鼻泪道阻塞患者逆行置管手术前后眼表疾病指数变化的临床研究

Assessment of ocular surface disease index in patients with nasolacrimal duct obstruction undergoing retrograde intubation

目的研究鼻泪道阻塞患者逆行置管手术前后眼表疾病指数(OSDI)的差异,并探讨OSDI量表相关参数用于评价鼻泪道阻塞患者眼表症状及生活质量的可行性。方法收集2014年1月1日~6月30日来本科行鼻泪道阻塞逆行置管且排除干眼的患者60例(60眼),分别于术前、术后2个月拔管时记录溢泪、泪道冲洗情况,并行OSDI评分和裂隙灯显微镜检查。根据术后2个月患者泪道冲洗结果,将患者分为A组(泪道冲洗通畅)和B组(泪道冲洗不通或狭通)。比较2组患者年龄、术前术后OSDI总分及各参数(眼部不适发生频率评分、眼部不适对日常活动影响评分、不良环境中眼部不适发生频率评分)的差异。结果 A组患者48例,平均年龄(52.1±13.2)岁,男性7例、女性41例;B组患者12例,平均年龄(52.3±14.6)岁,均为女性;2组患者年龄间差异无统计学意义(Z=-0.111,P=0.912)。A组术前、术后在OSDI总评分[(25.5±12.7)v.s.(5.1±6.5)]、OSDI表眼部不适发生频率评分[(3.8±2.8)v.s.(0.8±1.2)]、眼部不适对日常活动影响评分[(1.8±1.9)v.s.(0.5±0.8)]及不良环境的眼部不适发生频率评分[(5.2±2.1)v.s.(0.8±1.1)]方面差异均有统计学意义(P值均<0.05)。B组术前、术后在OSDI总评分[(30.2±7.1)v.s.(25.8±6.1)]、OSDI表眼部不适发生频率评分[(4.3±1.9)v.s.(3.5±1.8)]、眼部不适对日常活动影响评分[(2.8±2.7)v.s.(2.3±1.1)]及不良环境的眼部不适发生频率评分[(5.8±2.7)v.s.(5.0±2.1)]方面差异均没有统计学意义(P值均<0.05)。结论逆行置管术后成功的鼻泪道阻塞患者OSDI总分及各亚项评分均改善明显,置管失败患者评分则无明显改善。OSDI量表对于定量评价鼻泪道阻塞患者眼表不适症状及生活质量具有一定的临床指导意义。

Objective To explore the changes of ocular surface disease index （OSDI） in patients with nasolacrimal duct obstruction before and after undergoing retrograde intubation, and to assess the feasibility of OSDI in evaluating the symptoms and life quality of nasal lacrimal duct obstruction patients. Methods Sixty nasolacrimal duct obstruction patients without dry eye syndrom who underwent retrograde intubation were enrolled from January 1, 2014 to June 30, 2014. Patients were followed up at baseline and 2 months after surgery. Information on epiphora, OSDI scores and slit-lamp microscope examination was recorded. Patients were divided into two groups, including group A （lacrimal passages unobstructed） and group B （lacrimal passages complete obstructed or incomplete obstructed）. The chi-square and non-parametric Mann-Whitney tests were used to analyze the clinical data. Results There were 48 patients （7 males and 41 females） in group A whose mean age was （52. 1 ±13.2） years. There were significant differences in OSDI total scores, the ocular surface discomfort frequency scoring, the daily activities limited by ocular surface discomfort scoring, and the ocular surface discomfort frequency in special situations scoring before and after surgeries in group A （P 〈0. 05）, while there was no statistically significant differences in group B （P 〉 0.05）. Conclusions Ocular surface disease index scores significantly improved in patients with nasolacrimal duct obstruction after successful retrograde intubation. However, they did not change in the failure patients. OSDI questionnaire seems to be a useful tool for evaluating the ocular discomfort quantitatively of patients and visual related life quality with nasolacrimal duct obstruction.