复发性翼状胬肉切除角膜缘重建术后泪膜功能变化

目的 评价角膜缘重建术治疗复发性翼状胬肉手术前后泪膜功能的变化.方法 对30例(30只眼)单侧复发性翼状胬肉患者实施翼状胬肉切除、自体健眼角膜缘联合球结膜片移植术,重建角膜缘屏障功能.进行全面的眼科查体及相关的全身查体,排除睑板腺功能障碍、糖尿病、类风湿性关节炎及甲状腺机能亢进等影响泪液膜功能的疾病;记录术前1天及术后1月、2月、3月泪膜破裂时间(BUT)、基础泪液分泌试验(Schirmer Ⅰ testS Ⅰt)、角膜荧光素染色(FL)的结果.术前与健眼对照;术后不同时间结果与术前对照.结果 术前与健眼比较:患眼的BUT明显缩短(P＜0.01)、S Ⅰ t明显减少(P＜0.01)、FL评分明显高于健眼(P＜0.01).患眼手术前后比较:术后1个月:三项试验与术前无统计学意义(P＞0.05).术后2个月情况:BUT明显延长(P＜0.01),S Ⅰt比术前增加(P＜0.01),FL评分比术前显著降低(P＜0.01);但该时期的测试结果与健眼:BUT及FL评分仍存在差异(P＜0.01),而S Ⅰt已接近健眼水平(P＞0.05).术后3个月:三项试验已恢复到健眼水平(P＞0.05).结论 复发性翼状胬肉患者常合并泪膜功能异常,而翼状胬肉切除并角膜缘重建术可使患眼的泪膜功能得到很大程度的改善.     

不同手术方式对翼状胬肉患者泪液功能的影响

目的:探讨不同手术方式对翼状胬肉患者泪液功能的影响及其可能机制。方法:翼状胬肉患者50例50眼,随机分成两组,A组30例30眼行翼状胬肉切除联合带蒂结膜瓣移植术,B组20例20眼行翼状胬肉切除联合自体角膜缘干细胞移植术,分别于术前和术后1,3mo检查泪膜破裂时间(BUT)、SchirmerI试验、角结膜荧光素染色(CFS)、泪液羊齿状物试验(TFT),采用眼表疾病指数(OSDI)评价胬肉及胬肉切除术后泪液功能变化对患者生活质量的影响,并作统计学分析。结果:两组术后1moBUT缩短、CFS增多、OSDI变高、泪液羊齿结晶形成较差,和术前比较差异有显著意义(P<0.05),而术后1moSchirmerI和术前比较差异无显著意义。两组术后3moBUT,SchirmerI,CFS,OSDI,TFT和术前比较差异无显著意义。术后1moB组BUT较A组长,CFS较A组少,OSDI较A组高,泪液羊齿结晶形成较A组良好,差异有显著意义(P<0.05),而术后1mo两组SchirmerI比较差异均无显著意义。术后3mo两组BUT,SchirmerI,CFS,OSDI,TFT比较差异均无显著意义。结论:翼状胬肉切除术后早期对泪膜功能有影响,术后3mo泪膜功能恢复至术前水平。行翼状胬肉切除联合自体角膜缘干细胞移植术后早期对泪膜功能的影响小于翼状胬肉切除联合带蒂结膜瓣移植术。     

Are high-water-content contact lenses safe?

We examined the role of tear secretion on contact lens water content during selection. Tear secretion was estimated using Schirmers tests. High-water-content contact lenses compromised the tear film more than low-water-content contact lenses, hence they should not be advised in low or marginal Schirmers test cases. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which include unlabeled, unapproved, or investigative products or devices.     

翼状胬肉不同手术方法患者泪液功能的临床分析

目的探讨两种不同手术方式治疗翼状胬肉对泪液功能的影响及影响因素。方法选取翼状胬肉患者40例(40只眼)随机分成两组:A组20个病人(20只眼)翼状胬肉切除联合冻干羊膜移植术;B组20个病人(20只眼)翼状胬肉切除联合带自体角膜缘干细胞结膜瓣移植术。术前,术后1mo,术后3mo行泪膜破裂时间(BUT)、泪液分泌试验(SchirmerI)、角膜荧光素染色(CSF),评价翼状胬肉及翼状胬肉切除术后泪膜功能变化对患者生活质量的影响。结果两组病人术后1moBUT缩短,角膜荧光素染色增多,差异有统计学意义(p<0.05),而术后SchirmerI与术前相比无统计学意义,两组术后3moBUT,SchirmerI,CFS与术前相比无统计学意义,翼状胬肉切除联合带自体角膜缘干细胞结膜瓣移植术组术后早期泪膜稳定性优于翼状胬肉切除联合冻干羊膜移植术,差异具有统计学意义(p<0.05)。结论翼状胬肉切除术早期对泪膜功能有影响。翼状胬肉切除联合带自体角膜缘干细胞结膜瓣移植术早期对泪膜的影响小于翼状胬肉切除联合冻干羊膜移植术。     

The acute effects of sildenafil on tear functions

The acute effects of 50 mg of sildenafil on tear functions were evaluated in 12 impotent patients. Mean tear breakup time, cotton thread, and Schirmer I tests were 19.42±6.45 s, 13.92±6.63 mm, and 16.58±12.19 mm, respectively before sildenafil and 20.33±10.40 s, 10.92±6.14 mm, and 18.08±12.36 mm, respectively, 1 hour after sildenafil. The results suggest that sildenafil does not adversely affect tear functions. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

翼状胬肉切除联合带蒂结膜瓣移植术对泪液功能的影响

目的:评价翼状胬肉切除联合带蒂结膜瓣移植术对翼状胬肉患者泪液功能的影响情况。 方法:对入选的翼状胬肉患者行胬肉切除联合带蒂结膜瓣移植手术,在术前1d;术后3,7d;术后1mo做泪膜破裂时间(BUT) 、泪液分泌(Schirmer Ⅰ)试验和泪液羊齿状试验(TFT),在术前1d和术后1mo做结膜印迹细胞学检查, 以评价患者术前、术后的泪液功能。 结果:共纳入87例87眼患者,其中男45例, 女42例。年龄45～81（ 平均64.1±8.8）岁。术后1mo BUT较术前1d延长,分别为11.47±3.23s和9.43±3.25s (P<0.05);术前羊齿状试验结果正常(Ⅰ级和Ⅱ级)的患者占22%,术后1mo正常的患者增加至90%,术后1mo TFT较术前明显改善(P<0.05);术后杯状细胞密度要高于术前结膜杯状细胞密度,分别为39.73±18.46个/10个高倍镜和48.85±18.80/10个高倍镜 (P<0.05)。泪液分泌Ⅰ试验结果显示术后早期分泌较术前增多(P<0.05),但术前、术后晚期差异无显著意义(P>0.05) 。 结论:胬肉切除联合带蒂结膜瓣移植术手术前后的泪液功能明显有改变, 手术可使患者的泪液功能得到一定的恢复。     

Tear function and goblet cell density after pterygium excision

PURPOSE: To evaluate the short-term effect of pterygium excision on tear function and conjunctival goblet cell density. METHODS: In all, 70 patients (70 eyes) with primary pterygia who underwent a bare-sclera procedure were enrolled in this study. Tear break-up time, Schirmer, and tear-ferning tests and conjunctival goblet cell density obtained by impression cytology were evaluated before and 1 month after surgery. RESULTS: At 1 month postoperation, the tear break-up time (11.49+/-3.76 s) was significantly prolonged when compared with the preoperation tear break-up time (9.74+/-3.43 s, P=0.002). Before surgery, only 17% of the patients showed normal crystallization in the tear-ferning test. This proportion was significantly increased to 90% 1 month after surgery (P<0.001). There is no significant difference in the Schirmer test value between pre- and postsurgery (P>0.05). The mean goblet cell density in conjunctival impression specimens before surgery was 41.82+/-18.29/10 fields, which was increased significantly 1 month after surgery (P<0.001) with a mean cell density of 50.67+/-18.71/10 fields. CONCLUSION: Tear function in patients with primary pterygium improves after pterygium excision, which indicates that pterygium has a close relationship with dry eye.     

翼状胬肉切除联合角膜缘干细胞移植术前术后的泪膜变化

目的：探讨翼状胬肉切除联合角膜缘干细胞移植手术前、术后泪膜功能的变化。方法：对24例24眼翼状胬肉患者行逆向胬肉切除联合自体角膜缘干细胞移植术,分别于术前1d;术后1,2mo行Schirmer试验和泪膜破裂时间（BUT）检查,比较各时间点上泪膜的稳定性。结果：患者24例术前1d;术后1,2mo SchirmerⅠ试验分别为15.5±7.81,15.76±7.39,16.00±8.05mm,BUT分别为8.15±3.611,10.05±3.03,10.50±4.26s,术前术后BUT差异具有统计学意义（P〈0.05）,Schirmer试验术后与术前比较无明显变化（P〉0.05）。结论：翼状胬肉切除联合角膜缘干细胞移植可以恢复眼表的形态及泪膜功能的稳定性。     

翼状胬肉扩大切除联合自体角膜缘干细胞移植术的效果观察

目的：观察翼状胬肉扩大切除联合自体角膜缘干细胞移植的手术效果。

方法：将59例60眼翼状胬肉患者,随机分为A,B两组,A组27例27眼行翼状胬肉单纯切除; B组32例33眼行翼状胬肉扩大切除联合自体角膜缘干细胞移植,比较两组复发率、角膜创面愈合时间、术后泪膜恢复情况。

结果：术后随访15～25(平均18±3.6)mo,A组复发8眼(30%),B组复发2眼(6%),B组术后角膜创面愈合时间较A组缩短,泪膜破裂时间长,两组差异具有统计学意义。

结论：翼状胬肉扩大切除联合自体角膜缘干细胞移植,角膜创面愈合快,术后复发率低,是一种安全、有效的方法。     

2型糖尿病患者不同翼状胬肉手术方式的疗效比较及其对泪膜的影响

目的:比较2型糖尿病患者三种不同翼状胬肉手术方式的疗效及其对泪膜的影响.方法:回顾分析我院2013-03/2016-03期间收治的手术治疗的翼状胬肉合并2型糖尿病患者102例102眼.其中行翼状胬肉单纯切除术34例34眼(单纯切除组);胬肉切除联合自体结膜瓣移植术34例34眼(球结膜瓣组);胬肉切除联合角膜缘干细胞移植术34例34眼(干细胞组).观察三组患者术后伤口修复时间、并发症、裸眼视力、复发率以及手术前、手术后6、12 mo三组患者泪膜破裂时间(BUT)、基础泪液分泌试验(SⅠt).结果:术后三组患者视力均较术前明显提高(P=0.039、0.013、0.024),且三组间比较无统计学差异(P=0.317).术后单纯切除组伤口修复时间为5.67±1.45d,明显大于球结膜瓣组(4.18±0.76d)与干细胞组(4.09±0.79d),差异有统计学意义(P<0.001);而结膜瓣组与干细胞组比较无统计学差异(P=0.937).术后单纯切除组有4例复发,复发率为11.8%,明显高于其它两组(P=0.037),球结膜瓣组有1例复发,复发率为2.9%,而干细胞组未见明显复发患者.术后SⅠt和BUT均明显增加(P<0.05),尤其是结膜瓣组和干细胞组增加比较显著(P<0.001).而球结膜瓣组和干细胞组间无统计学差异(P=0.845、0.894).结论:翼状胬肉切除联合结膜瓣移植和角膜缘干细胞移植对于治疗血糖和泪膜功能正常的2型糖尿病患者具有相似的疗效及术后泪膜功能,且优于单纯翼状胬肉切除术.     

胬肉切除联合结膜瓣移植治疗原发性翼状胬肉的疗效分析

目的:探讨翼状胬肉切除联合游离结膜瓣移植术治疗原发性翼状胬肉的疗效及对泪膜功能的影响。方法:选择2018-01/2019-10我院收治的120例126眼原发性翼状胬肉患者作为研究对象,按照随机数字表法分为2组,结膜移植组62例64眼行翼状胬肉切除联合游离结膜瓣移植术治疗,羊膜移植组58例62眼行翼状胬肉切除联合羊膜移植治疗。测定术前,术后3、6mo时泪液分泌长度(SⅠt)、泪膜破裂时间(BUT)、角膜荧光素染色(FL)评分、非侵入性首次泪膜破裂时间(NIBUT)、泪河高度(TMH)、结膜杯状细胞数量,采用眼表疾病指数(OSDI)评估患者生活质量,于术后6mo时评估治疗效果及复发情况。结果:结膜移植组及羊膜移植组患者角膜上皮平均修复时间、症状持续时间比较均无差异(P>0.05)。术后6mo结膜移植组患者BUT(11.11±2.77s vs 10.01±2.41s)、NIBUT(10.01±1.52s vs 9.52±0.98s)高于羊膜移植组(P<0.05),FL评分(0.44±0.10分vs 0.50±0.11分)低于羊膜移植组(P<0.05)。术后两组患者结膜杯状细胞数量均明显增加(P<0.05),术后3、6mo时结膜移植组患者结膜杯状细胞数量多于羊膜移植组(311.41±58.45/mm2vs 285.46±68.96/mm2,342.41±66.89/mm2vs 314.41±70.12/mm2,均P<0.05)。术后两组患者OSDI评分均显著降低(P<0.05),结膜移植组、羊膜移植组患者OSDI评分组间无差异(P>0.05)。两组患者总体疗效无差异(P>0.05);结膜移植组及羊膜移植组患者复发率分别为6.3%、6.5%,组间无差异(P>0.05)。结论:翼状胬肉切除联合自体结膜瓣移植在术后恢复及预防翼状胬肉复发方面与羊膜移植相当,对患者泪膜功能稳定性有更好的改善效果。     

Pterygium and dry eye

PURPOSE: To assess the correlation between dry eye and pterygium. METHODS: Tear breakup time (BUT), Schirmer test with/without anesthesia and tear function index were evaluated in both eyes of patients with unilateral pterygium. RESULTS: Tear BUT, was shortened significantly in the eye with pterygium. The Schirmer test with anesthesia was shortened and the tear function index was decreased in the eye with pterygium with marginal significance. CONCLUSION: There is a correlation between pterygium formation and shortened BUT. Unstable tear film may contribute to the initiation of pterygium.     

翼状胬肉患者手术前后泪膜功能的变化(英文)

目的:通过观察翼状胬肉患者行翼状胬肉转位术前后泪膜功能的变化,分析翼状胬肉手术治疗与患者泪膜功能的关系。方法:对20例20眼翼状胬肉患者行胬肉转位术,于术前1d;术后1,2,4,6wk分别进行泪液分泌(SchirmerI)试验、泪膜破裂时间(break-uptime,BUT)检查。结果:翼状胬肉眼手术前后比较:术前和术后不同时间的SchirmerI试验结果差异无显著性;术后6wkBUT值较术前延长(P<0.05)。结论:翼状胬肉转位术可使患者泪膜功能得到一定程度的改善。     

角膜缘上皮移植与羊膜移植治疗原发性翼状胬肉的对比观察

目的：对比观察翼状胬肉切除联合角膜缘上皮移植术与羊膜移植术对原发性翼状胬肉复发率的影响。
　　方法：采用随机对照分组的方法将我院手术治疗的原发性翼状胬肉患者99例103眼随机分为A,B两组。 A组为角膜缘上皮移植术组( n=54眼),采用翼状胬肉切除联合角膜缘上皮移植术;B组为羊膜移植术组( n=49眼),采用翼状胬肉切除联合羊膜移植术。术后随访1a,以泪膜破裂时间( breaking-up time,BUT)、复发率等指标作为分析参考指标。
　　结果：术后1a,联合角膜缘上皮移植术组有4眼(7.4%)复发。联合羊膜移植术组有11眼(22.5%)复发。两组复发率比较,差异有统计学意义( P<0.05)。两组间BUT比较无统计学意义(P>0.05)。
　　结论：相比羊膜移植术,翼状胬肉切除联合角膜缘上皮移植术治疗原发性翼状胬肉,能更有效的降低术后复发率。     

单侧翼状胬肉患者50例泪液功能的改变(英文)

目的:检测泪液功能试验(SchirmerⅠtest,SⅠt)及泪膜破裂时间(tear filmbreak-up time,TBUT)在翼状胬肉患者中的改变。方法:筛选50例患者(100眼,50例翼状胬肉眼),行SⅠt及TBUT试验。结果:SⅠt试验在翼状胬肉眼的平均值为19.6±11.6 (1 ～40) mm,对照眼为17.2±10.6(1 ～35)mm,翼状胬肉眼中20例(40%)SⅠt试验结果异常,对照眼为21例(42%),其差异无统计学意义(P=075)。两组间差异无统计学意义(t=1.453,P=0.15)。TBUT在翼状胬肉眼及对照眼中分别为7.4±5.1 ( 2 ～20)s, 13.4±6.1 (2 ～25)s,两组间的差异有显著统计学意义(t=8.029,P<0.01)。翼状胬肉眼中TBUT异常的为39眼(78%),对照眼中为16眼(32%);差异有显著统计学意义(P<0.01)。结论:与对照眼相比较,SⅠt试验在翼状胬肉眼中差异无统计学意义,TBUT在翼状胬肉眼中有所下降。     

Study on tear function abnormality in pterygium

The purpose of this study was to determine whether there is any abnormality in the tear function in patients with pterygium. Eighty-four patients with pterygia (56 with unilateral and 28 with bilateral involvement) and 45 healthy controls were entered in the study. Schirmer's test, breakup time test and mucus fern test were applied to both eyes of the subjects. This was a prospective, comparative and interventional study. Tear function test results between the eyes with pterygium and controls were compared. They were similar in the eyes with or without pterygium. There were no tear function abnormalities in pterygium.     

No effects of long-term sildenafil treatment on ocular functions

Purpose Sildenafil is a new and effective oral medication for the treatment of erectile dysfunction. The purpose of this study was to assess the long-term effects of sildenafil on visual acuity, color vision, intraocular pressure (IOP), electroretinography (ERG), blue-on-yellow and white-on-white Humphrey visual field (HVF), and tear functions. Methods Ten impotent patients ingested 50 mg of sildenafil one or more times a week for a minimum of 3 months. Ten age-matched subjects without any ophthalmological disorders other than refractive problems served as controls. Visual acuity (Snellen), color discrimination (Ishihara), and a slit-lamp examination were performed on the patients. Cotton thread and Schirmer I tests and tear break-up time were applied to random eyes of all subjects. IOP was measured in both eyes of the patients by Goldmann applanation tonometry. Both eyes of each subject were tested with white-on-white (fastpac 30-2, size 3 stimulus) followed by blue-on-yellow (fastpac 30-2, size 5 stimulus) HVF analyzer. ERG in scotopic (dark-adapted) condition was performed with unipolar corneal electrodes and rod response was recorded. Results In comparison with control, no clinically or statistically significant differences were detected in the patients ingesting sildenafil with regard to the visual acuity, color discrimination, IOP, mean deviation, cotton thread and Schirmer I tests, tear break-up time, amplitude, and implicit time of b-wave. Conclusion Long-term treatment with sildenafil did not produce any significant abnormality on ocular functions. Repeated exposures of ocular tissues to therapeutic doses of sildenafil are unlikely to impair their functions. The authors do not have any significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes, unlabeled, unapproved, or investigative products or devices.     

翼状胬肉切除联合带自体角膜缘干细胞的结膜移植治疗复发性翼状胬肉

目的：观察翼状胬肉切除联合带自体角膜缘干细胞的结膜移植治疗复发性翼状胬肉的临床疗效。 方法：复发性翼状胬肉患者84例,随机分为两组,研究组（43例43眼）行翼状胬肉切除联合带自体角膜缘干细胞的结膜移植术;对照组（41例41眼）行翼状胬肉切除联合自体结膜移植术。术后随访12mo,观察角膜上皮愈合时间、术后1,3 mo行泪膜破裂时间（ BUT）、泪液分泌试验（ S玉t试验）、角膜荧光染色检查（ FL）、复发率,评价其临床疗效。 结果：研究组比对照组术后角膜上皮愈合时间短、复发率低（P〈0.05）,但在术后1mo及3mo的BUT,S玉t试验,FL方面并无优越性（P〉0.05）。 结论：翼状胬肉切除联合带自体角膜缘干细胞的结膜移植是治疗复发性翼状胬肉的一种方便、安全、有效的方法。     

双通道视觉质量分析系统评价翼状胬肉手术前后患者的视觉质量

目的　利用视觉质量分析系统对翼状胬肉切除前后患者的客观光学质量变化进行分析。方法　选取我院2016年9月至2017年5月在武汉大学人民医院眼科中心确诊为单眼翼状胬肉并且进行翼状胬肉切除伴自体结膜瓣移植手术患者20例20眼,根据翼状胬肉尺寸大小分为小胬肉组10例10眼和大胬肉组10例10眼,采用双通道视觉质量分析系统Ⅱ进行视觉质量检测,记录健康眼及患眼术前、术后1个月、3个月的调制传递函数截止频率（modulation transfer function cut off,MTF_cutoff）、斯特列尔比（Strehl ratio,SR）、基础客观散射指数及总客观散射指数值,通过计算得出泪膜客观散射指数（tear film objective scatter index,TF-OSI）。结果　与术前相比,两组中患眼术后3个月MTF_cutoff、SR均升高,TF-OSI降低,差异均有统计学意义（均为P<0.05）,而术前与术后1个月相比两组三项视觉质量参数无明显统计学差异（均为P>0.05）。两组之间的视觉质量参数相比,只有术后3个月的MTF_cutoff、SR、TF-OSI比较差异具有统计学意义（均为P<0.05）,术前与术后1个月的视觉质量参数均无统计学意义（均为P>0.05）。两组中健康眼与患眼术前相比MTF_cutoff、SR、TF-OSI均有统计学意义（均为P<0.05）。结论　翼状胬肉会影响视觉质量及泪膜功能,早期手术切除能够带来改善,但这种改善可能出现在术后较长的一段时间内。利用视觉质量分析系统Ⅱ可以对手术前后的结果进行客观分析,MTF_cutoff、SR、TF-OSI可作为综合指标来评价临床上翼状胬肉患者的视觉质量。