| Objective: This paper intends to study the dynamic change trend of ocular surface and tear film stability in the early stage after vitreoretinal surgery and its influencing factors.Methods:With cluster sampling of 84 patients were underwent vitreoretinal surgery in Guang Zhou Overseas hospital(including 48 males and 36 females,aged 22 to 72 years with an average age of 52.7 ±11.1 years.)during November 2016 to March 2018.According to operated,eyes of patient were divided into two groups : experimental group(84 eyes)and control group(84 eyes).All operations were performed by the same skilled ophthalmologist under local anesthesia with 23 G PPVs,and the same OCULUS Kearatograph5 M was used by the same technician for dynamic detection of 0 day(pre-operation),1 month,2months,3months(post-operation).Recording the NITMH(Non-invasive tear meniscus height),FTBUT(First time of break up time),ATBUT(Average time of break up time),the severity of dry eye,the distribution and color of lipid layer of tear film,and the classification of thickness of meidum,the grading of meidum and opening blockages,the scoring of meibomian gland missing area,the classification of bulbar redness etc.Results:1.General situation analysis:The subjects included 168 eyes of 84 patients between the ages of 22 and 72,with an average age of 52.7 ±11.1 years,including 48 males and 36 females,19 patients with hypertension,65 patients without hypertension,5 patients with diabetes mellitus and79 patients without diabetes mellitus.There were 8 cases with high myopia and 76 cases without high myopia.2.Dynamic analysis of tear film stability at different time points in experimental group and control group(1)NITMH: The difference of NITMH between the control group and the experimental group was statistically significant(P < 0.05),and that in the experimental group was higher than that in the control group.There was no significant difference between the two groups(P>0.05).In experimental group,there was a statistically significant difference by time-variation in 0 days pre-operation,1 month,2 months,3months of central and nasal NITMH(P<0.05),there was statistically significant difference in 0 days pre-operation,1 month,2 months,3 months of NITMH(center P=0.002,nasal side P=0.023)but there was no significant difference in 1 month,2 months,3 months of NITMH(P > 0.05).In the control group,there was no significant difference of each time point of NITMH.(P >0.05)There was no significant difference by time-variation between two groups(P > 0.05).(2)FTBUT: there was no significant difference between two groups of FTBUT(P >0.05),there was no significant difference by time-variation between two groups of FTBUT(P > 0.05).(3)ATBUT: There was no significant difference between two groups of ATBUT(P >0.05)There was no significant difference by time-variation between two groups of ATBUT(P > 0.05).(4)Severity of dry eye:There was no significant difference between the two groups of severity of dry eye(P > 0.05).There was no significant difference by time-variation between two groups of severity of dry eye(P > 0.05).(5)The distribution and color of lipid layer of tear film : There was no significant difference between the two groups of the distribution and color of lipid layer of tear film(P > 0.05).There was no significant difference by time-variation between two groups of the distribution of tear film lipid layer(P > 0.05).(6)Color analysis of tear film lipid layer: There was no significant difference between the two groups of color analysis of tear film lipid layer(P > 0.05).There was no significant difference by time-variation between the two groups of tear film lipid layer(P > 0.05).(7)Tarsal gland lipid layer thickness grading: There was no significant difference between two groups of tarsal gland lipid layer thickness grading(P > 0.05).There was no significant difference by time-variation between the two groups of color analysis of tarsal gland lipid layer thickness grading(P > 0.05)(8)Analysis of eyelid gland opening blockage: There was no significant difference between two groups of analysis of eyelid gland opening blockage(P > 0.05).There was no significant difference by time-variation between the two groups of eyelid gland opening blockage(P > 0.05).(9)Score of lipid character of meibomian gland opening: There was no significant difference between the two groups of meibomian gland opening(P > 0.05).There was no significant difference by time-variation between two groups of score of lipid character ofmeibomian gland opening(P > 0.05).(10)Analysis of redness index: There was no significant difference in eye red index between two groups of 0 day pre-operation both sides,3 months post-operation nasal side of conjunctival and ciliary(P > 0.05),there was statistically significant in both sides of 1 month,2 months post-operation and the temporal side of conjunctival and ciliary of 3months post-operation(P < 0.05),the redness index of experimental group was higher than the control group.There was significant difference by time-variation between two groups of all sides of redness index(P <0.05).In the experimental group,the redness index of the nasal side of conjunctival of 0 day pre-operation was lower than that in 3months postoperative,3 months post-operation was lower than 2 months post-operation,2 months post-operation was lower than 1 months post-operation(P <0.05).At each time point,the difference was statistically significant(P=0.000).In the experimental group,the redness index of temporal side of conjunctival,both sides of ciliary of 2months and 3 months were higher than 0 day but lower than 1 month,there was no significant difference between 2 months and 3 months post-operation(P =0.346,P =0.227,P =0.074).In the control group,there was significant difference in 0 day of pre-operation and 1month,2 months,3 months of post-operation(P>0.05).The redness index of 0 day of pre-operation was lower than 1 month,2 months,3 months of post-operation,but there was no significant difference in 1 month,2 months,3 months.(P=0.876,P =0.859),there was no significant difference in time-variation between both side of ciliary(P >0.05).(11)Tarsal gland missing area score: There was no significant difference between the two groups of 0 day pre-operation,1 month,2 months and 3months post-operation of score of tarsal gland missing area score(P >0.05).There was no significant difference in time-variation between two groups of 0 day pre-operation and 1 month,2 months,3months post-operation of tarsal gland missing area score(P > 0.05).Conclusions:1.The results of measuring the height of the lacrimal river after 23 Gauge Pars Plana vitrectomy showed that the height of the central and nasal lacrimal rivers increased and the amount of lacrimal secretion increased at 1 month after vitrectomy.The stability of lacrimal film tended to be stable with the extension of postoperative time and returned to normal at 2 months after operation.2.The analysis of eye red index after 23 Gauge Pars Plana vitrectomy showed thatthe conjunctival and ciliary hyperemia was severe at 1 month after vitrectomy,and gradually alleviated with the prolongation of postoperative time,and there was still mild conjunctival and ciliary congestion at 3 months after vitrectomy.It is confined to the suture of scleral incision. |
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