Assess the tear secretion change after Lasik surgery in myopia

TAP CHlY D\jgc LAM SANG 108 Tap 11-565/2016

Danh gia sy biln ddi ch§ tik nu-o-c mat sau phau thuat Lasik tren mat can thi

Assess the tear secretion change after Lasik surgery in myopia

Nguyin Xuan Hilp Benh vien Mat Trung uong

Muc tiiu: Danh gia sU b i l n ddi ehe t i l t ndde mat sau p h l u t h u l t Lasik tren m i t can thj va tim h i l u mdt sd y l u t d lien quan d i n su b i l n ddi nude mat. Ddi tugng va phuang phdp: Benh nhan can thj, dddc phau t h u l t Lasik t d t h i n g 4/2009 den 11/2009 tai Bfnh vien M i t Trung UOng, dUde theo ddi tdi t h i l u 6 t h i n g . Loai t r d benh nhan dang sd dung bat ky thudc gl cd anh hddng tdi t i l t nddc m i t . Nghidn cdu md t l lam sang, t i l n edu. Banh gia su bien ddi c h i t i l t , su b i n vdng phim nude mat b i n g hai test Schirmer v l test BUT. Kit qud: SU suy g i l m v l chi sd nddc mat sau md Lasik d i l u t n can thi nhieu nhat d t u i n dau sau m d , su suy g i l m t i l p tuc d nhdng t h i n g t i l p theo va hdi phuc h o l n toan v i o thang t h d 6. Khong cd sU khic nhau v l b i l n ddi e h l t i l t nUde mat khi so sanh hai gidi cung nhU nhdm tudi va mdc d d c l n khac nhau. Kit ludn: Sau m o L a s l k d i l u tri can thi edsU suy g l i m e h l t i l t nUdc mat nhUng hdi phuc hoan toan vao t h i n g t h d 6 va suthay ddi khdng lien quan d i n gidi, nhom tudi va mdc do can.

TUkhda: C h i t i l t nUdc m i t .

Summary

Objective: Assess the tear secretion change after lasik surgery In myopia and and find some factors related to the tear secretion. Subject and method: Myopia patients with Lasik surgery from 4/2009 t o 11/2009 in VNIO, were followed up at least 6 months. Excluding patients who used any medications affecting the tears secretion. Clinical and prospective descriptive study. Assess the secretion change, the tear film stability by Schirmer test and BUT test. Result: A decline In the tear index after Lasik surgery for myopia treatment was mostly in the first week after surgery, the decline continued In the following months and full recovered in next six months. There is no difference about tear secretion change between sex, age groups and myopia degrees. Conclusion: After Lasik surgery fpr myopia treatment, decline secrete tears but complete recovery at 6 months and the change is not related to gender, age group and level of access.

Keywordsilhe tear secretion.

Ng^ nhgn 30/9/2016, ngdy chdp nhgn 30/10/2016 Ngumphdn hoi: Nguyen Xuan Hiip - Benh viin Mat Trung uang

JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.11-N-s/ioie

1 . D a t van d e

Trong vai nam g i n d l y Lasik d l t r d t h a n h phUdng p h i p phau t h u a t (P"0 chinh sda t i t khCic xa dugc da chudng nhat va dugc p h d bien rdng khap tren t h e gidl t u y nhien cd da cd rat n h i l u bao cao v l sd suy g i l m nddc mat dac biet cd t i I I k h d mat sau PT Lasik t d d n g cldi cao va t i le nay cdng thay ddi theo nghien edu, dja dU, khi hau khae nhau [1]. Oe nhan d j n h ve d i l u nay cung n h u t o a n dien v l Uu v i l t eua Lasik d i e biet ve sU che tiet va t m h ben v d n g cCia p h i m nddc mat, d l tai cd muc tieu: Ddnh gid su biin ddi chetiit nUdc mat sau PT Lasik trin mdt edn thi vd tim hieu mdt s6 yeu to liin quan din su bien doi nude mdt.

2. Ddi t u g n g va phUtfng phap 2.1. Ooi tuang

Benh nhan (BN) can t h j , dugc PT Lasik t d t h i n g 4/2009 den thang 11/2009 tai Benh vi^n M i t Trung Udng v l ed d l l u kien theo ddi t d i t h i l u 6 t h a n g . Loai t r d BN dang sd d u n g bat ky t h u d c gl ed I n h h d d n g t d i t i l t nddc mat.

2.2. Phuang phdp

T h i l t k l m d t l l l m s i n g , t i l n cdu.

Dung cu kham v l PT Lasik: May do do day, chup b i n do g i l c mac, bang giay Ige Schirmer. Danh g i l trudc va sau PT ve thj luc, khuc xa (KX), nhan I p , t l n h trang GM, soi d l y m i t , sieu a m , dien v d n g mac...

Danh gia su b i l n ddi ehe t i l t v l b i n v d n g p h i m nude mat bang ba test Schirmer

Test Schirmer h D o mdc t h a m eua nddc mat tren bang giay sau khi dat bang giay vao vl t r i 1/3 ngoai ci!ia ciing d d mi dUdi, sau 5 phut dgc k i t q u i . Binh t h u d n g d g t h l m s l O m m v a n l u < 10mm la k h d mat.

Test Schirmer II: Qi danh gia e h l t i l t n d d c mat c d b i n , lam test Schirmer I sau tra t h u o c t e n h d tai cho. N l u S: 5 m m la b i n h t h u d n g va k h d m a t khi < 5 m m .

Test BUT: Do t h d i gian pha hu)i p h i m nude mat la t h d i gian t d khi chdp mat den khi x u l t hien cham khd dau tien, sau khi da nhd fluorescein 2% v i o b l mat nhan cau. N l u BUT > 10 giay la binh t h u d n g va kho m i t khi BUT < 10 giay.

Tiiu ehi ddnh gid: Tudi chia 3 n h d m : Nhdm 18 d i n 20 t u d i , n h d m 21 d e n 30 t u o i va n h d m t r l n 30 t u d i . Oanh gia ve sU che t i l t nUdc m a t b a n g e l e test Sehirhmer I, Schirmer II, test BUT, t h j lUc. Mdc do can t h i chia lam 3 n h d m la nher~1 D < KX ^ 3D, viJa: 3D <

KX < 6D va nang; KX > -6D. O I n h gia sU l i l n quan gida b i l n doi nUdc mat sau PT den gldl, t u d i , do can d eae mdc t h d i gian sau PT 1 t u a n , 1 t h a n g , 3 thang va 5 t h i n g .

3. K i t qua va b a n luan 3.1. Dgc diem benh nhdn

Nghien cdu 60 BN vdi 116 mat, t r o n g do co 32 BN n d e h i l m 52,6%. O d t u d i t r u n g binh I I 24,81 t r o n g d d 72,4% d n h d m t u d i 21 den 30. K i t qua nay eCia chiding t d i c u n g t d d n g t U k i t qua eCia L I Thj Hdng N h u n g [2].

Thj lue: Thj lue t r d d c PT khi chinh kfnh tdi da (CKTD) t r u n g binh 11 0,94 {0,2 den 1,0). Trong khi do T r l n H I i Yen [3] chi Ida c h g n mat t h j lUc t d i t h i l u la 1,0. Mdc TL > 7/10 (CKTO) cd t^ le t r d d c PT I I 93,9% i v l sau PT 1 t u a n , 1 t h a n g , 3 t h i n g ed eac ty I I tUOng d u o n g 93,1 %, 95,7% va 91,4%.

Nhdn dp: TrUdc PT t r u n g b i n h 18,45mmHg va sau PT la 17,22mmHg, g l i m so vdi trddc PT va dn d i n h d e l e t h d i diem t h e o d o i .

Khde xg: G i l m t r u n g b i n h t d -5,46D trUde PT x u d n g - 0,52D sau PT 1 t u a n va d n d j n h d cac t h d i } diem sau PT.

Cdng sudt khucxg gidc mac: TrUdc PT t r u n g binh la +44,06D (-1-41^+470) g i l m cdn -1-40,01 D 6 tuan , dau (p<0,05) v l d n d j n h d cac t h d i d i l m sau PT.!;, (p>0,05). K i t qua t h u d u g c tUdng tU Arimoto A ^ |

Le Thj Hdng N h u n g . - ^ H 3.2. SU thay ddi che tiet nUdtc m6t vd do binj^

vUng cOa phim nUcfc m6t SUbien doi chitiitnUde mdt

Cd n h i l u quan d i l m va p h u o n g phap khiM de d a n h gia v l ndde m i t n h u n g hau h i t c a e l sd d u n g test Schirmer 1, Schirmer II va test B l | d a n h g i l trude va d c i c t h d i d i l m sau PT 1 t ^ t h i n g , 3 t h i n g , 6 t h i n g [3].

58

T*P CHl Y Dt/dC \JM SANG 108

Tap 11-S6 5/2016

Bing 1. Si/bi£n doi che tiet niidc mSIt theo test Schirmer I, test Schirmer II

Thcri diem danh gia Tri/6c PT Sau PT 1 tuan Sau PT 1 thang Sau PT 3 thang Sau PT 6 thang

Test Schirmer 1 (mm) 24,23 ±3,85 (100%) 16,49 ±4,24 (68,06%) 18,96 ±5,72 (78,25%) 22,64 ±4,34(93,43%) 24,19 ±4,43 (99,8%)

Test Schirmer II (mm) 14,41 ±3,06(100%) 9,11 ±2,68 (62,87%) 10,74 ±3,3 (74,53%) 13,69 ±1,22 (87,78%)

14,46 ± 2 , 8 1

Sir bien d6i che tiet nirac mat trong nghien ciju sau 3 thang la 0,9% va 1,7% nhUng sau 6 thing cda chung toi tUOng flong vfli l<et qua cua Dimitrios I<h6ng gap mat nao. NhU vay sau PT ti le suy giSm [5]. Tieu chi \ih6 mat theo Schirmer I va Schirmer II che t i f t nirSc mat d ngUSng tieu chuSn chan floan thi t^ le kho mat trong nghien culu nay d tuan dau kho mat gap cao nhat S thdi dilm mot tuSn va mot sau PT la 6,9% va 1,7%, sau mot thang la 6% va 6%, thang.

h BJng 2. So sanh sU bien doi che tiet nude mat theo test Schirmer I, test Schirmer II vdi Dimitrios [5]

W Thdi dilm

Sau PT 1 tuan Sau PT 1 thang Sau FT 3 thang Sau PT 6 thang

Test Schirmer 1 (mm) Dimitrios

81,5%

86,8%

100%

N . X . H l e p 68,06%

78,25%

93,43%

99,8%

Test Schirmer 11 (mm) Dimitrios

79%

94,1%;

98,2%.

N . X . H i e p 62,87%

74,53%

87,78%

100%

Op ben vOng cijfa phim nUde mat

Thdi gian ben vdng eCia phim nude mit vdi test BUT trddc PT la 13,44 gily, giam xudng cdn 8,5 gily

sau PT 1 tuan sau dd tang dan d thdi dilm 1 thing (10,05 gily). BUT dn djnh va trd lai tUong dUdng vdi trUde PT tdthdi diem sau PT 3 thing (13,27giay).

Bdng 3. Test Schirmer I va test BUT giuTa cac gia thiet khac

Thorl diem nghien cuTu

Trtfcic PT Sau PT 1 tuSn Sau ?\ 1 thSng Sau PT 3 thang Sau PT 6 thang

Test Schirmer 1 T . H . Y e n

21,17

11,63 9,48 9,81

N.cihi 24,23 16,49 18,96 22,64 24,19

Test BUT T . H . Y e n

15,72

14,37 14,08 15,48

N. ciifu 13,44

8,5 10,05 12,72 13,27

Sau mo 1 tuan, 1 thang, 3 thang c6 su suy giSm test BUT so v6i txildc mo (p<0,05), tuy nhien cac chi

nuac m5t vdi cS ba test Schirmer 1, test Schirmer II, so nay deu tr6 lai binh thudng 4 thdi diem sau mo 6

JOURNAL OF 108 - aiNICAL MEDICINE AND PHARMACY VoLII-N-S/ZOie

thing. Trong khi Tran Hai Yen bao elo Schirmer I tai thdi dilm 6 thing sau PT van chda hdi phuc. Cd sU khic biet nay la do Tran Hai Yen tao vat giac mac co cuong d 12 gid, ehung tdi tao vat cd cudng d phia mui nin bao tdn dugc bd than kinh Idn chui vao GM d vj tri nay va dam rdi than kinh se thdc day nhanh hdn qua trinh hdi phuc. Hem nda trong nghiln cud cda Tran HIi Yen cd tdi 34,7% test BUT trudc md dudi 10 gily va 24% test Schirmer I dudi 10mm.

Edward Y.W.Yu eho ring "trong giai doan hau phiu sdm thi tfnh dn dinh eda mang phim nddc mat (BUT) bj Inh hudng mdt cich cd y nghta mac

du cd tang phan xa tiet nUdc mit. BUT thap cd kha nang II do chan thUdng te b i o bleu md khi PT", dgc tinh cua thudc, dap dng vi§m... va giac mac bj' giam cam gllc dan tdi hoat ddng chdp mat cung giam theo [6].

3.3. fAgt so yeu td lien quan din bien d6i nUcfcmdt

Theo gidi:

Khdng cd sU khic biet 3 ehi sd nude mat Schirmer I, Schirmer II, test BUT gida nam va nd 6 thdi dilm trddc va sau PT (p>0,05).

Bang 4. Bien doi nUdc mat theo gidi

Test

Schirmer 1

Schirmer II

Test BUT Gldl

Nam NO:

Nam NB Nam NQ

SoBN (So mSt) 28(55) 32(61) 28 (55) 32(61) 28 (55) 32(61)

TrUdc phau thuat

23,96 ±3,45 24,48 ±4,19 14,40 ±2,67 14,57 ±3,38 13,49 ± 1 , 1 13,39 ±0,99

Sau phau thuat

1 tuan

17 ± 4 , 3 6 16,03 ± 4 , 1 1

9,44 ±2,82 8,82 ± 2,54 8,47 ± 2 , 1 6 8,53 ± 2,67

1 t h a n g

20,04 ± 5 , 5 0 17,98 ± 5 , 7 8 11,36 ± 3 , 3 5 10,18 + 3,16 10,31 ±2,31 9,82 ± 2,66

3 thang

22,42 ± 4 , 3 1 22,84 ± 4 , 4 13,65 + 2,63 13,72 ± 3 , 5 12,69±1,17 12,74 ± 1 , 2 6

6thang

23,64 ±4/49 24,69 ±4,36

14,4 ±2,54 ;'.

14,51 ±3,06 i 12,96 ±0,86 ;.

13,16±0,73

Theo nhdm tudi

Bang 5. SU che tiet va ben vuTng cOa phim nude m^t theo nhom tuoi

Test

Schirmer 1

Schirmer II

Test

Birr

Thdi diem Trudc PT Sau 1 thang Sau 3 thang Sau 6 thang Trudc PT Sau 1 thang Sau 3 thang Sau 6 thang Trudc PT Sau 1 thang Sau 3 thang Sau 6 thang

18.;. 20 27,14 ±2,97 23,33 ±3,81 26,24 + 2,86 27,14 ±2,87 15,76 ±2,39 13,09 ±1,67 15,62 ± 1 , 9 4 15,38 ±2,36 13,9 ±0,77 11,19±2,27 13,33 ±0,86 13,38 ±0,63

2 1 * 3 0

24,05 ± 3,66

18,5 ±5,5 22,45 ±4,02 24,39 ± 3 , 9 4 14,52 ±3,02 10,5 ±3,15 13,5 ± 3 , 1 6 14,63 ± 2,62 13,51 ±0,99 9,98 ± 2,41 12,57±1,29 13,11+0,8

31+40

20,09 ± 2 , 0 7 14,09 ± 5 , 2 8 17,18 ± 2 , 4 8 17 ± 2 , 2 4 11,82 ± 2 , 9 3

8,09 ± 4 , 0 6 11,45 ± 2 , 5 8

11,36 ± 3 , 2 12 ± 0 , 6 3 8,45 ± 2 , 7 7 12,64 ±0,81 12,18 ± 0 , 8 3

Trung binh 24,23 + 3,85 1 18,95 ±5,72 22,64 ±4,34 24,19 ±4,43 14,49 ±3,05 10,74 ±3,3 13,69 ±3,11 14,46 + 2,81 : 13,44±1,04

10,05 ±2,5 12,72 ±1,21 13,07 + 0,8

,i

1

'^ '

' •

i

1

TAP CHf Y DUOC LAM SANG 108

Tap 11-565/2016 Phau t h u l t Lasik t i e ddng true t i l p t r l n GM lam

thay ddi hlnh the GM, t i e ddng d i n mang ludi than kinh GM lam g l i m d m giac GM. Hoat ddng e h l t i l t nddc mat bj I n h hudng bdi cam giac be mat nhan cau. Thue t l cho thay d nhdm tudi eang t r i , elm giac GM cang tdt nen sU hdi phuc v l e h l ehe t i l t nddc mat cang nhanh va do ben vdng cda phim nUde m^t cang tang.

6 ele nhdm do tudi khac nhau sU bien ddi v l nddc mat cd y nghTa thdng ke d cac thdi d i l m sau

Theo mUc do cdn

PT. Khi tfnh chung cho toan bd nhdm nghien cdu chi sd nddc m i t deu g i l m den tan thdi diem 3 t h i n g va hdi phuc hoan t o l n d thdi diem 6 t h i n g . Tuy nhien khi t i c h rilng ele nhdm khie nhau chung tdi thay d cac nhdm tudi khac nhau thi sd hoi phuc khic nhau, nhdm 18 den 30 tudi thi ehe t i l t nude mat khdng cdn sU khie biet so vdi trddc PT trong khi do nhdm tren 30 tudi van giam mot each ed y nghTa so vdi trudc PT. K i t qua nay phu hdp vdi Tran Thj Tuyet Nhung [7].

Bang 6. Che tiet nude mat theo nhom 66 can

1 1

Test

L Schirmer 1

9

Schirmer 11

Test BUT

Thdi diem

TrUdc md Sau PT 6 thang Trudc md Sau PT 6 thang Trudc mo Sau PT 6 t h i n g

-1D + -3D 23,84 ±3,17 25,05 ±3,78 14,95 + 2,72 14,58 ±2,67 1 3 , 6 8 ± 1 13,21 ±0,63

-3,1D + -6D

25,21 ± 3,38 25,17 ± 4 , 2 14,93 ±2,83 14,59 ±2,69 13,64±1,12 13,2 ± 0 , 8

> - 6 D 23,07 ±4,42 22,44 ± 4 , 5 7 13,68 ±3,38 14,22 + 3,08 13,05 ± 0 , 8 4 13,83 ±0,83

Trung binh

24,23 ± 3,9 24,19 ±4,43 14,41 ± 3 , 0 6 14,46 ± 2 , 8 1 13,44 ± 1 , 0 4 13,07 ± 0 , 8

Cd su khac biet v l chi sd nUde mat Schirmer I trddc PT cung nhd sd hdi phuc 6 t h i n g k h i nang e h l t i l t nUdc mat d thdi d i l m sau PTgiOa cac nhdm do ein khac nhau la khic nhau cd ^ nghTa thdng ke (p<0,05). Tuy nhiln khdng cd su khic biet Test Schirmer 11 d eae thdi diem nghidn edu trddc va sau md theo nhdm dd can khac nhau (p>0,05). Cd nghTa la d ele mdc do can thi khie nhau PT khdng I n h hudng gi den sU thay ddi cda ehe t i l t nude mat ed ban. Cd sd khic biet ehl sd BUT trddc v l sau PT gida cac nhdm c l n thj (p<0,05).

4. Ket luan

Su suy giam v l chi sd nddc m i t sau md Lasik dieu tri can thj nhieu nhat d t u i n dau sau md, su suy giam tiep tuc xay ra d i n t i n 3 t h i n g sau PT so vdi trUdc md. Vao thdi d i l m 6 t h i n g sau PT md su

suy g i l m nddc m^t d l hdi phuc t r d ve n h u lOe trudc PT.

Khdng ed sU khac nhau v l b i l n ddi e h l t i l t va b i n vdng eua phim ndde mat sau PT Lasik khi so sinh hai gidi cung nhd eac nhdm tudi, mdc do can khie nhau.

Tai lieu tham khSo

1. Bd mdn mat TrUdng Dai hgc Y Dugc Thanh phd Hd Chi Minh (2007) Nhdn khoa ldm sdng. N h i Xuat b i n Y hoc, tr. 350-352, tr. 418-420.

2. Le Thj Hdng Nhung (2007) Nghien cUu sU thay doi chi so nhdn dp sau phdu thudt lasik tren binh nhdn can thi. Luan van Thae sy Y khoa. TrUdng Dal hoe Y Ha Ngi.

3. Tran HII Yen (2008) Ddnh gid cam gide gidc mgc vd tinh trgng khd mdt sau phdu thudt Laser excimer

61

JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.11 - N^S/aoie^

dieu tri edn vd logn thi Tap chf nhan khoa Viet 6. Edward. W. Yu, Alfred leung, Srinivas, Dennis SC.

Nam, 12/2008; 13,tr. 36-44. Lam (2000) Effect of Laser in situ keratomileusis:oij:

4. Arimoto A, Shimlzu K, Shoji N, et al (2002) feorsfab///(y.Ophthalmology 107(12):2131-2135.

Underestimation of intraocular pressure in eyes after 7. Tran Thj T u y l t Nhung (2005) Ddnh gid su ehe tiet laser in situ keratomileusis. Jpn J Ophthalmol 46: nude mdt qua mot s6 test ldm sdng trin mot nhom 645-649. ngUdi Viet Nam trudng thdnh. Luan van Thae sy Y 5. Dimitrios S. Siganos, Corina N. Popescu (2002) Tear khoa. TrUdng Dai hgc Y H I Ndi.

Secretion Following Excimer Laser in situ Keratomileusis.

J. Refract Surg 18 March/April: 124-126.