| Objective:To investigate the changes of ocular surface and tear film before and after double eyelid operation with incision method,and to explore the effect of double eyelid operation with incision method on tear film function,while to analyze the correlation between double eyelid operation with incision method and dry eye occurrence,besides to evaluate the application value of dry-eye related examination preoperatively,also to provide theoretical basis and guiding proposal for clinical practice.Method:According to the inclusion criteria and exclusion criteria,17 patients(34 eyes)were selected to perform double eyelid operation with incision method in ophthalmology department of Affiliated Hospital of Yan’an University during 2017/10~2018/07.Ocular surface disease index questionnaire survey(OSDI),Schirmer I test(SⅠt),break-up time of tear film(BUT),corneal fluorescein staining,tear fern test(TFT)and conjunctival impression cytology(CIC)were examined to evaluate the function of ocular surface and tear film before and after the double eyelid operation with incision method.SPSS20.0 statistical software package was used to test and analyze all datas.Result:1.The occurrence of ocular discomfort before and after surgery: there are 10 eyes(29.4%)felt discomfortable before surgery,and 26 eyes(76.5%),20 eyes(58.8%),16 eyes(47.1%),10 eyes(29.4%)and 8 eyes(23.5%)felt discomfortable at 1d,7d,14 d,1mo,3mo postoperatively.The number of eyes with discomfort at the early stage after surgery(1,7,14 days)significantly increase compared with preoperative,while the number of eyes with discomfort at the late stage after operation(1,3 mo)has not significantly different from that preoperative.The influence of visual function account for a higher proportion before surgery,and ocular symptoms account for a higher proportion at 2wk postoperatively.2.Ocular surface disease index questionnaire(OSDI): The average scores of OSDI were 8.09±4.67,12.98±5.33,11.66±5.58,10.85±5.77,8.24±4.53,8.03±4.62 before and after surgery,respectively.The results were analyzed by repeated measurement variance analysis.There was a significant difference between before and after surgery(F=62.115,P<0.001).The scores increased within 2wk postoperatively(P<0.005).There was no significant difference between preoperative and postoperative 1mo,3mo(P =0.451、0.769).It showed that the discomfort of patients within 2wk postoperatively was higher than that before surgery,and recovered to the preoperative level at 1mo after postoperative.3.Break-up time of tear film(BUT): The average values of BUT before and after surgery were12.29±2.78,12.03±2.28,12.35±2.12,12.26±1.97,12.29±1.77,12.44±1.85,respectively.The analysis of variance of repeated measurements indicated that there was no significant difference in BUT before and after surgery(F=0.565,P=0.675).4.Corneal fluorescein staining test: The average values of corneal fluorescein staining scores were 2.18±1.06,2.76±1.08,2.68±1.20,2.24±1.13,2.26±1.14,2.15±1.08 respectively before and after surgery.The analysis of variance of repeated measurements were F=7.933,P<0.001,indicated that the corneal fluorescein staining scores were different between before and after surgery.There were significant differences between 1d postoperatively and preoperative,14 d,1mo,3mo postoperative(P=0.008、0.002、0.004、0.002).But there was no significant difference between the remaining time points.5.Schirmer I test: The mean values of Schirmer I test(mm/5min)before and after surgery were 13.97±6.26,17.62±5.97,15.76±5.54,14.91±5.75,14.21±5.5,14.06±5.57.The repetitive measurement variance analysis results are F=42.195,P<0.001,which meant that there were significant differences between before and after surgery.There were significant differences between preoperative and 1d,7d,14 d postoperative(P <0.05).However there was no significant differences between preoperative and 1mo,3mo postoperative(P = 0.367、0.720).6.Conjunctive Impression Cytology(CIC): The mean number of goblet cells in conjunctiva before and after surgery was 36.92±8.49,34.70±8.85,36.11±8.57,35.24±8.72,36.82±8.64,36.63±8.48.The repetitive measurement variance analysis showed that there was a significant difference in the number of goblet cells before and after surgery(F= 8.947,P<0.001).There was a significant difference between preoperative and 1d postoperative(P<0.001).Meanwhile there was no significant difference between preoperative and 7d,14 d,1mo,3mo postoperative(P = 0.063、0.170、0.844、0.052).7.Tear Fern Test(TFT): Ridit analysis was used to analyze the classification of tear fern test before and after surgery.88%(30/34)patients had normal results(grade I and II)before operation,and the percentage of grade I and II decreased on the 1d,7d postoperatively.The percentage of grade I and II increased on 2wk,1mo,3mo postoperatively.Grades I and II were the lowest 1wk postoperative,accounting for 82%(28/34).So there was no significant difference among the groups(P>0.05).Conclusion:1.In the early stage,dry eye-related discomfort and irritation symptoms occurred.Cornea epithelium was slightly damaged,conjunctival goblet cells were slightly reduced,and tear secretion was significantly increased compared with that before surgery.2.There were no significant changes in Tear break-up time(BUT)and Tear fern test(TFT)before and after surgery.3.In the 1mo postoperative,with the reconstruction of the ocular surface microenvironment,the test results gradually recovered to the preoperative level,and the function of corneal and conjunctival epithelium recovered. |
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