小梁切除术中连续锁边缝合的两种不同结膜瓣对泪膜的影响

Effects of two kinds of conjunctiva flap with continuous suture on tear film after trabeculectomy

目的探讨小梁切除术中连续锁边缝合的两种不同结膜瓣对泪膜稳定性的影响。方法双眼原发性青光眼患者26例,双眼均行小梁切除术,左眼组:以穹窿部为基底的结膜瓣组26例26眼;右眼组:以角膜缘为基底的结膜瓣组26例26眼,两组中结膜瓣均采用连续缝合密闭切口,并检测术前1d、术后1d、7d、14d、30d、60d的泪膜破裂时间(Breakup Time,BUT)、基础泪液分泌试验(Schirmer I test,SIT)、角膜荧光素染色积分(fluorescence integral,FI)。结果两组间BUT、Schirmer I试验于术后1d、7d、14d、30d及60d比较差异均有统计学意义(均P<0.01),角膜荧光素染色于术后1d、7d、14d比较差异有统计学意义(均P<0.01),30d及60d比较差异无统计学意义(均P>0.05)。结论连续锁边缝合的以穹窿为基底结膜瓣的小梁切除术显著降低了泪膜的稳定性,为提高患者的舒适度我们主张以角膜缘为基底作为手术切口。

Objective To study the effect of two kinds of conjunctiva flap with continuous suture on tear film after trabeculectomy. Methods Both eyes of 26 patients with primary glaucoma underwent trabeculectomy. The left eye group： the fornix based conjunctival flap; the right eye group ： the limbus based conjunctival flap. Both groups＇ conjunctival flap was closed by continuous suture. At preoperative 1d, postoperative 1d, 7d, 14d, 30d, 60d, BUT（Breakup Time, break-up time BUT）, Schirmer test（Schirmer I, test, SIT）, corneal fluorescein staining score（fluorescence integral, FI） were recorded. Results the two groups＇ BUT and Schirmer I test after operation of 1d, 7d, 14d, 30 d and 60 d were statistically different（P〈0.01）, corneal fluorescein staining after operation in 1d, 7d and 14d had significant difference（P〈0.01）, but there was no significant difference of at postoperative 30d and 60d（P〈0.05）. Conclusion Continuous suture of the fornix based conjunctival flap in trabeculectomy significantly reduces the stability of the tear film,so we proposal the limbal based conjunctival flap as surgical incision to improve the comfort of patients.