目的：该研究旨在应用Keratograph 5M评估玻璃体切除手术(PPV)对眼表的影响。

方法：本研究纳入23G玻璃体切除手术的患者30例30眼。分别于手术前、手术后1、2、4、8及12wk行眼表疾病指数(OSDI)问卷评分，采集眼表参数包括泪河高度(TMH)、非侵入性泪膜破裂时间(NITBUT)和眼红指数，并进一步分析各临床参数之间的相关性。

结果：玻璃体切除术后4wk内，畏光、异物感较术前显著增加，但是手术后8、12wk降至术前水平； 术后1wk眼胀不适较前显著增加，但术后2、4、8及12wk与术前无显著差异。OSDI评分在术后4wk内显著增加，但在术后8wk及12wk降至术前水平。TMH在术后2wk较前增高，但与术前相比差异无统计学意义。首次NITBUT和平均NITBUT在术后8wk内显著缩短，但术后12wk延长至术前水平。眼红指数在术后4wk内显著增加，但术后8wk降至术前水平。首次NITBUT和平均NITBUT在每次随访时间点均呈显著正相关，TMH与平均NITBUT在术后1wk呈显著正相关。

结论：Keratograph 5M可作为评估玻璃体切除手术对眼表影响的一种可靠方法。玻璃体切除手术可引起早期眼表症状及体征的改变，但是这些改变在手术后12wk内将逐渐恢复到术前水平。

METHODS: Totally 30 consecutive patients(30 eyes)undergoing primary 23G PPV were recruited in the study. Ocular Surface Disease Index(OSDI)questionnaire was performed. Ocular surface parameters, including tear meniscus height(TMH), noninvasive tear break up time(NITBUT)and bulbar redness score were obtained preoperatively, in 2, 4, 8 and 12wk postoperatively by Keratograph 5M. Correlations between all the clinical parameters were analyzed further.

RESULTS: The percentages of both photophobia and gritty within 4wk after PPV were significantly higher than preoperation, while they decreased to the preoperative levels in both 8wk and 12wk postoperatively. The percentage of sore eyes in the first week postoperatively was significantly higher than preoperation, but there were no significant differences between the percentages of preoperation and 2, 4, 8 and 12wk postoperatively. OSDI score increased significantly within 4wk postoperatively, but it returned to the preoperative level in 8 and 12wk. TMH increased with 2wk postoperatively, but there were no significant differences compared with preoperation. Both NITBUT-first and NITBUT-average shortened significantly within 8wk postoperatively, but they gradually improved to the preoperative levels in 12wk. Bulbar redness score was significantly higher than the preoperative level within 4wk postoperatively, but it returned to the preoperative level in 8wk. NITBUT-first and NITBUT-average had a significant positive correlation at each visit. TMH had a significant positive correlation with NITBUT-average in the first week postoperatively.

CONCLUSION: Keratograph 5M can provide a reliable noninvasive method to assess the influence of PPV on the ocular surface. PPV may cause various changes in both symptoms and signs of ocular surface damages at the early stage, while all these changes will return to preoperative levels gradually in 12wk postoperatively.