准分子激光辅助翼状胬肉切除术联合自体角膜缘干细胞移植术治疗的临床应用

Application of Excimer Laser in Combined Therapy of Pterygium Excision and Limbal Stem Cell Transplantation

目的观察准分子激光治疗性角膜切削术（Phototherapeutic keratectomy,PTK）在翼状胬肉切除联合自体角膜缘干细胞移植术中的临床效果。方法 2014年7月至2014年11月,采用翼状胬肉手术治疗患者66例87只眼,均为初发病例。随机分为2组。实验组患者25例36只眼,采用翼状胬肉切除术联合角膜缘干细胞移植术后,再用准分子激光治疗性角膜切削术治疗;对照组患者41例51只眼,行翼状胬肉切除术联合角膜缘干细胞移植术。两组患者术后常规处理,术后7~10 d拆线。比较两组患者术后6个月角膜透明度、复发率和角膜散光的临床疗效。结果实验组术后6个月复查,角膜散光（1.24±0.6）D,鼻侧表浅白斑1只眼,复发1只眼。对照组术后6个月,角膜散光（1.68±0.9）D,鼻侧角膜斑翳、表浅白斑等透明度异常10只眼,复发3只眼。两组患者的角膜透明度和角膜散光比较,差异具有显著意义（P〈0.05）。两组患者复发率比较,差异无显著意义（P〉0.05）。结论 PTK能降低翼状胬肉切除联合自体角膜缘干细胞移植术后角膜散光,提高角膜透明度,对降低复发率的作用还有待于进一步研究。

Objective To observe the clinical effect of excimer laser for treatment of corneal ablation （PTK） in pterygium excision combined with limbal stem cell. transplantation.Methods Totally 87 patients received pterygium surgery in our hospital and first diagnosed from Jul. to Nov. 2014 were randomly di-vided into 2 groups ： the experimental group with 36 eyes of 25 patients given PTK treatment after pterygium excision combined with limbal stem cell transplantation, and the control group with 51 eyes of 41 patients given combined therapy of pterygium excision and limbal stem cell transplantation. The patients in both groups received routine treatment after the therapy and were removed of the suture 7-10 days after the operation. The corneal transparency, recurrence rate and corneal astigmatism were compared between the patients of the two groups 6 months after the surgery.Results The corneal astigmatism was （ 1.24 ＋ 0. 6） D in the experimental group 6 months after the operation. Corneal leukoplakia oc- curred to one eye and recurrence to one eye. As to the control group, the corneal astigmatism was （ 1.68 ＋ 0. 9） D 6 months after the operation. Corneal leukoplakia occurred to 10 eyes and recurrence to 3 eyes. The corneal opacity and astigmatism of the two groups were statistically compared, and the difference were statistically significant （P 〈 0. 05 ）. The difference between two groups in recur- rence rate was not significant （P 〉 0. 05） Conclusions PTK may reduce the corneal astigmatism after combined therapy of pterygium excision and corneal limbal stem cell transplantation, and improve the corneal transparency. However, the effect of PTK to reduce the recurrence rate needs further study.