闭合式玻璃体切除手术后早期患者泪膜功能的变化

目的 观察闭合式玻璃体切除手术对泪膜的影响及术后泪膜功能的恢复情况.方法 42例(42眼)行玻璃体切除手术的患者,分别于术前1 d,术后1、3、7、14 d、1个月及3个月询问患者是否存在不适症状,并行泪膜破裂时间(Break-Up Time,BUT)、泪液分泌试验(Schirmer I test,SIt)、角膜荧光素染色(Cornea Fluorescein Staining,CFS)检查.结果 与手术前相比,术后第1天患者的不适症状评分和CFS评分较术前显著增加(P＜0.01),无法形成稳定的泪膜,而SIt显著增加,83.3%的患者(35例) SIt＞30.0 mm,其余7例患者SIt均＞25.0 mm.术后第3、7天的不适症状评分较术前增加且差异显著(P＜0.01,P＜0.05),至术后14 d恢复至术前水平(P＞0.05).术后第3、7、14天,BUT较术前减少且差异显著(P＜0.01),SIt和CFS较术前增加且差异显著(P＜0.01).至术后1个月,BUT较术前仍减少且差异显著(P＜0.05),SIt和CFS与术前相比差异不显著(P＞0.05),恢复至术前水平.至术后3个月,BUT也恢复至术前水平(P＞0.05).结论 玻璃体切除术可显著影响泪膜的稳定性,至术后3个月,所有检查项目完全恢复至术前水平.

Early tear film changes after closed vitrectomy: a prospective randomized study

Objective To evaluate tear film changes and recovery after closed vitrectomy.Methods Forty-two consecutive patients undergoing vitrectomy(42 eyes)were involved in this prospective randomized study.Uncomfortable symptoms were inquired,as well as tear break-up time(BUT),Schirmer I test(SIt)value and corneal fluorescein staining(CSF)were measured on preoperative day 1 and postoperative day 1,3,7,14 as well as in 1 month and 3 months postoperatively.Results On postoperative day 1,the dry eye symptoms scores and CFS scores increased significantly(P<0.01),and the stable tear film failed to form.However,the SIt value of 35 patients exceeded 30 mm,while that of the rest 7 patients exceeded 25 mm.On postoperative day 3,7,the dry eye symptoms scores increased significantly(P<0.01,P<0.05),and returned to their preoperative values on day 14(P>0.05).On postoperative day 3,7,14,the mean BUT decreased significantly(P<0.01),the mean SIt value and CFS scores increased significantly(P<0.01).At 1 month after operation,the mean BUT was still significantly lower than that before operation(P<0.05),while the mean SIt value and CFS scores returned to their preoperative values(P>0.05).At 3 months after operation,the mean BUT returned to the level before operation(P>0.05).Conclusion Vitrectomy significantly alters the stability of tear film.The tear film function returned to preoperative conditions in 3 months after operation.