角膜缘梯形结膜瓣切口与改良Parks切口对斜视患者泪膜功能及术后并发症的影响

目的:探讨角膜缘梯形结膜瓣切口与改良Parks切口对斜视患者泪膜功能及术后并发症的影响。方法:前瞻性研究,选择2017-01/2019-10于南阳医专一附院手术治疗的斜视患者作为研究对象,分为结膜瓣切口组(60例82眼,行角膜缘梯形结膜瓣切口斜视手术)及改良Parks组(62例83眼,行改良Parks切口斜视手术),评价斜视治疗效果,于手术前后进行干眼症状评分,泪液分泌试验(SⅠt)、泪膜破裂时间(BUT)及角膜荧光素染色(FL)评分,采用眼表综合分析仪测定泪河高度(TMH)、非侵入性泪膜破裂时间(NIKBUT),手术满意度及不良反应。结果:两组患者均完成手术,角膜缘梯形结膜瓣切口组、改良Parks组分别有80、79眼达到眼位基本正位(±10PD以内),两组治愈率比较无差异(P>0.05)。改良Parks组术后7d SⅠt、BUT、FL评分、NIKBUT与角膜缘梯形结膜瓣切口组比较有差异(P<0.05)。术后14d改良Parks组SⅠt、BUT、TMH、NIKBUT较角膜缘梯形结膜瓣切口组有差异(P<0.05)。角膜缘梯形结膜瓣切口组及改良Parks组手术总体并发症发生率无差异(7.3%vs 2.4%,P>0.05),总体满意度有差异(83.3%vs 95.2%,P<0.05)。结论:角膜缘梯形结膜瓣切口与改良Parks切口手术术式对斜视均有较好的矫正效果,但改良Parks切口手术对泪膜稳定性影响较小,手术满意度较高。

Effect of corneal limbal trapezoid conjunctival flap incision and modified Parks incision on tear film function and postoperative complications in patients with strabismus

AIM:To explore the effect of corneal limbal trapezoid conjunctival flap incision and modified Parks incision on tear film function and postoperative complications in patients with strabismus.METHODS:A prospective study was conducted in patients with strabismus who had been treated with surgery in the First Affiliated Hospital of Nanyang Medical College between January 2017 and October 2019.The subjects were divided into conjunctival flap incision group(60 cases with 82 affected eyes treated with strabismus surgery via corneal limbal trapezoid conjunctival flap incision)and modified Parks group(62 cases with 83 affected eyes treated with strabismus surgery via modified Parks incision).Therapeutic effects on strabismus were evaluated,and dry eye symptoms were scored before and after surgery.Schirmer I test(SⅠt),tear film break up time(BUT)and cornea fluorescein staining score(FL score)were recorded.Comprehensive ocular surface examination was performed to determine tear river height(TMH)and noninvasive keratograph tear breakup time(NIKBUT).Satisfaction with surgery was surveyed,and adverse reactions were statistically analyzed.RESULTS:Both groups of patients completed the surgery.Totally 80 eyes and 79 eyes of the conjunctival flap incision group and the modified Parks group were basically in normal position(within±10PD),and there was no statistically significant difference in cure rate between the two groups(P>0.05).S I t and BUT of the modified Parks group were significantly higher than those of the conjunctival flap incision group at 7 and 14d after surgery,and the FL score was significantly lower than that of the conjunctival flap incision group at 7d after surgery(P<0.05).TMH of the modified Parks group was significantly higher than that of the conjunctival flap incision group at 14d after surgery,and NIKBUT was significantly longer than that of the conjunctival flap incision group at 7d and 14d after surgery(P<0.05).The overall incidence rates of complications in the conjunctival flap incision group and the modified Parks group were 7.3%and 2.4%,respectively(P>0.05).The overall satisfaction rates of the conjunctival flap incision group and the modified Parks group were 83.3%and 95.2%,respectively(P<0.05).CONCLUSION:Surgeries with corneal limbal trapezoid conjunctival flap incision or modified Parks incision can achieve good correction effects on strabismus,but surgery with modified Parks incision has less effect on tear film stability,with higher surgical satisfaction and better clinical application effect.