目的:观察糖尿病患者经微创玻璃体视网膜切除手术后泪膜的早期变化及其后期的恢复情况。方法:自2009-03/07行微创玻璃体视网膜切除手术的连续病例116例116眼,其中伴有2型糖尿病患者30例30眼作为A组,无糖尿病的患者86例86眼作为B组,对侧眼作为对照,均于手术前1d,术后1,3,10d;1,3mo行干眼不适症状(dryeyessymptom,DES)评分、泪膜破裂时间测定(break-uptime,BUT)、基础泪液分泌试验(SchirmerⅠtest,SⅠt)及角膜荧光素染色(corneal fluorescein staining,CFS)等检查。对比分析两组泪膜之间的变化,根据临床检查结果评分进行统计学分析。结果:A组与B组比较:术前A组30%患者诉眼干、眼痒等不适症状,术前1d,A组与B组之间差异有统计学意义(P=0.029);A组泪液分泌量少于B组,BUT时间短于B组,但两者之间没有统计学差异。两组术后1,3d,患者未感到明显不适,术后1d,A组与B组之间差异有统计学意义(P=0.034),17%患者主诉有轻度痛痒感及红肿;CFS评分两组术眼之间无统计学差异,对照眼术后3d之间有统计学差异(P=0.039);BUT:术眼术后1d两组之间差异有统计学意义(P=0.001),对照眼之间术后3d差异有统计学意义(P=0.007);SⅠt术眼之间、对照眼之间各时间点均无差异,但A组整体泪液分泌量趋势明显少于B组。B组术眼与对照眼:术后1,3d,眼部不适感、BUT,SⅠt均有差异(P<0.05);CFS评分各时间点均有差异(P<0.05)。结论:糖尿病患者本身的泪膜稳定性差,微创玻璃体切除术影响泪膜的稳定性,糖尿病患者经微创玻璃体视网膜切除手术后早期可出现泪膜的异常改变,尤其表现为泪膜稳定性下降和泪液分泌量的下降,且术后泪膜恢复比较慢。

·AIM:To investigate the early change in tear film after vitreous microsurgery and the recovery of tear film in patients with type 2 diabetes.·METHODS:Totally 116 eyes of 116 patients,30 patients with type 2 diabetes(group A)and 86 patients without type 2 diabetes(group B)who underwent 23-gauge or 25-gauge vitreous microsurgery were enrolled in this consecutive control series between March and July in 2009.The contralateral eyes were regarded as control.Uncomfortable symptoms score,break-up time(BUT),Schirmer Ⅰ test(SⅠt)and corneal fluorescein staining(CFS)were recorded 1 day before surgery and 1 day,3,10 days,1 and 3 months after surgery in all patients.Data from all ophthalmologic examinations were collected.·RESULTS:Before surgery,30% of patients in group A complained of uncomfortable symptoms such as dry eye and eye itching.Tear secretion and BUT of group A were less than group B but no statistical difference was found between the two groups,17% patients complained of mild pain and red eye.There was no statistical difference existing in CFS score in surgery eyes at each follow-up in both groups,but a significant difference was found between surgery eyes and contralateral eyes 1d and 3d postoperafively(P=0.039).Significant difference of BUT scores of postoperafive eyes in two groups at the first day(P=0.001)was obtained;and there was significant statistical difference(P=0.007)between surgery eyes and non-surgery eyes until 3 days after surgery.No statistical difference between SⅠt and the control group before and after surgery was found,but the secretion of tear of group A was less than the group B.Uncomfortable symptoms scores,BUT,and SIT were significantly different between the surgery eyes and non-surgery eyes of group B 1 day and 3 days after surgery(P<0.05).And significant difference of CFS was found in each test(P<0.05).·CONCLUSION:The stability of tear film of type 2 diabetes patient is poorer than normal patients and is more vulnerably affected by surgery at the early period after vitreous microsurgery owing to its poor stability.And the secretion of the tear in diabetes patients is declined and the tear film recovers slowly after the surgery.·