小梁切除术对泪膜功能影响的研究

Effect of trabeculectomy on tear film function

目的观察小梁切除术对泪膜功能的影响,并结合眼表疾病指数(OSDI)问卷评估术后主观干眼症状,以指导对干眼的防治。方法选取行小梁切除术的青光眼患者25例33眼,分别于术前1d及术后1、3、6个月采用OSDI问卷评估眼部症状,采用Keratograph眼表综合分析仪测量中央泪河高度(TMH)、泪膜首发破裂点位置、首次和平均非侵入式泪膜破裂时间(NITBUT),并对OSDI评分和泪膜参数进行相关性分析。结果术前和术后不同时点OSDI评分比较差异有统计学意义(P<0.01)。术后1和3个月OSDI评分较术前明显增加,差异均有统计学意义(均P<0.01);术后6个月和术前比较差异无统计学意义(P>0.05)。术前和术后1个月泪膜首发破裂点位置最常见于鼻下象限,术后3和6个月泪膜首发破裂点位置最常见于鼻上象限。术前和术后不同时点首次NITBUT和平均NITBUT比较差异均有统计学意义(均P<0.05)。术后1、3、6个月首次NITBUT及术后1、3个月平均NITBUT较术前缩短,差异均有统计学意义(均P<0.05);但术后6个月平均NITBUT和术前比较差异无统计学意义(P>0.05)。术前和术后不同时点TMH比较差异无统计学意义(P>0.05)。术前和术后不同时点OSDI评分和首次NITBUT及平均NITBUT均呈负相关(均P<0.05),但OSDI评分和TMH无明显相关性(均P>0.05)。结论小梁切除术影响眼表泪膜的功能从而产生干眼症状,术后半年时,虽然主观干眼评分已经恢复到术前水平,但泪膜的稳定性仍未恢复,泪膜首发破裂点位置最常见于和滤过泡邻近的鼻上和颞上象限。

Objective To evaluate the tear film changes after trabeculectomy and to estimate the subjective symptoms using ocular surface disease index （OSDI）. Methods Twenty five glaucoma patients undergoing trabeculectomy were recruited. OSDI score, first tear film break-up point, first and average non-invasive tear film break-up time （NITBUT） and tear meniscus height （TMH） were measured preoperatively, 1, 3 and 6 months postoperatively. Correlation between OSDI scores and the tear film parameters was analyzed. Results The preoperative and postoperative OSDI scores were significantly different（P〈 0.01）. Compared with pre-operation, OSDI scores of at l m and 3m postoperatively were increased significantly （all P〈0.01）, however, it was no significant different with that at 6m postoperatively （P 〉0.05）. The first tear film break-up point was located most frequently at the inferenasal quadrant pre-operation and lm postoperatively, but it was located at the supernasal quadrant at 3m and 6m postoperatively. The first NITBUT was decreased at 1m, 3m and 6m postoperatively compared with pre-operation （P〈0.05）. The average NITBUT at lm and 3m postoperatively decreased significantly, but at 6m postoperatively showed no difference compared with pre-operation （P 〉0.05）. There was no statistically significant difference between preoperative and postoperative TMH （P 〉0.05）. OSDI scores showed negative correlation with NITBUT in each time point, and no significant correlation with TMH. Conclusion At 6 months after trabeculectomy, although the subjective symptoms scores are restored in glaucoma patients, however, the stability of tear film is still unrecovered and the first tear film break-up point is most frequently located at supernasal and supertemporal quadrant adjacent the filtering bleb.