25G经结膜微创玻璃体切除术对眼表功能的影响

Effect of 25G transconjunctival sutureless vitrectomy on ocular surface function

目的观察25G经结膜免缝合微创玻璃体切除术(TSV)后患者眼表功能的变化。方法前瞻性、观察性研究。2019年6~9月于北京大学第一医院眼科行25G TSV的患者30例(30只眼)。所有受试者术眼均由3位资深玻璃体视网膜医生完成25G TSV,并由同一位住院医师分别于术前1 d、术后1 d、1周、1个月、2个月及3个月评估术眼眼表功能,分析各指标的变化趋势。观察指标包括标准干眼症状评估(SPEED)问卷评分、泪膜破裂时间(TBUT)、睑板腺分泌功能评分(MGYSS)、Marx’s线评分(MLS)、结膜印迹细胞学Nelson分级。结果SPEED问卷评分:术后1 d、1周、1个月分别为(18.69±4.53)分、(18.78±2.58)分,(18.67±2.39)分,均大于术前(14.29±3.29)分,差异具有统计学意义(P<0.05);术后2个月、3个月与术前比较差异无统计学意义(P>0.05)。TBUT:术后1 d、1周、1个月分别为(3.27±0.81)s,(3.97±0.88)s、(4.05±0.63)s,均低于术前(4.54±1.20)s,差异具有统计学意义(均P<0.05);术后2个月、3个月与术前比较差异无统计学意义(P>0.05)。MGYSS:术后1 d、1周、1个月分别为8.00(4.25,12.00)分,8.50(5.00,14.25)分,10.00(6.25,16.25)分,均低于术前16.75(11.00,20.25)分,1 d,差异具有统计学意义(P<0.05);术后2个月、3个月与术前比较差异无统计学意义(P>0.05)。MLS:术后1 d、1周、1个月、2个月、3个月与术前比较差异均无统计学意义(P>0.05)。结膜印迹细胞学Nelson分级:术后1周、1个月及2个月的Nelson分级结果分别为(2.46±0.67)级、(2.26±0.76)级、(2.15±0.69)级,均高于术前(1.92±0.58)级,差异具有统计学意义(P<0.05);术后3个月与术前1 d比较差异无统计学意义(P>0.05)。结论25G TSV术后短期内患者眼表功能显著降低。患者干眼症状、泪膜稳定性、睑板腺分泌功能和结膜印迹细胞Nelson分级结果均较术前差,干眼症状、泪膜稳定性、睑板腺分泌功能在术后2个月内恢复至术前水平,结膜印迹细胞Nelson分级在术后3个月内恢复至术前水平。25G TSV术后MLS未见明显改变。

Objective To investigate the dynamic ocular function change after 25G transconjunctival sutureless vitrectomy(TSV).Methods A total of 30 consecutive patients(30 eyes)who underwent 25G TSV at the Peking University First Hospital from June 2019 to September 2019 were enrolled in this prospective observational study.Three experienced vitreoretinal experts completed the 25G TSV in all eyes,and the ocular surface function were evaluated at 1 day before the surgery,as well as at 1 d,1 week,1 month,2 months and 3 months after the surgery.Observation parameters included Standard Patient Evaluation of Eye Dryness(SPEED)questionnaire score,Tear Break Up Time(TBUT),Meibomian Gland Yielding Secretion Score(MGYSS),Marx’s Line Score(MLS),and the Nelson's grade of conjunctival impression cytology.Results The SPEED questionnaire scores at 1 d,1 week and 1 month after the surgery were significantly higher than that at 1 day before the surgery(P<0.05),which was 18.69±4.53,18.78±2.58,18.67±2.39,14.29±3.29,respectively.The SPEED questionnaire scores at 2m and 3m after the surgery were lower than that at 1 day before the surgery,but the difference was not statistically significant(P>0.05).The TBUTs at 1 d,1 week and 1 month after the surgery were significantly shorter than that at 1d before the surgery(P<0.05),which was 3.27±0.81s,3.97±0.88s,4.05±0.63s,4.54±1.20s,respectively.However,the TBUTs at 2 months and 3 months after the surgery were also lower than that at 1 before the surgery,but the difference was not statistically significant(P>0.05).The MGYSSs at 1 d,1 week and 1 mmonth after the surgery were significantly lower than that at 1 d before the surgery(P<0.05),which was 8.00(4.25,12.00),8.50(5.00,14.25),10.00(6.25,16.25),16.75(11.00,20.25),respectively.The MGYSS scores at 2 months and 3 months after the surgery were lower than that at 1 day before the surgery,but the difference was not statistically significant(P>0.05).There was no significant difference between the postoperative and preoperative MLS(P>0.05).The Nelson's grades at 1 week,1 month and 2 months after the surgery were significantly higher than that at 1 d before the surgery(P<0.05),which was 2.46±0.67,2.26±0.76,2.15±0.69,1.92±0.58,respectively.The Nelson's grade at 3 months after the surgery was higher than that at 1d before the surgery,but the difference was not statistically significant(P>0.05).Conclusions The ocular surface function was extensively impaired for a short period after 25G TSV,which could recover in 2 or 3 months after the surgery.The dry eye symptoms,tear film stability,and meibomian gland function were worse than those before the 25G TSV surgery,and returned to the preoperative level within 2 months.The Nelson's grade of conjunctival goblet cell aggravated after the 25G TSV,and it took about 3 months to return to the preoperative state.No significant changes in MLS were observed after the 25G TSV.