微创切口巩膜扣带术后干眼的评估

doi:10.3760/cma.j.cn115909-20191206-00327

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Abstract Objective: To compare dry eye signs and symptoms after minimal in situ conjunctival incision for segmental scleral buckling surgery. Methods: In this prospective clinical study, consecutive patients, enrolled in the Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, from May 2015 to April 2017, who had minimal in situ conjunctival incision or standard segmental scleral buckling surgery were assessed. Dry eye markers including the ocular surface disease index (OSDI) and subjective symptom questionnaire, tear-film assessment using Keratograph 5M corneal topography, Schirmer Ⅰ testing, and fluorescein staining were sequentially evaluated preoperatively and at 1 day, 1 week, and 1 month postoperatively. A Chi-square test, Student's t-test or Mann-Whitney U test was used to compare differences between the two groups. Results: Seventy-eight patients (78 eyes) with similar baseline characteristics were recruited. Most patients developed dry eye postoperatively. Subjective symptoms and fluorescein staining scores elevated from baseline, tear break-up time and Schirmer Ⅰ testing values decreased postoperatively, which peaked at 1 day and did not return to baseline within 1 month. There were no significant differences between the 2 groups (all P>0.05) at 1 day and 1 week except for the higher tear meniscus height (Z=1.04, P=0.041), noninvasive first tear break-up time and average break-up time (t=2.51, P<0.001), and Schirmer Ⅰ test values (Z=2.34, P=0.043), in the minimal in situ conjunctival incision group at 1 month postoperatively. OSDI scores and subjective symptoms were lower in the minimal in situ conjunctival incision group at 1 week and 1 month postoperatively (OSDI: t1 week=2.54, P=0.012; Z1 month=-1.03, P=0.020; subjective symptoms: t1 week=3.04, P=0.011; t1 month=3.94, P<0.001). Sub group analysis using flouesecein staining showed obvious worsening 1 day, 1 week and 1 month postoperatively in patients with preoperative dry eye (Z=-2.42, P<0.001; Z=-1.54, P=0.034; Z=-1.83, P=0.041). Conclusions: Segmental scleral buckling surgery can induce or aggravate dry eyes. Compared with standard procedures, minimal in situ conjunctival incision segmental scleral buckling surgery can improve and shorten the ocular surface discomfort in the early postoperative period, especially in patients with dry eyes before surgery.

Key words： segmental scleral buckling surgery small incision dry eyes

Received: 06 December 2019

Fund:New Medical Technology Project of the First Affiliated Hospital of Xi'an Jiaotong University (XJYFY-2016W26, XJYFY-2017W61)

Corresponding Authors: Zhao Liu, Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China (Email: dr.liuzhao@foxmail.com)

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https://www.cjoovs.com/EN/ 10.3760/cma.j.cn115909-20191206-00327 OR https://www.cjoovs.com/EN/Y2020/V22/I8/582

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