小梁切除术结膜瓣缝合方式对早期泪膜功能影响

Effect of different suture conjunctiva flap on early tear film function after trabeculectomy

目的对比观察暴露线头和包埋线头结膜缝合方式，对小梁切除手术后早期泪膜功能的影响。方法收集2012年12月至2014年10月，在徐州市眼病防治研究所，行以穹窿部为基底结膜瓣小梁切除术治疗的青光眼患者100例（136只眼），随机分A、B两组。A组：暴露线头结膜缝线50例67只眼；B组：包埋线头结膜缝线50例69只眼。询问眼部症状，检查结膜充血和分泌物情况，检测术前、术后1d、1周、2周和术后1个月泪膜破裂时间（BUT）、泪液分泌试验（Schirmer I试验）、角结膜荧光素染色等相关泪膜功能。结果两组间异物感术后1d、1周比较差异均有统计学意义（P=0．05．P〈0．01）。两组间干涩灼热感术后1d、1周及2周比较差异均有统计学意义（P≤0．01，P〈0．05）。两组间畏光感术后1d、1周及2周比较差异均有统计学意义（均P〈0．01）。两组间结膜充血术后1周、2周及1个月比较差异均无统计学意义（P〉0．05）。两组间分泌物术后1d、1周及1个月比较差异均无统计学意义（P〉0．05）。两组间BUT术后1d、1周、2周及1个月比较差异均无统计学意义（P〉0．05）。两组间Schirmer I试验术后1d及1周比较差异均有统计学意义（P〈0．05）。两组间角膜荧光素钠染色术后1d、1周及2周比较差异均有统计学意义（均P〈0．05）。结论以穹窿部为基底结膜瓣缝合中暴露线头和包埋线头的缝合方式对早期泪膜功能影响存在差异，包埋线头的缝合方式对早期泪膜功能影响相对小。

Objective To observe the roles of exposed and embeded threads in the head of sutures conjunctiva flap on early tear film function after trabeculectomy. Methods A 100 glaucoma patients （136 eyes） with fomix based conjunctival flap in trabecula resection at Eye Institute of Xuzhou from December 2012 to October 2014 were randomly divided into two groups. Group A： 50 cases （67 eyes） of conjunctival suture thread exposed; group B： 50 cases （69 eyes） of conjunctival suture implanting head bag. The symptoms and signs of dry eye disease, tear break-up time （BUT）, Schirmer I test and corneal fluorescein staining of tear film function were analyzed. Results Between the two groups, in foreign body sensation at 1 day and 1 week, dryness at 1 day and 1 month and photophobia at 1 day, 1 week and 2 weeks after surgery, the differences were statistically significant （P 〈0.05）; but in conjunctival hyperemia and secretions, were not significant different （P 〉0.05）. Between the two groups, BUT after surgery showed no significant difference （P 〉0.05）, While in schirmer I after surgery and corneal fluorescein staining, the differences were statistically significant （P 〈0.05）. Conclusions There are differences on early tear function at the fornix based conjunctival flap by exposed thread and implanting head of suture methods. Effects of the embedding suture method on early tear film function is relatively small.