AS-OCT在翼状胬肉切除联合自体结膜移植加戴绷带镜术后的结膜植片厚度测量中的应用

Measurement of conjunctival graft thickness after pterygium excision combined with autologous conjunctival transplantation and bandage lens wearing by anterior segment optical coherence tomography

目的应用前段光学相干断层成像(anterior segment optical coherence tomography,AS-OCT)对翼状胬肉切除联合自体结膜移植加戴绷带镜术后患者球结膜植片厚度进行研究,同时研究绷带镜对翼状胬肉患者术后角膜上皮愈合率、疼痛评分的影响。方法回顾性分析2016年1月至2018年1月在我院眼科就诊的52例单眼初发翼状胬肉患者资料。行翼状胬肉切除联合自体球结膜移植加戴绷带镜26例为试验组,行相同手术方式但不加戴绷带镜26例为对照组,应用AS-OCT测量两组患者术后1 d、1周、2周及2个月鼻侧结膜植片距离巩膜突1 mm、2 mm及3 mm的厚度并进行比较,同时比较两组患者角膜上皮愈合率、疼痛评分。结果术后1 d,两组患者各部位结膜植片厚度比较,差异均无统计学意义(均为P>0.05);术后1周、2周、2个月,试验组各部位结膜植片厚度均较对照组薄,差异均有统计学意义(均为P<0.05)。术后1 d、1周,两组患者三处部位平均结膜植片厚度比较,差异均无统计学意义(均为P>0.05);术后2周、2个月,试验组患者三处部位平均结膜植片厚度均较对照组薄,差异均有统计学意义(均为P<0.05)。术后1 d,两组患者角膜上皮均未愈合;术后1周、2周,试验组患者角膜上皮愈合率均较对照组高,差异均有统计学意义(均为P<0.05);而术后2个月,两组差异无统计学意义(P>0.05)。术后1 d、1周、2周,试验组患者疼痛评分均低于对照组,差异均有统计学意义(均为P<0.001);而术后2个月,两组患者疼痛评分差异无统计学意义(P>0.05)。结论角膜绷带镜可减轻翼状胬肉术后的结膜植片水肿,也可促进术后早期角膜上皮愈合,缓解术后疼痛。

Objective To investigate the thickness of conjunctival grafts after pterygium excision combined with autologous conjunctival transplantation and bandage lens wearing by anterior segment optical coherence tomography(AS-OCT),and to explore the effect of bandage lens on corneal epithelial healing rate and pain score after pterygium surgery.Methods Totally 52 patients with unilateral primary pterygium were selected retrospectively from January 2016 to January 2018.Pterygium excision combined with autologous conjunctival transplantation and bandage lens wearing was performed in 26 patients(experimental group)and 26 patients received same surgery without bandage lens(control group).Anterior segment optical coherence tomography(AS-OCT)was used to measure the thickness of the nasal bulbar conjunctival grafts at 1 mm,2 mm and 3 mm from the scleral process at 1 day,1 week,2 weeks and 2 months after surgery,and the results were compared between the groups.Corneal epithelial healing rate and pain score were also compared between the two groups.Results There was no significant difference in the thickness of conjunctival grafts at different parts between the two groups at 1 day after surgery(all P>0.05),but the thickness of conjunctival grafts at different parts in the experimental group was thinner than that in the control group at 1 week,2 weeks and 2 months after surgery,and the differences were statistically significant(all P<0.05).The mean thickness of conjunctival grafts at the three parts showed no difference between the two groups at 1 day and 1 week after surgery(all P>0.05).The mean thickness of conjunctival grafts at the three parts in experimental group were thinner than that in control group at 2 weeks and 2 months after surgery(all P<0.05).Corneal epithelium did not heal in both two groups at 1 day after surgery,and had higher healing rate in experimental group than that in control group at 1 week and 2 weeks after surgery(both P<0.05),while there was no significant difference between the two groups at 2 months after surgery(P<0.05).Patients in experimental group had lower pain scores than those in control group at 1 day,1 week and 2 weeks after surgery,and statistical differences were found(all P<0.001),while no significant difference was found in pain score between the two groups at 2 months after surgery(P>0.05).Conclusion Corneal bandage lens can relieve conjunctival graft edema,promote early corneal epithelial healing and relieve postoperative pain after pterygium surgery.