超高分辨率眼前节OCT评价翼状胬肉术后绷带式角膜接触镜的治疗效果

An evaluation of the therapeutic effect of the bandage contact lenses after pterygium surgery using ultra-high resolution optical coherence tomography

目的 应用超高分辨率眼前节OCT（UHR-OCT）技术评价翼状胬肉术后绷带式角膜接触镜（BCL）的治疗效果.方法 前瞻性病例对照研究.选取行翼状胬肉切除联合自体结膜移植术的患者60例（60眼）.随机分成2组：观察组和对照组各30眼,观察组在手术末予配戴博士伦纯视BCL 1片.术后连续3d,之后隔天复查至角膜上皮完全愈合,用UHR-OCT扫描评价角膜上皮愈合情况,最终愈合通过荧光素染色确认.术后疼痛值采用视觉模拟评分法（VAS）.2组间的上皮愈合时间比较采用独立样本t检验,VAS疼痛值的比较采用Mann-Whitney U检验.结果 观察组所有患者均成功地配戴BCL,无一例出现角膜接触镜相关并发症.在戴镜情况下,UHR-OCT清晰地显示术后角膜的超微形态学特征,连续扫描显示角膜上皮的动态愈合过程.UHR-OCT判断的角膜上皮愈合与荧光素染色结果具有高度一致性（符合率为95％）.基于UHR-OCT的评估,角膜上皮愈合平均时间观察组为（3.7±1.2）d,对照组为（4.8±1.5）d（t=16.78,P＜0.01）.观察组的VAS疼痛值在术后各个时间点均显著低于对照组（Z=-4.75、-3.84、-2.96、-2.52、-1.98,P均＜0.05）.结论 BCL可明显缩短翼状胬肉术后角膜上皮修复时间,减少术后疼痛,可作为胬肉术后的辅助治疗措施.UHR-OCT作为一种非接触式检查手段,是监测胬肉术后角膜上皮愈合的理想工具,可为适时取出BCL提供参考.

Objective To evaluate the therapeutic effect of the bandage contact lens （BCL） using ultra-high resolution optical coherence tomography （UHR-OCT） after pterygium surgery.Methods Prospective case-control study.Sixty eyes of 60 patients undergoing pterygium excision and conjunctival autografting were randomly allocated into 2 groups：30 eyes were covered with silicone hydrogel BCLs at the conclusion of surgery and 30 eyes served as a control.UHR-OCT scans of the cornea were performed sequentially on day 1,day 2,day 3,and then every other day until the end of re-epithelialization after surgery.Complete corneal epithelial healing was verified with fluorescein staining after removal of the BCLs.Post-surgical pain was evaluated using the visual analogue scale （VAS）.An independent t test and a Mann-Whitney U test were used.Results All BCLs were successfully fit without any contact lens-related complications.UHR-OCT images clearly revealed the architectural features of the postoperative cornea with BCL in situ and showed the epithelial healing process.UHR-OCT imaging highly agreed with the fluorescein staining in detecting corneal epithelial defects （95％）.Based on the assessment by UHR-OCT,the average time line for re-epithelialization in the BCL group was 3.7±1.2 days while in the control group it was 4.8±1.5 days （t=16.78,P＜0.01）.VAS scores reported lower pain levels in the BCL group compared to the control group at each time point （Z=-4.75,-3.84,-2.96,-2.52,-1.98,all P＜0.05）.Conclusion Silicone hydrogel BCL is recommended as an adjuvant therapy after pterygium surgery for its efficacy in improving re-epithelialization and postoperative comfort.UHR-OCT is an excellent tool in monitoring corneal epithelial healing under BCLs and determining the appropriate time for lens removal.