保存羊膜及丝裂霉素对翼状胬肉眼表的影响

Effects of preserved human amniotic membrance and mitomycin on the ocular surface in pterygium

目的探讨保存羊膜移植联合应用丝裂霉素对翼状胬肉眼表的影响。方法将42例(71只眼)翼状胬肉患者随机分为保存羊膜移植术组(A组)和保存羊膜移植联合术中应用丝裂霉素术组(B组),分别于术前、术后不同时间行结膜印记细胞学、流式细胞学检查和泪液功能检查。结果两组患者胬肉区结膜上皮细胞鳞状化生明显,术后30天检查示胬肉区结膜上皮细胞形态规整、小而密集、含大量杯状细胞;非胬肉区结膜杯状细胞数量较术前显著增加(P<0.05)。非胬肉区球结膜上皮细胞凋亡率术前与正常相比偏高(P>0.05);术前、术后非胬肉区结膜上皮细胞凋亡率各观察阶段比较P<0.01。两组患者术后BUT延长(P<0.05);SchirmerItest平均值术后7、14、30、90天与术前相比差异无统计学意义(P>0.05);下睑中央泪河高度平均值术后3天与术前、术后其他观察阶段比较差异有统计学意义(P<0.01);角膜荧光素染色平均值术后14天、30天、90天较术前差异有统计学意义(P<0.01)。术后随访1年,A组复发率19.04%;B组复发率4.76%。结论保存羊膜移植联合应用丝裂霉素能有效改善眼表,且毒副作用小,是安全、有效的手术方法。

OBJECTIVE To study the effect of preserved human amniotic membrance and mitomycin on the ocular surface in pterygium. METHODS Forty-two patients （71 eyes） suffered from pterygium were randomly divided into two groups. Pterygium excision combined with preserved human amniotic membrane transplantation was in group A,and low density mitomycin was applied in group B based on group A. Conjunctival Impression Cytology,Flow Cytology and tear film function were observed before and after pterygium surgery. RESULTS Epithelial cells in pterygium demonstrated squamous metaplasia before surgery but became regulated,small and intensive after surgery,conjunctival goblet cells＇ density in non-pterygium area increased significantly after surgery（P0.05）. The apoptotic rate of the conjunctival epithelial cells out of the pterygium area before surgery was higher than the normal value as low-grade inflammation,but no statistic variability （P0.05）,the fastigium of the apoptosis rate appeared respectively—7 days after surgery in group A and 14 days after surgery in group B. In the two groups,BUT prolonged after surgery （P0.05）,the Schirmer I Test and lacrimal river height after surgery had no significant difference with the corresponding result before surgery except that the result of the third day after surgery,Fluorescein Staining improved after surgery except the third day post-surgery. The recurrent rate of group A was 19.04%,but 4.76% was found in group B within the follow-up of 1 year. CONCLUSIONS Preserved amniotic membrance and mitomycin not only can promote the healing of the wound surface effectively,but also can be of a safe,effective surgical method with little side effect.