原发性翼状胬肉不同术式对泪膜的影响

Clinical observation of the dry eye after the different surgical methods for pterygium

目的比较翼状胬肉切除联合自体角膜缘干细胞移植和翼状胬肉切除联合生物羊膜移植2种术式术后干眼的阳性率及对患者泪膜功能的影响。方法选择翼状胬肉患者56例(56眼),按随机数字表法分成2组,A组28例(28眼)行翼状胬肉切除联合自体角膜缘干细胞移植术,B组28例(28眼)行翼状胬肉切除联合生物羊膜移植术。统计分析术后1、3个月干眼的阳性率;检查术前及术后1、3个月泪膜破裂时间(BUT)、SchirmerⅠ试验(SⅠt),对结果作统计学分析。结果术后1、3个月A组干眼阳性率均较B组低,但差异均无统计学意义(P=0.737,0.639)。A、B 2组术后1个月BUT、SⅠt均较术前缩短,差异有统计学意义(P<0.05);术后3个月BUT、SⅠt均较术后1个月明显改善,差异有统计学意义(P<0.05)。结论翼状胬肉切除联合自体角膜缘干细胞移植及翼状胬肉切除联合生物羊膜移植术对泪膜功能均有影响,术后3个月BUT及SⅠt均逐渐恢复。2种手术方式对术后泪膜功能的影响无明显差异。

Objective To explore the influence of different surgical methods on tear film function in patients with pterygium and the incidence rate of dry eye. Methods Fifty-eight patients（58 eyes） were entrolled from March 2013 to March 2014 in Xuzhou Medical College Affiliated Hospital. The patients were randomly divided into two groups： group A of 28 patients （28 eyes ）underwent pterygium excision combined with corneal limbal stem cell auto-graft transplantation and group B of 28 patients （28 eyes ） underwent pterygium excision combined with amnion transplantation. The incidence rate of dry eye of the two groups were observed at lmonth and 3 months postoperatively. The tear film break-up time（BUT） and Schirmer I test （Sit） were tested before and 1 month, 3 months after the surgery respectively. Results The incidence rate of dry eye of group A at 1 month and 3 months postoperatively was lower than that of group B with no significant difference （ P = 0. 737, 0. 639 ）. BUT and S I t were shortened in both groups at 1 month postoperatively with significant differences （P 〈0.05）. BUT and S I t of both groups at 3 months postoperatively were longer than that of 1 month postoperatively with significant difference（P 〈 0.05 ）. Conclusions Pterygium excision affects tear film function at the early postoperative stage. Tear film function returns to preoperative levels 3 months after the surgery. There was no statistical significant difference Of the tear film function in comparation of pterygium excision combined with corneal limbal stem cell auto-graft transplantation and arnnion transplantation.