The Clinical Research Of Changes Of Ocular Surface At Early Stage After Surgery For The Elderly Angle-closure Glaucoma Patients

Objective:To study the early Influence of trabeculectomy on Ocular Surface for the elderly angle-closure glaucoma glaucoma patients.Methods:105eyes of105randomly-selected patients with glaucoma who had integrated data underwent trabeculectomy in shengli hospital of Shandong from October2009to June2011. In which men are60cases(60eyes),women are45cases(45eyes).age ranges from65to81,average value is74.53±8.16. All subjects were divided into5-FU group and bank group according to using5-fluorouracil (5-FU) under conjunctiva and sclera in the operation or not. Routine ophthalmic examinations and ocular surface test were performed in all subjects preoperatively and1week、1month、3months、and6months postoperatively, including intraocular pressure(IOP), tear film break up time (BUT), tear Schirmer test I (ST Ⅰ),Fluorescein staining of cornea (FL) and conjunctiva impression cytology (CIC). And indexes of5-FU group and blank group were compared before operation and6months after operation. All data(IOP、BU、CIC) of re-measured three times and got average value,then they were statistically processed to acquire the difference between the preoperative and the postoperative adopting paired t-test and get the rule of changes of ocular surface.Results:1. intraocular pressure(IOP):the percentage of normal intraocular pressure (<21mmHg)is100%,97.1%,91.4%.85.7%on1week,1month,3months,6months after trabeculectomy respectively. Compared with the preoperative, there was significant difference (P<0.01).2. index of ocular surface test:Compared with the preoperative, Schirmer test I (STI) indicates secretion of tears reduce (P<0.01), Tear film break-up time(BUT) evidently shortened (P<0.01), score of FL raise up (P<0.01) on1week,1month after trabeculectomy; while conjunctiva goblet cell density decrease and score of FL raise up on3months after trabeculectomy, conjunctiva goblet cell density and score of FL on6months after trabeculectomy have already recovered the level of preoperative. Compared with the preoperative,there was no significant difference (P<0.01). at the same time, there was significant difference(P<0.01) between5-FU group and blank group in the change of tear film and ocular surface.Conclusions:1. The research confirmed that trabeculectomy evidently decrease pathological intraocular pressure, improve the symptoms of patients’complaint. trabeculectomy is effective means of glaucoma therapy.2.Trabeculectomy would effect tear secretion and distribution, and shortened tear film break-up time, decrease the stability of tear film, even resulting in the occurrence of dry eye. Nevertheless, tear secretion and the stability of tear film wound improve gradually with the time extending, and recover normal level of preoperative until the third month after trabeculectomy.3.Trabeculectomy wound result in reduction of conjunctiva goblet cell density, which is the main reason of complaint of patients.4.5-fluorouracil was able to aggratate ocular surface damage and tear film stability.