斜视青少年手术后眼表及睑板腺功能特征变化及影响因素分析

目的:探究斜视青少年手术后眼表及睑板腺功能特征变化,并分析相关影响因素。方法:回顾性研究。选取2019-01/12在我院行斜视手术的患儿168例224眼作为研究对象。根据手术切口将分为角膜缘切口组(A组,54例78眼),跨肌止端切口组(B组,48例62眼),近穹窿切口组(C组,66例84眼)。根据手术累及肌肉条数分为单条眼外肌组(68眼),双条眼外肌组(106眼)及三条眼外肌组(50眼)。评估患儿眼表健康状况,并采用LipiView眼表干涉仪等分析泪膜脂质层厚度(LLT)、泪河高度(TMH)、角膜荧光素染色评分(CFSS)、泪膜破裂时间(TBUT)、泪液分泌试验(SⅠt)和睑板腺开口情况。结果:术后1wk,三组患儿眼表及睑板腺功能均无明显差异。术后1mo,不同手术切口及手术累积不同肌肉条数患儿眼表及睑板腺功能均有明显改善(P<0.05),其中B组患儿TBUT明显高于A组(P<0.05),C组患儿的OSDI、CFSS、TBUT显著优于A组(P<0.05);且双条组患儿TMH显著高于单条组(P<0.05),三条组患儿的OSDI高于单条组(P<0.05)。术后3mo,各组患儿眼表及睑板腺功能均较术后1wk,1mo有显著改善(P<0.05);其中,C组患儿的OSDI、LLT、TMH、CFSS、TBUT及SⅠt均显著优于A组(P<0.05);双条组患儿TMH、CFSS、SⅠt及睑板腺开口情况均优于三条组,但差异无统计学意义(P>0.05),而双条和三条组患儿睑板腺开口评分低于单条组(P<0.05)。患儿OSDI、CFSS及睑板腺开口评分与手术累及肌肉数呈显著相关(P<0.05)。结论:近穹窿切口组患儿眼表及睑板腺功能恢复优于采用角膜缘切口组及跨肌止端切口组;且单条组患儿眼表及睑板腺功能恢复优于双条组及三条组患儿。采取的近穹窿切口,减少手术累及肌肉数,有利于青少年斜视术后眼表及睑板腺功能的恢复。

Changes of ocular surface and meibomian gland function and its influencing factors in strabismus adolescents after surgery

AIM:To investigate the characteristic changes of ocular surface and meibomian gland function after strabismus in adolescents and analyze the related influencing factors.METHODS:Retrospective study.Totally 168 cases(224 eyes)with strabismus surgery in our hospital from January 2019 to December 2019 were selected as the study objects.According to the surgical incision,all patients were divided into the limbal incision group(group A,54 cases,78 eyes),trans-muscular terminal-incision group(group B,48 cases,62 eyes),and near-fornix incision group(group C,66 cases,84 eyes).Based on the number of muscles involved in the operation,patients were divided into single extraocular muscle group(68 eyes),the double extraocular muscle group(106 eyes)and three extraocular muscle group(50 eyes).The children’s eye surface health were evaluated.Other eye index such as lipidlayer thickness(LLT),tear meniscus height(TMH),corneal fluorescence staining score(CFSS),tear film break up time(TBUT),tear secretion(SⅠt),and meibomial gland opening were analyzed by Lipiview eye surface interferometer.RESULTS:The eye surface and meibomian gland function presented no significant difference in groups after surgery 1wk.Postoperative 1mo,ocular surface and muscle operating meibomian gland function were improved significantly(P<0.05),which TBUT in group B was obviously higher than that of group A(P<0.05),and OSDI,CFSS,TBUT in group C were significantly better than that of group A(P<0.05).TMH of children in two groups was significantly higher than that of a single group(P<0.05),three children OSDI is higher than a single extraocular muscle group(P<0.05).Three month after surgery,the children with ocular surface and meibomian gland function were compared with postoperative 1wk and 1mo improved significantly(P<0.05).Among them,the OSDI,LLT,TMH,CFSS,TBUT and SⅠt of children in C group were significantly better than that of group A(P<0.05).And TMH,CFSS,SⅠt and meibomian gland orifices in other two groups were better than that of group A(P<0.05),double extraocular muscle group and three extraocular muscle group of children with meibomian gland orifices were lower than single extraocular muscle group(P<0.05).OSDI,CFSS and meibomian gland orifices score of children had significantly correlation with the surgery involving muscle number(P<0.05).CONCLUSION:Ocular surface and meibomian gland function recovery of children in the fornix incision group were better than that of corneal limbus incision group and across muscle check incision.The ocular surface and meibomian gland function recovery of children with single set were also better than that of children with two and three.Thus,taking nearly fornix incision and decreasing the number of the surgery involving the muscles was helpful to ocular surface and meibomian gland function recovery in the youth eye strabismus surgery.