| Objective:To observe the stability changes of tear film after 25G~+minimally invasive vitrectomy in patients by using Keratograph 5M,and exploring the related factors,prevention and treatment methods of the corneal epithelial cell dysfunction(CED)postoperation.Methods:Section 1 The changes of tear film stability after 25G~+minimally invasive vitrectomy:According to the development of inclusion and exclusion criteria of this research,57 patients(57 eyes)was involved in this study,who was undergoing 25G~+minimally invasive vitrectomy in our hospital from October 12,2015 to June 1,2016.The ocular surface disease index(OSDI)questionnaire was carried out,as well as tear meniscus height(TMH),fist tear break up time(FTBUT),average tear break up time(ATBUT),index of eye congestion,lipid layer thickness and scores of cornea fluorescein staining(CFS)were measured in1day preoperatively plus 1days,3days,1week,2weeks,1month and 2months postoperatively.All check items was measured by Keratograph 5M,and carried out by the same examiner in a dark and quiet room with no wind,in which temperature and humidity was constant.At last,the examiner performed a statistical analysis of above results.Section 2 Clinical analysis of CED after minimally invasive vitrectomy:According to the diagnostic criteria of CED,23 patients(23 eyes)was involved in this study,who was complicated with CED after 25G~+minimally invasive vitrectomy in our hospital,from December 5,2015 to February 6,2017.Collecting the clinical datas of subjects,such as general situation,onset time of CED,the best corrected visual acuity(BCVA),with diabetes or not,the complications of the eye,the causes of operation,surgical approach,the filler in the vitreous cavity,and the postoperative medication,and gathering eyelid gland images.Then,giving treatments to all patients according to the treatment principles of CED.At last,collecting all subjects BCVA,recovery time,treatment efficacy,and performing a statistical analysis of above results.Results:Section 1 The changes of tear film stability after 25G~+minimally invasive vitrectomy:At 1day and 3days postoperatively,the lipid layer thickness of tear film,became thinner than 3 days preoperatively,and the difference was statistically significant(P<0.05);but there were no significant difference in the thickness of lipid layer between 1week,2weeks,1month,2months postoperatively and 3 days preoperatively(P>0.05).At 1 day,3 days,1 week postoperatively,scores of OSDI and CFS,TMH and index of eye congestion increased significantly(P<0.05),but with a downward trend.At 1 day,3 days,1 week postoperatively,FTBUT,ATBUT decreased significantly(P<0.05),and with a upward trend.At 2 weeks,1month and 2 months postoperatively,scores of OSDI and CFS,TMH,FTBUT,ATBUT and index of eye congestion returned to preoperative levels,with no statistical differences compared to preoperative index(P>0.05).Section 2 Clinical analysis of CED after minimally invasive vitrectomy:All subjects including 7males and 16 females,male:female=1:2.29,with average age by(52.52±9.64)years.Onset time of CED were(26.82±13.08)days,and average recovery time is(21.65±12.32)days through treatment.LogMAR BCVA was enhanced after treatment,from2.04±0.74 to 1.85±0.75,and there was significant change(t=3.963,P=0.007).14 eyes only accepted drugs therapy,6 eyes were treated with drugs and corneal bandage mirror,and 3 eyes were treated with auologous serumt as well as drugs.After treatment,11 eyes were recovered,9 eyes were got effective results but with not recovered,2 eyes were invalid,and 2 eyes(8.70%)were recured after healing.16 patients suffer from diabetes,15 patients with meibomian gland dysfunction,and2 patients combined with trumpet(8.70%).There were diabetic retinopathy 11 eyes,retina detachment 6 eyes,macular membrane 3 eyes,vitreous hemorrhage 3 eyes.14 eyes undergo 25G~+minimally invasive vitrectomy combined with cataract surgery,and 9 eyes only accepted25G~+minimally invasive vitrectomy.19 eyes were filled with silicone oil,2 eyes were filled with C3F8,and 2 eyes were filled with BSS.Postoperatively,4 or more kinds of drugs were used to all of the 23 eyes,moreover,13 eyes accepted anti-glaucoma drugs treatment,because of high intraocular pressure postoperative.Conclusion:(1)25G~+minimally invasive vitrectomy could influences the stability of tear film,but it would returned to preoperative levels in two weeks,however,lipid layer restored sooner than other indicators,which returned to preoperative level in one week postoperation.(2)Expective results could be achieved treatmented by drugs,or corneal bandage mirror,or autologous serumt.(3)The related factors of CED postperation including diabetes,meibomian gland dysfunction,cataract surgery combined with vitrectomy,drugs toxicity and so on. |
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