微创切口巩膜扣带术后干眼的评估

Evaluation of Dry Eye after Minimal in Situ Conjunctival Incision for Segmental Scleral Buckling Surgery

目的:评估微创切口巩膜扣带术后的干眼情况。方法:前瞻性临床研究。选取2015年5月至2017年4月在西安交通大学第一附属医院眼科就诊的孔源性视网膜脱离拟行巩膜扣带术的患者78例(78眼),按随机数字表法分为2组:微创组接受微创切口巩膜扣带术,对照组接受标准巩膜扣带术。术前1周(基线)和术后1 d、1周和1个月分别采用眼表疾病指数(OSDI)和受试者干眼问卷进行干眼相关指标评估,运用眼表综合分析仪进行泪膜评估,采用SchirmerⅠ试验和荧光素染色。计数资料采用χ2检验进行组间比较,2组间比较采用独立样本t检验或Mann-WhitneyU检验。结果:2组患者基线资料差异无统计学意义。大部分患者在巩膜扣带术后发生或加重了干眼。主观症状和感受评分、荧光素染色评分均升高,泪膜破裂时间、泪液分泌试验均下降,术后1 d是拐点,术后1个月未回归至术前基线水平。2组泪河高度、泪膜破裂时间、泪液分泌试验和荧光素染色情况在术后1 d和1周差异无统计意义;但是术后1个月时,微创组的泪河高度(Z=1.04,P=0.041)、泪膜破裂时间(t=2.51,P<0.001)和泪液分泌试验(Z=2.34,P=0.043)优于对照组。微创组的OSDI和干眼问卷评分在术后1周和1个月时高于对照组(OSDI:t术后1周=2.54,P=0.012;Z术后1个月=-1.03,P=0.020;干眼问卷:t术后1周=3.04,P=0.011;t术后1个月=3.94,P<0.001)。术前合并干眼的患者在巩膜扣带术后1 d、1周和1个月荧光素染色评分均明显升高(Z=-2.42,P<0.001;Z=-1.54,P=0.034;Z=-1.83,P=0.041)。结论:巩膜扣带术会诱发或加重干眼。相比标准术式,微创切口巩膜扣带术会改善和缩短术后早期的干眼症状,尤其是术前合并干眼的患者,行微创切口巩膜扣带术干眼风险更小。

Objective:To compare dry eye signs and symptoms after minimal in situ conjunctival incision for segmental scleral buckling surgery.Methods:In this prospective clinical study,consecutive patients,enrolled in the Department of Ophthalmology,the First Affiliated Hospital of Xi'an Jiaotong University,from May 2015 to April 2017,who had minimal in situ conjunctival incision or standard segmental scleral buckling surgery were assessed.Dry eye markers including the ocular surface disease index(OSDI)and subjective symptom questionnaire,tear-film assessment using Keratograph 5M corneal topography,SchirmerⅠtesting,and fluorescein staining were sequentially evaluated preoperatively and at 1 day,1 week,and 1 month postoperatively.A Chi-square test,Student's t-test or Mann-Whitney U test was used to compare differences between the two groups.Results:Seventy-eight patients(78 eyes)with similar baseline characteristics were recruited.Most patients developed dry eye postoperatively.Subjective symptoms and fluorescein staining scores elevated from baseline,tear break-up time and SchirmerⅠtesting values decreased postoperatively,which peaked at 1 day and did not return to baseline within 1 month.There were no significant differences between the 2 groups(all P>0.05)at 1 day and 1 week except for the higher tear meniscus height(Z=1.04,P=0.041),noninvasive first tear break-up time and average break-up time(t=2.51,P<0.001),and SchirmerⅠtest values(Z=2.34,P=0.043),in the minimal in situ conjunctival incision group at 1 month postoperatively.OSDI scores and subjective symptoms were lower in the minimal in situ conjunctival incision group at 1 week and 1 month postoperatively(OSDI:t1 week=2.54,P=0.012;Z1 month=-1.03,P=0.020;subjective symptoms:t1 week=3.04,P=0.011;t1 month=3.94,P<0.001).Sub group analysis using flouesecein staining showed obvious worsening 1 day,1 week and 1 month postoperatively in patients with preoperative dry eye(Z=-2.42,P<0.001;Z=-1.54,P=0.034;Z=-1.83,P=0.041).Conclusions:Segmental scleral buckling surgery can induce or aggravate dry eyes.Compared with standard procedures,minimal in situ conjunctival incision segmental scleral buckling surgery can improve and shorten the ocular surface discomfort in the early postoperative period,especially in patients with dry eyes before surgery.