术后即刻配戴角膜绷带镜。于术后7-14d时取出角膜绷带镜。对患者进行裂隙灯显微镜检查及荧光素钠染色检查，记录患者的自觉症状、眼红指数及结膜瓣切口愈合情况，评价角膜绷带镜的安全性和效果。手术前及术后7d患者的舒适度和眼表综合分析情况以均数±标准差（x±s）的形式表示，并采用配对t检验的方法进行比较。手术前及术后7d患者的疼痛程度按照0．5级、1级和2级分为3个等级，以眼数和百分比的形式表示，并采用Kruskal．WallisH秩和检验的方法进行比较。手术前及术后7d患者荧光素角膜染色的情况以眼数和百分比的形式表示，并采用x。检验的方法进行比较。结果术前患者的眼部刺激感、眼部刺痛及流泪评分分别为（0．06±0．38）分、（0．59±0．45）分及（0．18±0．39）分，术后分别为（0．53±0．22）分、（0．96±0．21）分及（0．45±0．37）分，术前与术后差异有统计学意义（t=5．87，6．89，4．23；P〈0．05）。术前患者的烧灼感及睁眼困难评分分别为（0．04±0．29）分和（0．03±0．15）分，术后分别为（0．07±0．19）分和（0．02±0．24）分，差异无统计学意义（t=1．78，1．24；P〉0．05）。术前疼痛为0．5级者31例（35只眼），占92．11％；疼痛为1级者1例（3只眼），占7．89％；术后7d疼痛为0．5级者34例（37只眼），占97．37％；疼痛为1级者1例（1只眼），占2．63％，手术前、后疼痛情况比较，差异无统计学意义（Hc=1．02，P〉0．05）。术前患者的泪膜破裂时间为（9．46±3．78）S，术后为（7．33±4．82）s，差异无统计学意义（t=1．87，P〉0．05）。术前患者的泪河高度为（0．24±0．56）mm，术后为（0．48±0．28）mm，差异有统计学意义（t=2．98，P〈0．05）。术前患者的眼红分析值为（1．2±0．87），术后为（2．8±0．46），差异无统计学意义（t=1．26，P〉0．05）。术前角膜染色阳性者5例（8只眼），占21．05％；角膜染色阴性者27例（30只眼），占78．95％。术后7d角膜染色阳性者5例（5只眼），占13．16％；角膜染色阴性者32例（33只眼），占86．84％，差异无统计学意义（x2=0．84，P〉0．05）。角膜绷带镜配戴不稳脱落者1例（1只眼），眼部有异物感的患者2例（3只眼）。治疗中无显著缺氧、角膜水肿及继发感染等并发症发生。结论角膜绷带镜在结膜瓣以穹窿为基底的小梁切除术中的治疗是安全、有效的，特别在缓解眼部异物感、促进角膜上皮修复及结膜切口愈合方面有显著效果。

Objective To observe the corneal bandage lens in conjunctival fornix to trabecular resection in the basal indications, timing and methods and clinical effect, to assess the value of corneal bandage treatment in glaucoma in the mirror. Methods The clinical data of 32 patients （38 eyes） with glaucoma were collected from September 2015 to March 2015 in Xuzhou First People＇s Hospital in Jiangsu Province, and the clinical data were retrospectively analyzed. In patients with conjunctival fornix trabecular resection immediately after basal corneal bandage mirror, after 7-14 d removed the bandage contact lens. Slit lamp microscope and fluoreseein staining of the patients, record the symptoms, patients with index and conjunctival incision healing, corneal bandage evaluation of the safety and efficacy of mirror. Preoperative and postoperative 7 d patient comfort and ocular surface comprehensive analysis of mean standard deviation （：~_＋ s） representation, and using the paired t test comparison. Before and after surgery 7 d, the patients were divided into 3 grades according to the level of 0.5,1 and 2, the number and percentage of the patients were expressed in the form of H Kruskal-Wallis. Preoperative and postoperative 7 d patients with fluorescein corneal staining in the form of eye number and percentage, and the use of A2 test method for comparison. Results The ocular irritation, eye irritation, and tears were （0.06±0.38） and （0.45±0.45） and （0.18±0.59） and （0.53±0.39） and （0.22±0.21） and （0.37±0.96）. The difference was statistically significant （ t = 5.87,6.89,4.23 ;P〈0.05 ）. Preoperative patients with burning and open difficulties scores were （0.04±0.29） % and （0.03±0.15 ）, after operation respectively （0.07±0.19） % and （0.02±0.24）, the difference was not statistically significant （ t = 1.78,1.24 ; P〉0.05 ）. Preoperative pain was 0.5 levels in 31 cases （35 eyes） ,accounting for 92.11%. Pain was 1 levels in 1 cases （3 eyes）, accounting for 7.89%. After surgery 7 d,0.5 levels of pain were 34 cases （37 eyes） , accounting for 97.37%. Pain was 1 levels in 1 cases （1 eyes） , accounting for 2.63 %. Before and after the operation,the difference was not statistically significant （Hc=-I.O2,P〉O.05）. Preoperative break-up time （9.46±3.78） for s after surgery （7.33±4.82） s,the difference was not statistically significant （ t = 1.87, P〉0.05 ）. The river height of the patients was （ 0.24±0.56） mm, and （ 0.48±0. 28 ） mm, the difference was statistically significant （ t = 2.98, P 〈 0.05 ）. Preoperative patients with analysis of value is （ 1.2±0.87 ） , after surgery （ 2.8±0.46 ）, the difference was not statistically significant （ t = 1.26, P〉0.05 ）. 5 cases （ 8 eyes） were positive, accounting for 21.05%. 27 cases （30 eyes） with corneal staining,accounting for 78.95%. After surgery7 d, 5 cases （5 eyes） were positive,accounting for 13.16%. There were 32 cases （33 eyes） with corneal staining, and the difference was not statistically significant （X2 = 0.84, P 〉 0.05 ）. 1 cases （ 1 eyes） with a foreign body sensation, and 2 cases （3 eyes） with a foreign body in the eye. No significant hypoxia, corneal edema, secondary infection and other complications occurred in the treatment. Conclusion Corneal bandage in conjunctival fornix to mirror the trabecular substrate during resection is safe and effective, especially in relieving ocular foreign body sensation, has significant effect on promoting corneal epithelial repair and conjunctival incision healing.