摘要
目的 探讨翼状胬肉患者术中角膜、结膜缺损面积与其术后干眼的相关性.方法 收集2021年10月至2022年6月于山西省眼科医院角膜病科行翼状胬肉切除术患者60例(60只眼)的临床资料.其中,男性23例(23只眼),女性37例(37只眼);年龄50～70岁,平均年龄(61.3±6.8)岁.术中测量全部患者的角膜与结膜缺损面积,并于术前3 d,术后2周、1个月及3个月进行眼表疾病指数(OSDI)评分、泪膜破裂时间(BUT)、泪河高度(TMH)、角膜荧光素染色(CFS)分级及脂质层分级等检查.检查结果以术后减去术前表示,即△检查项目.所有患者年龄、角膜缺损面积、结膜缺损面积、△OSDI评分、△BUT及△TMH均服从正态分布,采用(x)±s表示;△CFS分级及△脂质层分级不服从正态分布,采用中位数和四分位数表示.角膜缺损面积、结膜缺损面积与△OSDI评分、△BUT及△TMH的相关性采用Pearson分析,与△CFS分级及△脂质层分级的相关性采用Spearman分析.结果 翼状胬肉患者术后2周、术后1个月、术后3个月的△OSDI评分分别为(21.21±10.65)分、(13.80±5.30)分及(3.28±6.92)分;△BUT 分别为(-3.92±4.10)s、(-1.80±4.28)s 及(-0.49±3.53)s;△TMH 分别为(-0.15±0.09)mm、(-0.09±0.08)mm 及(-0.02±0.05)mm;△CFS 分级的平均中位数和四分位数分别为1.00(1.00,2.00)级、0.00(0.00,1.00)级及0.00(0.00,0.00)级;△脂质层分级的平均中位数和四分位数分别为1.00(1.00,2.00)级、0.00(0.00,1.00)级及0.00(-1.00,0.75)级.翼状胬肉患者术中角膜缺损面积与术后2周△OSDI评分、△CFS分级及△脂质层分级呈正相关性均具有统计学意义(r=0.659,0.864,0.535;P＜0.05),与术后2周△ BUT及△TMH 呈负相关性具有统计学意义(r=-0.422,-0.492;P＜0.05);与术后1个月△OSDI评分及△CFS分级呈正相关性均具有统计学意义(r=0.362,0.737;P＜0.05),与术后1个月△BUT及△TMH呈负相关性均具有统计学意义(r=-0.365,-0.354;P＜0.05);与术后3个月△CFS分级呈正相关性具有统计学意义(r=0.395,P＜0.05),与术后3个月△OSDI评分、△ BUT、△TMH及△脂质层分级无相关性均不具有统计学意义(r=0.105,-0.085,0.004,-0.031;P＞0.05).结膜缺损面积与术后2周△OSDI评分、△CFS分级及△脂质层分级呈正相关性均具有统计学意义(r=0.544,0.601,0.487;P＜0.05),与术后2周△BUT及△TMH呈负相关性均具有统计学意义(r=-0.267,-0.540;P＜0.05);与术后1个月△OSDI评分及△ CFS分级呈正相关性均具有统计学意义(r=0.294,0.586;P＜0.05),与术后1个月△BUT及△TMH呈负相关性均具有统计学意义(r=-0.291,-0.427;P＜0.05);与术后3个月△OSDI评分、△BUT、△ TMH、△ CFS分级及△脂质层分级无相关性不具有统计学意义(r=0.248,-0.004,-0.239,0.232,0.011;P＞0.05).结论 术中角膜、结膜缺损面积大小与术后泪膜稳定性相关,角膜与结膜的损伤共同参与了翼状胬肉切除术后干眼的发生与发展.
Abstract
Objective The aim of this study is to investigate the relationship between corneal and conjunctival defect areas and postoperative dry eye in patients with pterygium.Methods Sixty patients(60 eyes)who underwent pterygium excision in Shanxi Eye Hospital between October 2021 and June 2022.Among them,there were 23 males(23 eyes)and 37 females(37 eyes).with an average of(61.3±6.8)years(ranged from 50 to 70 years).The intraoperative corneal and conjunctival defect areas were measured.Eye examinations were performed before surgery for 3 days and after surgery for 2 weeks,1 month,and 3 months,including ocular surface disease index(OSDI)scores,breaking-up time(BUT),tear meniscus height(TMH),corneal fluorescein staining(CFS)grade and lipid layer grading.The examination results were represented by subtracting preoperative items from postoperative ones,namely △ examination items.Age,corneal defect area,conjunctival defect area,△OSDI score,△BUT and △TMH of patients followed a normal distribution and were described by(x)±s,and CFS grade and lipid layer grade were ordinal categorical variables that were expressed by frequency and percentile,and CFS grade and lipid layer grading did not follow a normal distribution and was described as a median(interquartile range).The correlation between corneal defect area and conjunctival defect area and OSDI score,BUT and TMH were analyzed using Pearson analysis.The correlation between corneal defect area and conjunctival defect area and CFS grade and lipid layer grade were analyzed using Spearman analysis.Results The △OSDI scores of pterygium patients after surgery for 2 weeks,1 month and 3 months were(21.21±10.65)scores,(13.80±5.30)scores and(3.28±6.92)scores,respectively.△BUT were(-3.92±4.10)s,(-1.80±4.28)s and(-0.49± 3.53)s,respectively.△TMH were(-0.15±0.09)mm,(-0.09±0.08)mm,(-0.02±0.05)mm,respectively.The mean median and quartile of the △CFS were 1.00(1.00,2.00)grade,0.00(0.00,1.00)grade,and 0.00(0.00,0.00)grade,respectively;the mean median and quartile of the lipid layer grade were 1.00(1.00,2.00)grade,0.00(0.00,1.00)grade,0.00(-1.00,0.75)grade.The area of corneal defect in patients with pterygium was positively correlated with △OSDI score,△CFS grade and lipid layer grade at 2 weeks after surgery,and the correlation was statistically significant(r=0.659,0.864,0.535;P＜0.05),and negatively correlated with △BUT and △TMH at 2 weeks after surgery,and the correlation was statistically significant(r=-0.422,-0.492;P＜0.05).It was positively correlated with△OSDI score and △CFS grade at 1 month after surgery,and the correlation was statistically significant(r=0.362,0.737;P＜0.05),and negatively correlated with △BUT and △TMH at 1 month after surgery,and the correlation was statistically significant(r=-0.365,-0.354;P＜0.05).It was positively correlated with △ CFS grade at 3 months after surgery,and the correlation was statistically significant(r=0.395,P＜0.05).There was no significant correlation with △OSDI score,△BUT,△TMH and lipid grade 3 months after surgery(r=0.105,-0.085,0.004,-0.031;P＞0.05).The area of conjunctival defect was positively correlated with △ OSDI score,△ CFS grade and lipid layer grade at 2 weeks after surgery,and the correlation was statistically significant(r=0.544,0.601,0.487;P＜0.05),and negatively correlated with △BUT and △TMH at 2 weeks after surgery,and the correlation was statistically significant(r=-0.267,-0.540;P＜0.05).It was positively correlated with △ OSDI score and △ CFS grade at 1 month after surgery,and the correlation was statistically significant(r=0.294,0.586;P＜0.05),and negatively correlated with △BUT and △TMH at 1 month after surgery,and the correlation was statistically significant(r=-0.291,-0.427;P＜0.05).There was no significant correlation with △ OSDI score,△BUT,△TMH,△ CFS grade,lipid layer grade at 3 months after surgery(r=0.248,-0.004,-0.239,0.232,0.011;P＞0.05).Conclusions The size of corneal and conjunctival defects during surgery is related to the stability of the tear film after surgery,and the damage to the cornea and conjunctiva jointly participates in the occurrence and development of dry eye after pterygium resection.
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