两种基底结膜瓣小梁切除术对青光眼患者术后早期泪膜功能及远期动态泪膜稳定性的影响

目的比较两种基底结膜瓣小梁切除术对青光眼患者术后早期泪膜功能及远期动态泪膜稳定性的影响。方法将106例即将行结膜瓣小梁切除术的青光眼患者根据手术方式的不同分为A组(53例,61眼)和B组(53例,65眼)。A组采用以穹隆为基底结膜瓣小梁切除术,B组采用以角膜缘为基底结膜瓣小梁切除术。比较两组患者术后1 d及1、6、12个月的泪膜破裂时间(BUT)、泪液分泌试验(SⅠt)、泪膜不稳定及干眼症状发生情况。结果术后1 d及1、6、12个月,A组的BUT、SⅠt均短于B组,差异具有统计学意义(P<0.05)。术后1 d、1、6、12个月,A组的泪膜不稳定及干眼症状发生率均高于B组,差异具有统计学意义(P<0.05)。结论以角膜缘为基底结膜瓣小梁切除术治疗青光眼患者,其术后早期泪膜功能以及远期动态泪膜稳定性均明显优于以穹隆为基底结膜瓣小梁切除术,值得临床推广应用。

Effects of two kinds of basal conjunctival flap trabeculectomy on postoperative early tear film function and long-term dynamic tear film stability in patients with glaucoma

Objective To compare the effects of two kinds of basal conjunctival flap trabeculectomy on postoperative early tear film function and long-term dynamic tear film stability in patients with glaucoma.Methods A total of 106 patients with glaucoma undergoing conjunctival flap trabeculectomy were divided into group A(53 cases,61 eyes)and group B(53 cases,65 eyes)according to the different operation methods.The group A was treated with trabeculectomy with fornix as basal conjunctival flap,the group B was treated with trabeculectomy with limbus as basal conjunctival flap.Tear film break up time(BUT),SchirmerⅠtest(SⅠt),tear film instability and dry eye symptoms at 1 d,1 month,6 months and 12 months after operation were compared between the two groups.Results At 1 d,1 month,6 months and 12 months after operation,BUT and SⅠt in the group A were shorter than those in the group B,the differences were statistically significant(P<0.05).At 1 d,1 month,6 months and 12 months after operation,the incidence of tear film instability and dry eye symptoms in the group A were higher than those in the group B,the differences were statistically significant(P<0.05).Conclusion The early postoperative tear film function and long-term dynamic tear film stability of trabeculectomy with limbus as basal conjunctival flap in the treatment of glaucoma are significantly better than those of trabeculectomy with fornix as basal conjunctival flap,which is worthy of clinical promotion and application.