先天性重度上睑下垂术后干眼的临床观察

Clinical observation on dry eyes after congenital severe blepharoptosis surgery

目的观察先天性重度上睑下垂术后干眼的发生情况。方法前瞻性随机对照研究。纳入孝感市中心医院2020年2月至2022年1月先天性重度上睑下垂41例(67眼)。按随机数字表法分为两组:研究组21例(35眼)行联合筋膜鞘悬吊联合上睑提肌缩短术, 对照组20例(32眼)行额肌瓣悬吊术。分别于术前、术后行眼表疾病指数问卷调查(OSDI)、泪膜破裂时间(BUT)、角膜荧光素染色(FL)、泪液分泌试验(SIt)及术后常见并发症进行观察比较。术后随访3个月。结果术后不同时间点两组OSDI评分、BUT、FL与术前相比差异有统计学意义(P<0.05), SIt差异无统计学意义(P>0.05)。术后两组间OSDI评分比较差异无统计学意义(P>0.05), 术后7 d、1个月研究组BUT高于对照组(t=-2.38, -2.02;P=0.021, 0.048), 术后7 d、1个月、3个月研究组FL低于对照组(t=-2.53, -3.44, 3.95;P=0.014, 0.001, <0.001)。研究组术后并发症发生率低于对照组(χ^(2)=3.97,P<0.05)。结论先天性重度上睑下垂术后早期干眼症状较术前明显。联合筋膜鞘悬吊联合上睑提肌缩短术较额肌瓣悬吊术对干眼影响小, 并发症少。

Objective To observe the condition of dry eyes after congenital severe blepharoptosis surgery.Methods This was a prospective random control study.Total of 67 eyes of 41 cases with congenital severe blepharoptosis from Feb.2020 to Jan.2022 in Xiaogan Central Hospital were included.They were divided into two groups based on random number table methods.In the study group,35 eyes of 21 cases received conjoint fascial sheath suspension combined with levator muscle shortening.And in the control group,32 eyes of 20 cases received frontal muscle flap suspension.The ocular surface disease index questionnaire(OSDI),tear break-up test(BUT),corneal fluorescence staining(FL),Schirmer’sⅠtest(SⅠt)and common postoperative complications were observed and compared.The follow-up time was 3 months after surgery.Results There were significant differences in OSDI score,BUT and FL between the two groups at different time points after operation(P<0.05),but the difference in SⅠt(P>0.05)wasn’t statistically significant between the two groups.There was no difference in OSDI score between the two groups after operation(P>0.05).The BUT of the study group was higher than that of the control group at 7 days and 1 month after operation(t=-2.38,-2.02;P=0.021,0.048),and the FL of the study group was lower than that of the control group at 7 days,1 month and 3 months after operation(t=-2.53,-3.44,3.95;P=0.014,0.001,<0.001).The incidence of postoperative complications in the study group was lower than that in the control group(χ^(2)=3.97,P<0.05).Conclusion The early dry eye symptoms of congenital severe blepharoptosis after operation are more obvious than those before operation.Conjoint fascial sheath suspension combined with levator muscle shortening has less effect on dry eyes and less complications than frontal muscle flap suspension.