目的:为了寻求安全、简便、经济、有效治疗结膜松弛症的方法,评价结膜松弛症结膜新月形切除术和药物治疗两组的临床疗效。方法:采用前瞻性随机分组对照研究方法,将2009-04/2010-03在上海市眼病防治中心按照结膜松弛症诊断标准入选治疗患者30例60眼按患者入选编号末位数的奇偶数随机分为两组。奇数组15例30眼行结膜新月形切除术手术;偶数组15例30眼行消炎人工泪液保守治疗。药物治疗和手术后第2,4,8wk两组分别随访患者症状改善程度、裂隙灯观察结膜松弛切除程度、手术切口愈合情况、手术并发症评价、测量泪河、BUT及氯霉素眼液尝味试验。结果:结膜新月形切除术后4wk眼表面疾病指数(OSDI)明显降低,术后8wkOSDI趋于稳定,与药物治疗组比较,差异有统计学意义(t=2.801,P=0.008)。结膜新月形切除术后2,4,8wk泪河明显改善,与药物治疗组比较差异有统计学意义(P<0.01),两组BUT≥10s者比较治疗后2,4wk差异无统计学意义(P>0.05)。治疗后8wk比较差异有统计学意义(χ2=5.455,P=0.020)。结膜新月形切除术后8wk,30眼中氯霉素眼液尝味试验阳性者14眼(47%);药物治疗组30眼中氯霉素眼液尝味试验阳性者6眼(20%)。两组比较差异有统计学意义(χ2=4.800,P=0.028)。结膜新月形切除术后2wk松弛结膜残留积分10分,4wk7分,8wk6分。手术并发症积分术后2wk6分,4wk12分,8wk8分。结论:球结膜新月形切除术治疗结膜松弛症安全、有效;消炎人工泪液能部分改善结膜松弛症症状。

·AIM:To compare the curative effect after crescent-shaped conjunctiva resection and pharmacotherapy in order to find a safe and effective treatment for conjunctivochalasis.METHODS:A total of 30 patients(60 eyes)with conjunctivochalasis were selected in this prospective randomization control study during April 2009 to March 2010 in Shanghai Ophthalmopathy Prevention and Cure Centre.15 patients(30 eyes)were treated by crescent-shaped conjunctiva resection and 15 patients(30 eyes)by pharmacotherapy.And they underwent system check including objective feeling with OSDI,slit-lamp observation for the residual conjunctiva and the wound healing,operation complications,BUT,measurement of lacrimal river and chloroptic tasting test after 2,4 and 8 weeks of treatment.RESULTS:The OSDI points became lower obviously 4 weeks after crescent-shaped conjunctiva resection,and stable 8 weeks postoperatively.The difference had statistical significance in two groups(t=2.801,P=0.008).The lacrimal river was improved after crescent-shaped conjunctiva resection than that of pharmacotherapy(P<0.01).BUT≥10s in two groups,the difference had no statistical significance 2,4 weeks after treatment(P=0.297),however there was statistical significance 8 weeks after treatment(χ2=5.455,P=0.020).After 8 weeks the chloroptic tasting test of 14 eyes(46.6%)was positive in crescent-shaped conjunctiva resection,and 6 eyes were(20.0%)positive in drug therapy group(χ2=4.800,P=0.028).Residual score of postoperative conjunctiva was 10 after two weeks,7 for 4 weeks and 6 for 8 weeks.Operation complications score was 6 after 2 weeks,12 for 4 weeks and 8 for 8 weeks.CONCLUSION:Crescent-shaped conjunctiva resection for treating conjunctivochalasis is safe and effective;however ophthalmic solutions can only improve the symptoms.

R779.6

中国上海市普陀区科委自主创新科研基金资助项目(No.2008B-88)