角膜磨削联合角膜缘干细胞移植术治疗翼状胬肉疗效观察

Keratomileusis with corneal limbal stem cell transplantation in treatment of pterygium

目的评价角膜磨削联合角膜缘干细胞移植术治疗翼状胬肉的临床疗效,寻找低复发率的治疗方法。方法对接受翼状胬肉手术治疗的124例(195只眼)分别进行手术前后视力、泪液分泌(SchirmerⅠ)试验、泪膜破裂时间(BUT)及角膜地形图变化的比较;并对其中的30例(49只眼)专项进行了手术前后视力和角膜平均散光的观察。结果术后4只眼复发,占2.1%;做专项光学比较的49只眼中除5只眼因翼状胬肉太大测不出之外,其余44只眼均有不同程度的散光,以顺规性散光为主。角膜地形图检查平均散光:术前为(3.40±2.76)D,术后1周为(1.41±1.27)D,术后1个月为(1.05±1.04)D,术后3个月为(1.02±0.98)D;术后1周、1个月与术前的差异均具有统计学意义(P(0.05);术后1周、1个月之间的差异有统计学意义(P(0.05);1个月与3个月之间的差异无统计学意义(P=0.062(0.05)。平均最佳矫正远视力:术前为(0.55±0.25),术后1周为(0.67±0.21),术后1个月为(0.80±0.23),术后3个月为(0.81±0.21);术后1周、1个月与术前的差异均具有统计学意义(P(0.05);术后1周、1个月之间的差异有统计学意义(P(0.05);1个月与3个月之间的差异无统计学意义(P=0.090(0.05)。角膜上皮愈合时间平均为3.78d;BUT恢复时间为(4.6±0.8)d。结论角膜磨削联合角膜缘干细胞移植术治疗翼状胬肉术后复发率低,角膜上皮修复快,散光得以改善,视力提高,是一种值得推广的安全有效的手术方法。

Objective To objectively evaluate keratomileusis with corneal limbal stem cell transplantation in treatment of pterygium,looking for a low recurrence rate of treatment.Methods Pterygium surgery received 195 eyes of 124 cases were carried out before and after surgery visual acuity,tear secretion （Schirmer Ⅰ） test,tear film breakup time （BUT） and the comparison of corneal topography changes; and one of the 30 cases 49 eyes underwent surgery before and after the special visual acuity and corneal astigmatism observed average.Results 4 eyes of recurrence after surgery,2.1%; do special optical comparison of 49 eyes with 5 eyes could not be determined because much of pterygium,the remaining 44 eyes had different degrees of astigmatism,astigmatism cis-regulatory main. The average topographic astigmatism： patients before （3.40 ± 2.76） D,after the week （1.41 ± 1.27） D,after one month （1.05 ± 1.04） D,after three months （1.02 ± 0.98 ） D; after week,month and preoperative differences were statistically significant （P0.05）; after week,month,statistically significant differences between （P0.05）; one month and three months no significant difference between the （P= 0.0620.05）. The average best corrected distance visual acuity： before surgery （0.55 ± 0.25）,after the week （0.67 ± 0.21）,after one month （0.80 ± 0.23）,after three months （0.81 ± 0.21）; surgery After one week,one month before operation were statistically significant differences （P0.05）; after week,month,statistically significant differences between （P0.05）; one month and three months between the difference was not statistically significant （P= 0.0900.05）. Corneal epithelial healing time averaged 3.78 days; BUT recovery time （4.6 ± 0.8） days.Conclusions Keratomileusis with corneal limbal stem cell transplantation in treatment of pterygium recurrence rate,corneal epithelial repair quickly to improve astigmatism,visual acuity,no adverse complications and should be promoted as a safe and effective surgical method.