3种不同翼状胬肉术后干眼症的临床观察

Xerophthalmia after three surgical methods for treatment of pterygium

摘要:

目的  通过评估翼状胬肉术后干眼症的发生情况及严重程度，寻找一种降低术后干眼发生的最佳手术方式。方法  将翼状胬肉120例120只眼随机分为A、B及C 3组，每组各40眼。A组采用翼状胬肉切除+自体角膜缘干细胞移植术；B组采用翼状胬肉切除+羊膜移植术；C组采用翼状胬肉切除+自体角膜缘干细胞联合羊膜移植术。术后1周内每天在裂隙灯显微镜下观察结膜和角膜创缘的愈合情况、移植片的生长情况，有无感染，角膜上皮修复情况及角膜新生血管生长情况等。术后1、6和12个月从Schirmer试验、泪液膜破裂时间及角膜荧光着色来观察胬肉术后干眼症的发生情况及严重程度。结果  A、B、C 3组在术后1、6和12个月泪液分泌（Schirmerl）试验差异无统计学意义（P >0.05）。术后1个月C组泪膜破裂时间长于A和B组，差异有统计学意义（P <0.05），且A、B组之间比较差异无统计学意义（P >0.05）；术后1个月C组角膜荧光染色分值低于A、B组，差异有统计学意义（P <0.05），且A、B组之间比较差异无统计学意义（P >0.05）；A、B、C 3组术后6和12个月泪液膜破裂时间及角膜荧光染色分值的差异无统计学意义（P >0.05）。结论  翼状胬肉切除+自体角膜缘干细胞联合羊膜移植术治疗翼状胬肉较翼状胬肉切除+羊膜移植术及翼状胬肉切除+自体角膜缘干细胞移植术在术后早期可保持更好的泪膜稳定性，但3种手术方式术后远期干眼症的发生情况及严重程度相当，应该根据患者情况决定手术方式。

Abstract:

Objective To investigate three surgical methods for treatment of pterygium, and evaluate the performance and severity of xerophthalmia after surgery so as to search the best surgical method for reducing the incidence of xerophthalmia. Methods A total of 120 cases (120 eyes) undergoing pterygium surgery were randomly divided into 3 groups with 40 cases in each group. Group A received pterygium excision with limbal stem cell transplantation, group B had pterygium excision with amniotic membrane transplantation and group C had pterygium excision with limbal stem cell and amniotic membrane transplantation. Schirmer test, tear break-up time and corneal fluorescein were measured in the 1st month, the 6th month and the 1st year after operation. The incision condition of the wound margin of conjunctiva and cornea was observed everyday by slit lamp microscope in the 1st week after pterygium surgery; and the growth of transplantation, occurrence of infection and corneal epithelium repair and growth of new blood vessels in cornea were also observed everyday. Results There was no significant difference in the amount of tear secretion among the three groups in the 1st month, the 6th month or the 1st year after operation (P > 0.05). Tear break-up time of the group C was significantly longer than that of the groups B and A in the 1st month after operation (P < 0.05), but there was no significant difference between the groups A and B (P > 0.05). The corneal fluorescein's score of the group C was lower than that of the groups A and B in the 1st month after operation (P < 0.05), but there was no significant difference between the groups A and B (P > 0.05). There was no significant difference in the tear break-up time or the corneal fluorescein's score among the three groups in the 6th month and the 1st year after operation (P > 0.05). Conclusions Tear film stability of pterygium excision combined with limbal stem cell and amniotic membrane transplantation is better than that of pterygium excision combined with limbal stem cell transplantation or amniotic membrane transplantation in early postoperative stage, but the forward performance and severity of xerophthalmia after surgical treatment of pterygium are about the same. Operation method should be chosen according to the patient's condition.