基于眼表综合分析仪和视觉模拟评分的翼状胬肉术后眼表炎症指数转归

The prognosis of ocular inflammation index after pterygium surgery based on Oculus Keratograph 5M and Visual analogue scale

目的利用眼表综合分析仪和视觉模拟评分探索翼状胬肉切除术后眼表炎症的变化规律,评估其作为抗炎治疗评价指标的有效性。方法采用前瞻性病例自身对照研究设计,纳入2016年6—9月在中山眼科中心就诊的18例原发性翼状胬肉患者。所有患者均接受翼状胬肉切除联合羊膜移植术,术后给予眼表抗炎治疗。患者术前,术后1、3、7、10、30和60 d进行眼表炎症评估,通过眼表综合分析仪眼红指数分析软件对颞侧球结膜眼红指数(TCHI)进行动态评估,采用眼部症状评分(OSS)、视觉模拟评分(VAS)对患者主观炎症状态进行分析,荧光素钠染色观察角膜及巩膜手术创面上皮化进程,并行最佳矫正视力(BCVA)、眼压和术后并发症的评价。结果在随访过程中,未观察到与手术和药物相关的全身和眼部严重并发症。术后10 d,角膜上皮缺损修复完全,术后30 d,巩膜暴露区结膜上皮化完全。术后60 d,BCVA(LogMAR)为0.12±0.17,与术前值0.34±0.36相比明显提高,差异有统计学意义(t=3.401,P=0.003)。术后1 d OSS及VAS均较术前值明显升高,差异均有统计学意义(OSS:Z=-4.255,P=0.000;VAS:Z=-5.256,P=0.000);术后7 d,OSS降至术前基线水平,与术前值比较差异无统计学意义(Z=-0.958,P=0.372);术后30 d,VAS降至术前基线水平,与术前值比较差异无统计学意义(Z=-1.631,P=0.192);术后60 d,OSS低于术前基线水平,与术前值比较差异有统计学意义(Z=-2.397,P=0.037)。术前TCHI均大于1.2,术后1 d TCHI升至峰值,术后1 d TCHI与术前值比较差异有统计学意义(t=-6.620,P=0.000),随着抗炎治疗的介入TCHI逐渐降低,术后7 d TCHI回落至术前基线水平,与术前值比较差异无统计学意义(t=-1.050,P=0.310);术后60 d,TCHI降至基线水平之下,与术前值比较差异有统计学意义(t=2.758,P=0.020)。结论翼状胬肉围手术期采用主观症状评分联合眼红指数分析可准确评估患者眼表炎症状态,并作为评价抗炎治疗效果的参考指标。

Objective To investigate the characteristics of ocular surface inflammation index after pterygium excision by using Oculus Keratograph?5M and Visual analogue scale and evaluated the effectiveness of anti-inflammatory treatment.Methods A prospective case control study was performed.Eighteen patients(6 males and 12 females)who suffered from primary pterygium were recruited in Zhongshan Ophthalmic Center from June to September 2016.All patients were treated with monocular pterygium excision combined with amniotic membrane transplantation.Anti-inflammatory treatment was given after surgery,and the ocular inflammation index was evaluated at preoperative and 1st,3rd,7th,10th,30th and 60th day postoperative.The temporal conjunctival hyperemia index(TCHI)was assessed by Oculus Keratograph?5M with a red eye index analysis software.Ocular symptom scores(OSS)and visual analogue scale(VAS)were used to analyze the subjective symptoms of the patients.Fluorescein staining was used to detect the epithelization of corneal and scleral wound.The best corrected visual acuity(BCVA),intraocular pressure and complications were evaluated in this study.This study was approved by the Medical Ethics Committee of Zhongshan Ophthalmic Center of Sun Yat-sen University(2016KYPJ024).All patients signed informed consent for clinical research.Results No drug-related ocular and systemic adverse events were found during the follow-up.Corneal epithelial defect was recovered on 10th day,and conjunctival epithelization was observed in sclera exposed area on 30th day.The BCVA on the 60th day was 0.12±0.17,which was significantly lower than 0.34±0.36 preoperatively(t=3.401,P=0.003).Compared with those before surgery,OSS and VAS were significantly increased on 1st day(OSS:Z=-4.255,P=0.000;VAS:Z=-5.256,P=0.000).The OSS on 7th day was not significantly different from that before surgery(Z=-0.958,P=0.372).VAS decreased to baseline on 30th day.The OSS on 60th day after surgery was significantly lower than that before surgery(Z=-2.397,P=0.037).TCHI was higher than 1.2 preoperatively,and increased to the highest on 1st day after surgery,with significant difference between them(t=-6.620,P=0.000).The TCHI decreased to baseline on 7th day,no significant difference were obtained when compared with preoperative TCHI(t=-1.050,P=0.310),and TCHI on 60th day after surgery was lower than that before surgery,with significant difference between them(t=2.758,P=0.020).Conclusions The subjective symptoms combined with conjunctival hyperemia can be more accurate assessment of ocular surface inflammation in the perioperative period of pterygium surgery,which can be used as an evaluation index to assess the effectiveness of anti-inflammatory treatment.