翼状胬肉切除联合自体结膜移植术后角膜缘上皮厚度变化的傅立叶域相干光断层成像研究

Evaluation the change of corneal epithelium thickness after pterygium excision with conjunctival autograft transplantation by fourier domain optical coherence tomography

目的 探讨通过傅立叶域OCT（FD-OCT）观察角膜缘上皮厚度的可行性及翼状胬肉切除联合自体结膜移植术患者围手术期角膜缘上皮厚度的变化规律.方法 前瞻性研究.选择2013年7至9月在复旦大学附属眼耳鼻喉科医院诊断为翼状胬肉的连续病例22例（24只眼）,另选取志愿者25例（25只眼）为对照组.试验组行翼状胬肉切除联合自体结膜移植术,于术前、术后第1、2、3、5、7天进行随访,记录患者症状指标、FD-OCT检测角膜缘内1和2 mm处上皮厚度、裂隙灯检查记录角膜荧光素染色面积大小.采用成组t检验比较对照组与试验组的组间差异.重复测量方差分析比较试验组患者术后不同时间角膜缘内1和2 mm处上皮厚度和术后角膜荧光素染色面积差异.结果 对照组鼻侧角膜缘内1 mm处角膜上皮厚度为（43.81 ±2.55） μm,试验组术后第1、2、3、5、7天此处角膜上皮厚度分别为（21.28 ±5.72）、（27.21 ±4.82）、（31.51 ±5.09）、（34.10 ±4.12）、（39.94±5.47）μm,与对照组相比差异均有统计学意义（t=-17.69,-14.97,-10.63,-9.86,-3.15;P＜0.05）.对照组鼻侧角膜缘内2 mm处角膜上皮厚度为（40.50±3.17） μm,试验组术后第1、2、3、5、7天此处角膜上皮厚度分别为（24.02±5.92）、（29.09±4.53）、（33.08 ±4.77）、（36.55±5.71）、（40.34±5.69） μm,除第7天外,与对照组相比差异均有统计学意义（t=-12.08,-10.27,-6.18,-2.99;P ＜0.05）.术后第1天角膜上皮缺损（荧光素染色阳性）面积为（39.31 ±22.77） mm2,至术后第7天减小至（1.01 ±1.72） mm2,术后第2、3天同前相比,角膜荧光素染色面积差异存在统计学意义（t =6.68,5.55;P＜0.05）;术后第5、7天同前相比差异无统计学意义（t=1.37,2.09;P＞0.05）.术后第7天,角膜上皮荧光素染色阴性率为66.7％.结论 FD-OCT是观察角膜缘上皮厚度的有效工具.翼状胬肉切除术后角膜缘上皮呈现从角膜中央部到周边逐步修复的规律.

Objective To evaluate the change of corneal epithelial thickness after pterygium excision with conjunctival autograft transplantation by Fourier Domain Optical Coherence Tomography （FD-OCT）.Methods Twenty-two patients （24 eyes） with the diagnosis of primary pterygium were enrolled.They underwent pterygium excision combined with conjunctival autograft transplantation.Twenty-five volunteers （25 eyes） served as the normal control group.FD-OCT was performed preoperatively and 1,2,3,5,7 days postoperatively to measure the thickness of corneal epithelium at 1 mm and 2 mm anterior to the nasal or temporal scleral spur.Corneal fluorescein staining was performed simultaneously.Comparisons on the thickness of corneal epithelium were made between preoperative values and postoperative ones.Results The thickness of cornea epithelium at 1 mm anterior to the scleral spur was （43.81 ± 2.55） μm in normal subjects.At day 1 after surgery,corneal epithelial thickness at the same location was （21.28 ± 5.72） μm and then gradually increased to （39.94 ± 5.47） μm at day 7 postoperatively.All the difference on postoperative days had statistically significant（t =-17.69,-14.97,-10.63,-9.86,-3.15,P 〈 0.05）.The thickness of cornea epithelium at 2 mm anterior to the scleral spur was （40.50 ± 3.17） μm in normal subjects.At day 1 after surgery,corneal epithelial thickness at the same location was （24.02 ± 5.92） μm,and then gradually increased to （940.34 ± 5.69） μm at day 7 postoperatively.All the difference on postoperative days except day 7 had statistically significant （t =-12.08,-10.27,-6.18,-2.99,P 〈 0.05）.Cornea epithelium at this location repaired sooner than that at 1 mm anterior to the scleral spur.At day 1 after surgery,corneal epithelium defect area were （39.31 ± 22.77） mm2,and then decreased to （1.01 ± 1.72） mm2 at 7 days （t =6.68,5.55,P 〈 O.05）.At day 7 postoperative,66.7% patients had a complete recovery of corneal epithelium with no fluorescein staining.Conclusions FD-OCT was the effective instrument for observing the change of limbus-peripheral cornea epithelium thickness.Within 7 days postoperatively,cornea epithelium restored almost normal.After pterygium surgery,limbus-peripheral cornea epithelium restoration showed the tendency from the central to peripheral cornea.