翼状胬肉合并睑板腺功能障碍患者术前干预对术后眼表的影响

Effects of preoperative interventions on postoperative ocular surface in patients with pterygium and Meibomian gland dysfunction

目的观察翼状胬肉合并睑板腺功能障碍(MGD)患者术前采取干预措施对术后眼表的影响。方法将拟行翼状胬肉切除联合角膜缘干细胞移植的53例(53只眼)翼状胬肉合并MGD患者随机分为A组(20例20只眼)、B组(18例18只眼)、C组(15例15只眼)。A组术前1周使用左氧氟沙星滴眼液、玻璃酸钠滴眼液及妥布霉素地塞米松眼膏,每日行热敷治疗,于术前1 d行睑板腺按摩,B组术前1周使用左氧氟沙星滴眼液、玻璃酸钠滴眼液及妥布霉素地塞米松眼膏,C组术前1周使用左氧氟沙星滴眼液、玻璃酸钠滴眼液及金霉素眼膏。三组患者术后2 d均加压包扎术眼,第3天开始接受相同的治疗。观察三组患者术后眼表组织修复情况及主观感受。结果(1)术后A组和B组的角膜上皮愈合时间明显短于C组。(2)术后各期三组间MGD睑缘评分差异无统计学意义。(3)术后3 d,A组眼部舒适度评分明显优于B组和C组,B组眼部舒适度评分明显优于C组;术后1周,A组眼部舒适度评分明显优于C组;术后2周及术后4周,各组眼部舒适度评分比较差异无统计学意义。(4)术后1周,A组和B组泪膜破裂时间(TBUT)明显长于C组;术后2周及术后4周,各组TBUT差异无统计学意义。结论翼状胬肉合并MGD患者术前使用抗生素滴眼液配合人工泪液,联合激素类眼膏及物理治疗,可明显促进术后眼表修复,改善患者术后眼部舒适度。

Objective To observe the effects of preoperative interventions on postoperative ocular surface in patients with pterygium and Meibomian gland dysfunction（ MGD）. Methods 53 patients（ n=53 eyes） with pterygium and MGD who were going to be treated with pterygium excision and limbal stem cell transplantation were randomly divided into three groups. Group A patients（ n=20 eyes） were treated with topical levofloxacin,sodium hyaluronate,tobramycin and dexamethasone ointment,and daily eyelid hot compress and Meibomian gland massage for one week before the surgery.Group B patients（ n=18 eyes） were given topical medications only. Group C patients（ n = 15 eyes） were given levofloxacin,sodium hyaluronate,and chlortetracycline eye ointment for one week. Ocular surface tissue repair and subjective feelings were observed. Results（1） Corneal epithelium repairing time in group A and group B were significantly shorter than in group C.（2） The differences in postoperative MGD eyelid margin score between groups were not statistically significant.3） On the third day after the surgery,ocular comfort assessment in group A was significantly higher than in two other groups,and in group B than in group C. On the fourteenth day and the Twenty-eighth day after the surgery,the differences between groups diminished. 4） On the seventh day after the surgery,the TBUT（ tear film breakup time） in group A and group B were significantly longer,but this difference diminished too by 2 weeks and 4 weeks after surgery. Conclusions To the patients with pterygium and Meibomian gland dysfunction,the preoperative intervention that combining antibiotic eye drops and artificial tears,glucocorticoid ointment and physical therapy can largely promote the recovery of postoperative ocular surface,and significantly improve the ocular surface comfort degree.