穹窿部切口斜视手术与干眼的相关性研究

Correlation between fornix incision strabismus surgery and dry eye

目的:探讨穹窿部切口斜视手术对术后干眼发生的影响。方法:选取2017年10月—2018年3月期间在汕头大学·香港中文大学联合汕头国际眼科中心行单眼共同性斜视矫正手术的患者39例(78只眼),行斜视手术的39只眼为手术组,39只非手术眼为对照组。斜视手术采用结膜穹窿部切口,分别于术前1 d、术后第1天、术后第7天、术后第30天对患者进行泪膜破裂时间、角膜荧光素染色等眼部检查,统计术后符合干眼诊断的眼数。结果:手术组患者术后第1天符合干眼诊断的有12例(30.7%),术后第7天10例(25.6%),术后第30天2例(5%)。手术组术后第1、7、30天的泪膜破裂时间低于对照组(P值均<0.001),也低于术前1 d(P值均<0.001)。手术组术后第1、7天的角膜荧光染色评分高于对照组(P值均<0.01),也高于术前1 d(P值均<0.01),术后第30天与术前1 d比较差异无统计学意义(P<0.05)。结论:穹窿部切口斜视手术可能会引起患者术后泪膜稳定性的下降和眼表功能的破坏,但大部分患者的眼表功能会在短期内恢复到正常范围。

Objective:To investigate the effect of fornix incision strabismus surgery on postoperative dry eye.Methods:Thirty-nine patients(78 eyes)who underwent monocular common strabismus correction surgery at Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong between October 2017 and March 2018 were selected,and 39 eyes undergoing strabismus surgery were the operation group and 39 non-surgical eyes were the control group.The strabismus surgery was performed by conjunctival fornix incision,and eye examinations such as breakup time of tear film and corneal fluorescence staining examination were performed on patients on the 1st day before surgery,the 1st day after surgery,the 7th day after surgery,and the 30th day after surgery,respectively.The number of eyes that met the diagnosis of dry eye after surgery was counted.Results:In the operation group,12 cases(30.7%)met the diagnosis of dry eye on the 1st day after operation,10 cases(25.6%)on the 7th day after operation,and 2 cases(5%)on the 30 th day after operation.The tear film breakup time of the operation group was lower than that of the control group on the 1st,7th,and 30th day after operation(all P<0.001)and was also lower than that on the first day before operation(all P<0.001).The corneal fluorescence staining scores of the operation group were higher than those of the control group on the 1st and 7th day after operation(all P<0.01),and higher than those on the 1st day before operation(all P<0.01).There was no significant difference between the operation group on the 30th day after operation and the 1 day before operation(P<0.05).Conclusion:Fornix incision strabismus surgery may cause the decrease of tear film stability and the destruction of ocular surface function,but the ocular surface function of most patients will return to the normal range in a short time.