Oculus眼表综合分析仪在复发性翼状胬肉切除联合自体角膜缘干细胞移植术后眼表功能评价中的应用

Evaluation of tear film changes after recurrent pterygium surgery with limbal stem cell autografts transplantation using oculus keratograph

目的通过Oculus眼表综合分析仪评估复发性翼状胬肉切除联合自体角膜缘干细胞移植术后眼表功能的变化。方法前瞻性临床研究。采用Oculus非侵入性眼表综合分析仪检测28例(28眼)复发性翼状胬肉患者行翼状胬肉切除联合自体角膜缘干细胞移植术的术前及术后14 d、1个月、3个月、6个月的非侵入性首次泪膜破裂时间(noninvasive first tear break-up time,NITBUTf)、非侵入性泪膜平均破裂时间(noninvasive average tear break-up time,NITBUTavg)及非侵入性泪河高度,并进行对比。结果患眼术前NITBUTf为(5.25±1.84)s,术后1个月、3个月、6个月分别为(7.86±1.82)s、(8.79±2.60)s、(10.03±2.43)s,均较术前显著增加,差异均有统计学意义(均为P<0.05);术后6个月与术后3个月NITBUTf相比差异有统计学意义(P<0.05)。术前NITBUTavg为(9.36±1.42)s,术后14 d、1个月、3个月及6个月分别为(9.00±2.04)s、(10.10±2.04)s、(12.04±2.40)s、(13.18±2.33)s,差异有统计学意义(P<0.05);术后6个月、术后3个月NITBUTavg分别与术前及术后14 d、1个月相比差异均有统计学意义(均为P<0.05)。术前非侵入性泪河高度为(0.25±0.06)mm,术后14 d、1个月、3个月及6个月分别为(0.30±0.07)mm、(0.28±0.07)mm、(0.31±0.08)mm、(0.31±0.08)mm,差异有统计学意义(P<0.05)。结论复发性翼状胬肉切除联合自体角膜缘干细胞移植术后眼表功能重建较为缓慢,术后6个月均为恢复期;Oculus眼表综合分析仪可以作为一种评估翼状胬肉手术前后眼表功能的无创性方法,结果客观可靠。

Objective To Evaluate the tear film changes after recurrent pterygium excision with limbal stem cell antografts using oculus keratograph.Methods A prospective study.Totally 28 eyes with recurrent pterygium were treated by pterygium excision with limbal stem cell autografts.The first non-invasive breakup time of tear films(NITBUTf),the average non-invasive tear film break-up time(NITBUTavg),non-invasive lower tear meniscus height(NILTMH)were tested preoperativeIy,14 days,1 month,3 months and 6 months postoperatively by the Keratograph 5M ocular surface analyzer(Oculus).Results NITBUTf was(5.25±1.84)s before surgery,(7.86±1.82)s,(8.79±2.60)s,(10.03±2.43)s 1 month,3 months and 6 months postoperatively,which were significantly increased than before pterygium surgery treatment(all P<0.05).There was a statistically significant difference in NIBUTf between 6 months and 3 months after surgery(P<0.05).The preoperative NITBUTav was(9.36±1.42)s,and after 14 days,1 month,3 months and 6 months postoperatively were(9.00±2.04)s,(10.10±2.04)s,(12.04±2.40)s,(13.18±2.33)s,and the difference was statistically significant(P<0.05).At 6 months and 3 months after operation,NIBUTavg had statistically significant differences compared with pre-operation and 14 days and 1 month after operation(all P<0.05).The NILTMH was(0.25±0.06)mm before surgery,and(0.30±0.07)mm,(0.28±0.07)mm,(0.31±0.08)mm,(0.31±0.08)mm after 14 days,1 month,3 months and 6 months after surgery,respectively,and the difference was statistically significant(P<0.05).Conclusion The ocular surface reconstruction after recurrent pterygium excision with limbal stem cell antografts is slow and tend to be stable in 6 months postoperatively.The noninvasive Keratography 5M is a effective tool in monitoring and evaluating the changes in tear film.