斜视术后眼表及睑板腺功能变化的危险因素分析OACSTPCD
Analysis of risk factors for changes in ocular surface and facial gland function after strabismus
目的 探讨斜视患者术后眼表及睑板腺功能变化及其危险因素分析.方法 回顾性病例对照研究.选取2019年1月至2021年6月我院收治的126例(188只眼)斜视患者为研究对象,根据手术切口将患者分为角膜缘切口组(A组)、跨肌止端切口组(B组)、近穹隆切口组(C组)三个组别,分别于术后1周、术后1个月、术后6个月观察患者的眼表与睑板腺功能变化,并分析眼表与睑板腺功能变化的单因素,采用Logistic回归分析进一步明确影响斜视患者术后眼表与睑板腺功能变化的因素.结果 眼表疾病评分指数(OSDI)、角膜上皮荧光染色评分(CFSS)、泪膜脂质层厚度(LLT)、SchirmerⅠ试验(SⅠt)、泪膜破裂时间(TBUT)、睑板腺开口评分的组间比较有统计学意义(F组间=35.912、28.093、32.115、35.021、32.984、35.765,P<0.05),不同时间点比较差异有统计学意义(F时点=67.982、69.038、62.091、59.181、64.282、61.224,P<0.05),同时各指标的组间与时点之间存在交互效应(F交互=52.126、56.098、55.223、59.719、54.033、49.914,P<0.05).其中C组OSDI、CFSS、LLT、SⅠt、TBUT、睑板腺开口评分改善优于B组、A组(P<0.05).性别、家族病史、术前立体视觉异常、合并弱视与斜视患者术后眼表与睑板腺功能恢复无关(P>0.05).发病年龄、病程、无控制正位、术后无立体视觉训练、手术切口、手术累及肌肉数目是影响斜视患者眼表与睑板腺功能恢复的影响因素(P<0.05).进一步使用Logistic回归分析结果显示,发病年龄>9岁、病程>1年、手术行角膜缘切口或跨肌止端切口、手术累及肌肉数目≥2条、术后无立体视觉训练是影响斜视患者术后眼表与睑板腺功能恢复的独立危险因素(P<0.05).结论 斜视患者手术时行近穹隆切口对其术后眼表与睑板腺功能恢复最佳.发病年龄>9岁、病程>1年、手术行角膜缘切口或跨肌止端切口、手术累及肌肉数目≥2条、术后无立体视觉训练均是影响斜视患者术后眼表与睑板腺功能恢复的危险因素.
Objective To explore the changes of ocular surface and meibomian gland function and analysis of risk factors in patients with strabismus after operation.Methods Retrospective case-control study.126 strabismus patients(188 eyes)admitted to our hospital from January 2019 to June 2021 were selected as the research objects.According to the surgical incision,the patients were divided into three groups:limbal incision group(group A),transmuscular end incision group(group B),and near-fornix incision group(group C).The changes of ocular surface and meibomian gland function were observed at 1 week,1 month,and 6 months after operation,respectively.The univariate factors of ocular surface and meibomian gland function changes were also analyzed,and logistic regression analysis was used to further clarify the factors affecting postoperative ocular surface and meibomian gland function changes in patients with strabismus.Results The comparison between groups of OSDI,CFSS,LLT,SIt,TBUT and meibomian gland opening score was statistically significant(Fgroup=35.912,28.093,32.115,35.021,32.984,35.765,P<0.05).There were significant differences between different time points(Ftime point=67.982,69.038,62.091,59.181,64.282,61.224,P<0.05).At the same time,there is an interaction effect between groups and time points of each index(Finteraction=52.126,56.098,55.223,59.719,54.033,49.914,P<0.05).The postoperative recovery of ocular surface and meibomian gland function in patients with strabismus was not related to gender,family medical history,abnormal preoperative stereopsis,and combined amblyopia(P>0.05).The recovery of ocular surface and meibomian gland function in optic patients was related to the age of onset,disease course,uncontrolled orthoposition,no postoperative stereo vision training,surgical incision,and the number of muscles involved in surgery(P<0.05).Further logistic regression analysis showed that the age of onset>9 years old,the course of disease>1 year,the lim-bus incision or transmuscular end incision was performed,the number of muscles involved in surgery was≥2,and there was no postoperative stereo vision training were independent risk factor affecting the recovery of ocular surface and meibo-mian gland function in patients with strabismus after surgery(P<0.05).Conclusions The near-fornix incision in strabis-mus patients had the best postoperative recovery of ocular surface and meibomian gland function.Age of onset>9 years old,the course of disease>1 year,the limbus incision or transmuscular end incision was performed,the number of muscles in-volved in surgery was≥2,and there was no postoperative stereo vision training were independent risk factor affecting the recovery of ocular surface and meibomian gland function in patients with strabismus after surgery.
赵智华;李科军;张茵;牛佳琳
050000 石家庄,河北省人民医院眼科050000 石家庄,河北省人民医院眼科050000 石家庄,河北省人民医院眼科050000 石家庄,河北省人民医院眼科
斜视眼表功能睑板腺功能手术危险因素
StrabismusOcular surface functionMeibomian gland functionSurgeryRisk factors
《临床眼科杂志》 2024 (3)
242-246,5
河北省医学科学研究课题计划(20190341)
评论