中华眼底病杂志

中华眼底病杂志

微创玻璃体切割手术对绝经后增生型糖尿病视网膜病变患者眼表功能的影响

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目的 观察微创玻璃体切割手术(MIV)对绝经后(PM)增生型糖尿病视网膜病变(PDR)患者眼表功能的影响。 方法 前瞻性临床对照研究。行MIV治疗的女性PDR患者61例61只眼纳入研究。其中,PM患者31例31只眼(PMW组),非PM患者30例30只眼(非PMW组),未手术眼为对照眼。手术前1 d,手术后1、10 d,1、3个月行角膜荧光素钠染色(FL)评分、泪膜破裂时间(TBUT)、基础泪液分泌试验(SIT)、中央角膜知觉和眼表主观症状(OSDI)评分的检测与评估。采用t 检验、Mann-WhitneyU检验和重复测量的方差分析进行统计学分析。 结果 手术前1 d,PMW组手术眼和对照眼TBUT均低于非PMW组,差异有统计学意义(t=−2.115,−2.035,P<0.05);OSDI评分高于非PMW组,差异有统计学意义(t=2.482,2.208,P<0.05)。手术后1、10 d,PMW组手术眼TBUT降低程度(Z=2.771,1.993)、OSDI评分增加程度(Z=2.539,2.157)均高于非PMW组,差异有统计学意义(P<0.05);SIT长度低于非PMW组,差异有统计学意义(t=−2.403,−2.029,P<0.05)。与手术前相比,非PMW组手术眼FL、OSDI评分于手术后10 d恢复至手术前(Z=−0.447,−0.513,P>0.05);PMW组手术眼手术后1个月恢复至手术前(Z=−1.500,−0.853,P>0.05);PMW和非PMW组手术眼TBUT、SIT均于手术后1个月恢复至手术前(Z=−0.715,−1.266,−1.531,−0.522,P>0.05)。手术后各时间点PMW组、非PMW组手术眼(Z=–1.941、–2.315、–2.872、–2.363、–3.763、–4.002、–3.412、–2.817)、对照眼(Z=–1.987,–2.012,2.311,2.543,–2.464,–3.128,2.487,3.531)中央角膜知觉比较,差异均无统计学意义(P>0.05)。 结论 PMW的PDR患者眼表功能差;MIV后易出现眼表泪液系统的损害,且持续时间长、恢复慢。

Objective To evaluate ocular surface changes following minimal vitreoretinal surgery in postmenopausal women patients with proliferative diabetic retinopathy (PDR). Methods Sixty-one women PDR patients (61 eyes) underwent vitreous microsurgery were recruited in this prospective study, including 31 postmenopausal women (PMW group) and 30 non-postmenopausal women (non-PMW group). The contralateral eyes were considered as the control group. Corneal fluorescein (FL) staining, tear break-up time (TBUT), Schirmer I test (SIT), central corneal sensitivity and ocular surface disease index (OSDI) were estimated. All tests were carried out 1 day preoperatively and 1 day, 10 days, 1 month and 3 months postoperatively. The student’st test or Mann-WhitneyU and ANOVA for repeat measurements test were used. Results Preoperatively, TBUT of surgery and non-surgery eyes in PMW were shorter than non-PMW (t=−2.115, −2.035;P<0.05), but higher OSDI scores were found in PMW (t=2.482, 2.208;P<0.05). TBUT reduction rate (Z=−2.771, −1.993;P<0.05) and OSDI rising rate (Z=2.539, 2.157;P<0.05) of surgery eyes in PMW were higher than non-PMW 1 day and 10 days postoperatively. The lower SIT of surgery eyes in PMW were observed at 1 day and 10 days (t=−2.403, −2.029;P<0.05) after surgery. At 10 days after surgery, FL and OSDI scores of surgery eyes in non-PMW returned to preoperative level (Z=−0.447, −0.513;P>0.05), but in PMW, the recovery process experienced 1 month (Z=−1.500, −0.853;P>0.05). TBUT and SIT of surgery eyes in two groups both reached preoperative level at 1 month following surgery (Z=−0.715, −1.266, −1.531, −0.522;P>0.05). Conclusions PMW with PDR had ocular surface dysfunction, which resulted in aggravated dry eye after minimal vitreoretinal surgery.

关键词: 玻璃体切除术/副作用; 绝经期; 眼表

Key words: Vitrectomy/adverse effects; Menopause; Ocular surface

引用本文: 高韶晖, 栗占荣, 裴晗, 李士清, 赵朝霞. 微创玻璃体切割手术对绝经后增生型糖尿病视网膜病变患者眼表功能的影响. 中华眼底病杂志, 2017, 33(3): 252-256. doi: 10.3760/cma.j.issn.1005-1015.2017.03.008 复制

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