摘要目的 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1d,手术后1、10d,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-Whitney U检验和重复测量的方差分析进行统计学分析.结果 手术前1d,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、10d,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10d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.

abstractsObjective 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's t test or Mann-Whitney U 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).Conclnsions PMW with PDR had ocular surface dysfunction,which resulted in aggravated dry eye after minimal vitreoretinal surgery.