羊膜移植联合冷冻术与板层角膜移植术治疗蚕食性角膜溃疡的近中期疗效比较

Comparison of the near and mid-term follow-up of amniotic membrane transplantation combined with cryosurgery and lamellar keratoplasty for the treatment of Mooren ulcer

摘要:

目的 分析羊膜移植联合冷冻术与板层角膜移植术治疗蚕食性角膜溃疡的近中期效果。方法 选取2017年12月—2019年12月郴州市第一人民医院收治的88例蚕食性角膜溃疡患者为研究对象，根据随机数字表法分为A组和B组，每组44例。A组采用羊膜移植联合冷冻术，B组采用板层角膜移植术。比较两组患者的临床疗效、术后视力、术后恢复情况、疼痛感、并发症、近中期预后。结果 两组治疗总有效率比较，差异有统计学意义（P <0.05），B组治疗总有效率比A组高。A组与B组术后1个月、术后6个月、术后12个月视力比较，采用重复测量设计的方差分析，结果 ①不同时间点的视力有差异（P <0.05）；②A组与B组视力有差异（P <0.05），A组与B组术后视力相比术前视力好，相对恢复效果好；③A组与B组视力变化趋势有差异（P <0.05）。A组角膜上皮愈合时间为（13.26±2.47）d，B组角膜上皮愈合时间为（10.05±1.45）d，B组角膜上皮愈合时间比A组短（P <0.05）。A组羊膜溶解脱落时间为（8.78±1.03）d。两组角膜/角膜植片透明度分级、溃疡愈合率比较，差异有统计学意义（P <0.05），B组角膜植片透明度分级轻于A组，溃疡愈合率高于A组。两组可见角膜新生血管率比较，差异无统计学意义（P >0.05）。A组与B组术后3 d、术后1个月、术后6个月VAS评分比较，采用重复测量设计的方差分析，结果 ①不同时间点的VAS评分有差异（P <0.05）；②A组与B组VAS评分有差异（P <0.05），A组与B组视力相比术前VAS评分比较低，缓解疼痛效果较好；③A组与B组视力变化趋势有差异（P <0.05）。两组治疗并发症发生率、术后1年及3年原病复发率比较，差异有统计学意义（P <0.05），B组并发症发生率比A组低，术后1年及3年原病复发率比A组高。结论 板层角膜移植术治疗蚕食性角膜溃疡更利于提高疗效、促进术后溃疡愈合、提高视力、缓解患者疼痛、降低并发症发生率，但羊膜移植联合冷冻术近中期复发率更低。

Abstract:

Objective To analyze the short- and mid-term effects of amniotic membrane transplantation combined with cryosurgery (AMT) and lamellar keratoplasty (LKP) in the treatment of Mooren ulcer.Methods From December 2017 to December 2019, 88 patients with Mooren ulcer treated in Chenzhou first people's Hospital were selected as the research objects. They were randomly divided into group A (AMT) and group B(LKP), with 44 cases in each group. The clinical efficacy, postoperative visual acuity, postoperative recovery, pain, complications, and near- and mid-term prognosis were compared between the two groups.Results The total effective rate of the two groups was statistically significant（P < 0.05), the total effective rate of group B was higher than that of group A; The visual acuity of group A was compared with that of group B at 1 month, 6 months, and 12 months after operation. The analysis of variance of repeated measurement data was used. There were differences in visual acuity at different time points (P < 0.05), and there was difference in visual acuity between two groups (P < 0.05). The visual acuity of group A was higher than that of group B before operation, and the relative recovery effect was better. There was a difference in visual acuity between group A and group B (P < 0.05); The healing time of corneal epithelium in group A was (13.26 ± 2.47) d and that in group B was (10.05 ± 1.45) d. There was significant difference between the two groups by T value test (P < 0.05). The healing time of corneal epithelium in group B was shorter than that in group A; The time of amniotic membrane dissolution and abscission in group A was (8.78 ± 1.03) d; The corneal transparency grade and ulcer healing rate of the two groups was statistically significant (P < 0.05), the transparency grade of corneal graft in group B was lighter than that in group A, and the ulcer healing rate was higher than that in group A; The rate of corneal neovascularization had no statistically significant in the two groups with χ² value test (P > 0.05); The VAS scores of group A and group B were compared at 3 days, 1 month, and 6 months after operation, with variance of repeated measurement data analysis. There were differences in VAS scores at different time points (P < 0.05) and differences in VAS scores between two groups (P < 0.05). The visual acuity of group A was lower than that of group B, and the pain relief effect was better. There was a difference in visual acuity between two groups (P < 0.05); The incidence of complications and the recurrence rate of primary disease at 1 and 3 years after operation were compared between the two groups was statistically significant (P < 0.05). The incidence of complications in group B was lower than that in group A, and the recurrence rate of primary disease at 1 and 3 years after operation was higher than that in group A.Conclusions LKP treatment for Mooren ulcer is more effective in improving curative effect, promoting ulcer healing, improving vision, relieving pain, and reducing complication rate, but recurrence rate is lower in the near and medium term for AMT.