摘要： 目的·分析唇黏膜移植重建睑缘术后的眼表及泪膜状态。方法·选择2017年11月至2019年12月在上海交通大学医学院附属第九人民医院眼科就诊的15例睑缘缺损患者为研究对象。均行唇黏膜移植术重建上睑缘，术后6~8周行眼表综合分析仪检查，包括：泪河高度（tear meniscus height，TMH）、泪膜破裂时间（tear film breakup time，BUT）和泪液分泌试验。术后复查时测量双眼睑裂高度（palpebral fissure height，PFH）和提上睑肌功能（levator function，LF）。术眼相关数据与自身健眼对应数据比较。患者在术后6~8周时填写眼表疾病指数（Ocular Surface Disease Index，OSDI）量表。结果·健眼TMH（0.24±0.07）mm，术眼TMH（0.23±0.11）mm，差异无统计学意义（
P=0.316）；健眼BUT（10.75±2.31）s，术眼BUT（7.75±2.05）s，差异无统计学意义（
P=0.065）；泪液分泌试验中健眼（10.20±1.96）mm/5 min，患眼（9.33±2.04）mm/5 min，差异无统计学意义（
P=0.376）；健眼PFH（10.16±1.18）mm，患眼PFH（10.11±2.11）mm，差异无统计学意义（
P=0.761）；健眼LF（9.59±0.93）mm，患眼LF（9.03±1.02）mm，差异无统计学意义（
P=0.552）。患者OSDI量表平均得分为26.44±3.88。结论·唇黏膜移植重建睑缘术后6~8周可获得较为满意的泪膜稳定性和双眼对称度；OSDI量表提示患者术后6~8周时可能存在干眼。
关键词: 睑缘缺损, 唇黏膜移植, 睑缘重建, 眼表 Abstract: Objective·To analyze the condition of ocular surface and tear film after reconstruction of palpebral margin with lip mucosa graft.
Methods·Fifteen patients with palpebral margin defect who were treated in the Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from November 2017 to December 2019 were selected. All patients underwent the lip mucosa graft for palpebral margin reconstruction. A series of ocular surface examination, some ophthalmological physical examination and a questionnaire were prepared for each patient 6?8 weeks after surgery. The ocular surface examination was constituted of tear meniscus height (TMH), tear break-up time (BUT) and Schirmer test. The ophthalmological physical examination included affected palpebral fissure height (PFH) and levator function (LF). Finally, Ocular Surface Disease Index (OSDI) was used as a questionnaire.
Results·There was no significant difference in TMH between fellow eyes and operated eyes [(0.24±0.07) mm vs (0.23±0.11) mm, P=0.316]. There was no significant difference in BUT between fellow eyes and operated eyes [(10.75±2.31) s vs (7.75±2.05) s, P=0.065]. There was no significant difference in the result of Schirmer text between fellow eyes and operated eyes [(10.20±1.96) mm/5 min vs (9.33±2.04) mm/5 min, P=0.376]. There was no significant difference in PFH between fellow eyes and operated eyes [(10.16±1.18) mm vs (10.11±2.11) mm, P=0.761]. There was no significant difference in LF between fellow eyes and operated eyes [(9.59±0.93) mm vs (9.03±1.02) mm, P=0.552]. The score of OSDI was 26.44±3.88 in average.
Conclusion·The lip mucosa graft for treating palpebral margin defects gives a satisfactory result in tear film stability and binocular symmetry. Patients may have dry eyes according to the score of OSDI 6?8 weeks after surgery.
Key words: palpebral margin defect, lip mucosa graft, palpebral margin reconstruction, ocular surface PDF全文下载地址:
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