两种术式对原发性闭角型青光眼患者眼表影响的对比研究

Comparative study of the ocular surface changes after phacotrabeculectomy and trabeculectomy

目的:探讨两种术式对原发性闭角型青光眼患者眼表的影响。方法:选择合并白内障的原发性闭角型青光眼患者60例60眼,随机分成A、B两组,各30例30眼,A组行小梁切除联合白内障超声乳化+人工晶状体植入术,B组行小梁切除术,比较两组患者术前1d和术后1wk,1、3mo的非接触性首次泪膜破裂时间(NIKf-BUT)、泪液分泌试验(SⅠt)和角结膜丽丝胺绿染色评分。结果:(1)NIKf-BUT:两组患者术后和术前相比均缩短,差异有显著统计学意义(均P<0.01);A组与B组相比,术后1wk、1mo和3mo时,A组的NIKf-BUT(2.78±1.44、3.72±0.94、5.95±0.81s)明显短于B组(4.54±1.68、5.14±1.01、8.34±1.15s),差异有统计学意义(t=-4.341、-5.636、-9.29,均P<0.05);(2)SⅠt:两组患者术后1wk、1mo和术前1d相比均减少,差异有统计学意义(均P<0.01);A组与B组相比,术后1 wk和1 mo时,A组的SⅠt(8.57±2.47、8.10±2.41mm)少于B组(10.07±2.07、9.53±2.29mm),差异有统计学意义(t=-2.5 4 9、-2.636,均P<0.05)。(3)角结膜丽丝胺绿染色评分:两组患者术后和术前相比均升高,差异有统计学意义(均P<0.01);A组与B组相比,术后1wk和1mo时,A组的角结膜丽丝胺绿染色评分(3.50±1.17、2.27±0.91分)高于B组(2.50±1.33、1.33±0.88分),差异均有统计学意义(t=3.092、4.036,均P<0.01)。结论:小梁切除联合白内障超声乳化+人工晶状体植入术对原发性闭角型青光眼患者眼表的影响较小梁切除术大,更需减少术中眼表损伤,防控术后泪膜不稳定。

AIM：To investigate the effect of phacotrabeculectomy with intraocular lens implantation and trabeculectomy on the ocular surface in patients with primary angle closure glaucoma.METHODS：We had seleted 60 eyes in 60 hospitalized patients with primary angle closure glaucoma and cataract.They were divided into group A and B randomly.Each group has 30 eyes of 30 cases.Group A was performed with phacotrabeculectomy with intraocular lens implantation and group B was performed with trabeculectomy.Ocular surface tests were performed in all subjects on the day before surgeries,1wk,1and 3mo after surgeries,respectively,including non-invasive keratograph first tear break-up time（NIKf-BUT）,Schirmer＇s I test（S I t）,and corneal and conjunctival lissamine green staining score.RESULTS：The postoperative NIKf-BUT of group A and B were significantly shorter than those preoperative（all P〈 0.01）.The NIKf-BUT of group A（2.78 ±1.44,3.72 ±0.94,5.95 ±0.81 s） were significantly shorter than those of group B（4.54±1.68,5.14±1.01,8.34±1.15s） at the postoperative 1 wk,1 and 3mo（t =-4.341,-5.636,-9.29,all P〈 0.05）.The S I t of group A and group B at the postoperative 1 wk and 1 mo were significantly less than preoperative S I t（all P 0.01）.The S I t of group A（8.57 ±2.47,8.10 ±2.41mm） were significantly less than those of group B（10.07±2.07,9.53±2.29mm） at postoperative 1wk and 1mo（t=-2.549,-2.636,all P 0.05）.The postoperative corneal and conjunctival lissamine green staining score of group A and group B were significantly higher than preoperative score（all P〈 0.01）.The score of group A（3.50 ±1.17,2.27 ±0.91） were significantly higher than group B（2.50±1.33,1.33±0.88） at the postoperative 1wk and 1mo（t =3.092,4.036,all P〈 0.01）.CONCLUSION：There was stronger effect of phacotrabeculectomy with intraocular lens implantation for the ocular surface in patients with primary angle closure glaucoma than trabeculectomy.It should be actively taken more measures to reduce damage of ocular surface during operations and to keep the stability of tear film at the postoperative stage.