全角膜羊膜覆盖和绷带型角膜接触镜用于较大翼状胬肉切除术的疗效比较

Comparison of amniotic membrane transplantation for all the cornea and bandage contact lens in the treatment for large pterygium surgery

目的:针对较大翼状胬肉,采用胬肉切除、角膜缘干细胞移植联合全角膜羊膜覆盖术,或胬肉切除和角膜缘干细胞移植术后配戴绷带型角膜接触镜进行治疗,观察两种方法的临床效果。方法:将侵及瞳孔区的较大翼状胬肉40眼随机分成两组,一组行翼状胬肉切除、角膜缘干细胞移植术联合全角膜羊膜覆盖术(羊膜组),另一组行胬肉切除和角膜缘干细胞移植术后配戴绷带型角膜接触镜(绷带镜组),每组各20眼。比较两组患者手术时间,以及术后第1、3d,1、3wk眼部舒适程度和角膜愈合情况与随访复发情况等。结果:平均手术时间:羊膜组为61.4±5.2min,绷带镜组为34.5±2.7min,绷带镜组手术时间明显缩短,两组差异有统计学意义(P<0.05)。两组患者的眼部舒适度在术后第1d无明显差异,但在术后第3d和术后1wk,绷带镜组患者的眼部舒适度明显优于羊膜组(P<0.01),至术后3wk时两组间差异无统计学意义(P>0.05)。术后3wk时两组患者的角膜愈合率评分分别为0.85±0.18分和1.15±0.18分,两组差异无统计学意义(P=0.25)。羊膜组有1眼胬肉复发。结论:在侵及角膜的较大翼状胬肉治疗中,胬肉切除和角膜缘干细胞移植术后联合全角膜羊膜覆盖或术后配戴绷带型角膜接触镜均有助于缓解眼部不适症状和促进角膜创面修复,使用绷带型角膜接触镜患者更舒适,治疗更便捷。

AIM:To investigate the amniotic membrane transplantation for all the cornea or bandage contact lens after pterygium excision combine with limbal stem cell transplantation in the treatment of large pterygium.METHODS:The40eyes of larger pterygium was randomly divided into2groups,one group,20eyes,with autologous limbal stem cell transplantation combine with amniotic membrane transplantation for all the cornea(amniotic membrane group);another group,20eyes,with bandage contact lens after limbal stem cell transplantation(bandage contact lens group).The surgery time,eye comfort postoperation,progress in corneal healing were observed at1,3d,1and3wk.RESULTS:The average surgery time of amniotic membrane transplantation group was61.4±5.2min,and the bandage contact lens group was34.5±2.7min,which was significantly shorter(Student's t-test,P<0.05).There was no difference of the degree of eye comfort between the two groups at first day after surgery.But3d and1wk postoperation,the degree of ocular comfort of bandage contact lens group was much better than amniotic membrane transplantation group(P<0.01),while there was no difference between the two groups3wk after surgery(P>0.05).The corneal healing score of the two groups was0?85±0.18and1.15±0.18in the3wk after operation respectively,and the difference between the two groups was not statistically significant(Student's f-test,P=0.25).There was only one case of recurrence in amniotic membrane group.CONCLUSION:Treatment of larger pterygium with amniotic membrane transplantation for all the cornea or wearing bandage contact lenses after autologous limbal stem cell transplantation,can both ease eye symptoms and promote corneal wound healing.Those patients with bandage contact lens feel more comfortable and convenient than with autologous limbal stem cell transplantation.Also the bandage contact lens surgery is more economical than the other one.