23G微创玻璃体切割术后眼表情况分析

Analysis of ocular surface condition after 23G minimally invasive vitrectomy

目的探讨23G玻璃体切割术后眼表情况,以指导术后预防及治疗。方法选取2017年10月~2018年7月我院收治的行23G玻璃体切割术的72例患者(72眼),将其对侧眼作为对照眼。所有患者均于术前1d和术后3、7、14、30d对患者的睑板腺和脂质层、眼红进行观察分析,记录泪河高度(TMH)、泪膜破裂时间(BUT)、荧光素钠染色评分(CFS)、泪液分泌试验(SIT)等相关参数,分析比较手术前后及术眼与对侧眼的眼表情况变化。结果与术前1d相比,术眼术后睑板腺缺失明显(U=7.251,P<0.05),脂质层色彩单一(U=5.882,P<0.05),术后3、7d的眼红明显(Z=10.485、8.897,P<0.05),TMH值高(Z=7.174、7.379,P<0.05),BUT值短(Z=3.952、4.727,P<0.05),SIT值多(Z=7.407、7.200、6.149,P<0.05),术后3、7、14d的CFS评分高(Z=25.076、27.134、3.280,P<0.05)。与对照眼相比,术后睑板腺缺失(Z=7.052,P<0.05),脂质层色彩单一(Z=6.038,P<0.05),术后3、7d眼红明显(Z=10.376、8.635,P<0.05),TMH值高(Z=6.562、6.819,P<0.05),BUT值短(Z=3.952、3.941,P<0.05),SIT值多(Z=7.393、7.421,P<0.05),3、7、14d的CFS评分高(Z=7.393、7.421、1.570,P<0.05)。结论23G玻璃体切割术后早期眼表情况较术前发生改变,睑板腺缺失,脂质层色彩单一且分布不均匀,眼红明显,泪液分泌增多,泪膜稳定性降低,角膜上皮缺失,术后应定期复查,早期适当给予干预措施以改善眼表情况。

Objective To investigate the ocular surface condition after 23G vitrectomy,to guide prevention and treatment after operation.Methods From October 2017 to July 2018,72 patients(72 eyes)admitted to our hospital underwent 23G vitrectomy were selected.The contralateral eye was used as the control eye.Meibomian gland,lipid layer and eye blush in all patients were observed and analyzed at 1 day before operation and 3,7,14 and 30 days after operation.Tear meniscus height(TMH),break-uptime(BUT),corneal fluorescein staining(CFS),schirmer I test(SIT)and other related parameters were recorded,the changes of ocular surface before and after surgery and between the eye and the contralateral eyes were analyzed and compared.Results Compared with 1 day before surgery,the absence of tarsal gland after ophthalmotomy was evident(U=7.251,P<0.05),and the lipid layer was single color(U=5.882,P<0.05),red eyes were obvious after 3 and 7 days postoperatively(Z=10.485,8.897,P<0.05),TMH scores was higher(Z=7.174,7.379,P<0.05),BUT scores was shorter(Z=3.952,4.727,P<0.05),SIT length was more(Z=7.407,7.200,6.149,P<0.05),the CFS scores were higher on 3,7,and 14 days(Z=25.076,27.134,3.280,P<0.05).Compared with the control eyes,the tarsal gland was absent(Z=7.052,P<0.05),and the lipid layer was single color(Z=6.038,P<0.05),red eyes were obvious at 3 and 7 days after surgery(Z=10.376,8.635,P<0.05),TMH scores was higher(Z=6.562,6.819,P<0.05),BUT scores was shorter(Z=3.952,3.941,P<0.05),SIT length was more(Z=7.393,7.421,P<0.05),the CFS scores were higher on 3,7,and 14 days(Z=7.393,7.421,1.570,P<0.05).Conclusion The early ocular surface changes after 23G vitrectomy are changed before surgery,for example the meibomian gland is lower,the lipid layer is single and unevenly distributed,the red-eyes is obvious,the tear secretion is increased,the tear film stability is reduced,and the corneal epithelium is missing,regular follow-up should be conducted after operation,early appropriate intervention should be given to improve the ocular surface conditions.