绷带镜联合游离球结膜移植治疗翼状胬肉的疗效观察

Evaluation of pterygium excision combined with conjunctival transplantation and bandage contact lens in the treatment of pterygium

目的比较翼状胬肉切除术、翼状胬肉切除术联合游离结膜瓣移植术和术后使用角膜绷带镜的临床效果。方法前瞻性研究方法。选择60例(60只眼)原发性翼状胬肉患者,随机分为对照组、游离组、绷带镜组3组,每组各20例。对照组行单纯翼状胬肉切除手术治疗;游离组行翼状胬肉切除联合自体结膜瓣移植术;绷带镜组行翼状胬肉切除联合自体结膜瓣移植术联合角膜绷带镜治疗。观察术后3组患者愈合情况,评价指标包括:角膜上皮愈合情况;术后主观感受评分;泪膜破裂时间(BUT)和泪液分泌试验(SIt)的改变;屈光状态变化;临床疗效。结果术后绷带镜组角膜上皮恢复时间相对短,绷带镜组在术后1~3 d角膜上皮愈合率高于游离组和对照组(P<0.05)。术后1 d和6 d,绷带镜组的畏光、眼部刺痛、流泪、异物感、视物模糊症状评分均高于对照组和游离组(P<0.05)。游离组和绷带镜组术后1个月、3个月的BUT均较术前延长,差异有统计学意义(F=6.36,P=0.041;F=7.21,P=0.023)。游离组和绷带镜组术后1个月、3个月的SIt均较术前提高,差异有统计学意义(F=7.14,P=0.029;F=8.91,P=0.017)。术后1个月、3个月时,各组患者的角膜散光值降低,绷带镜组角膜散光度低于游离组和对照组,差异有统计学意义(P<0.05)。术后绷带镜对照组术后有4例复发、游离组术后有2例复发、绷带镜组有1例复发。绷带镜组术后复发率最低。结论翼状胬肉切除术联合结膜瓣移植联合角膜绷带镜治疗翼状胬肉的效果较好,术后角膜创面愈合快,可减轻患者术后的不适度并能降低翼状胬肉复发率。

Objective To compare the clinical effects of pterygium excision,pterygium excision combined with free conjunctival flap transplantation and postoperative use of corneal bandage lens.Methods 60 patients with primary pterygium were randomly divided into three groups:control group,free group,bandage lens group,with 20 patients in each group.The control group was treated by pterygium excision alone.Pterygium excision with conjunctival autograft transplantation was performed in the free group.In the bandage lens group,pterygium excision combined with conjunctival flap autotransplantation combined with corneal bandage lens was performed.The postoperative healing of the three groups of patients was observed,and the evaluation indexes included:the healing of the corneal epithelium;Postoperative subjective feeling score;Changes of tear film rupture time and SchirmerⅠtest;Change of refractive state;Clinical efficacy.Results The recovery time of corneal epithelium in the bandage group was shorter than that in the free group and the control group.The healing rate of corneal epithelium in the bandage group was higher than that in the free group and the control group 1~3 days after the operation(P<0.05).The scores of photophobia,ocular tingling,tearing,foreign body sensation and blurred vision symptoms in the bandage lens group were higher than those in the control group and the free group(P<0.05).1 month and 3 months after surgery in the free group and the bandage lens group,BUT were longer than those before surgery,and the difference was statistically significant(F=6.36,P=0.041;F=7.21,P=0.023).1 month,3 months after operation,Schirmer were longer than preoperation in Free and bandage group,the difference was statistically significant(F=7.14,P=0.029;F=8.91,P=0.017).At 1 month and 3 months after surgery,the value of corneal astigmatism of patients in each group decreased,and the corneal astigmatism of the bandage group was lower than that of the free group and the control group,with statistically significant difference(P<0.05).There were 4 cases of recurrence in the control group,2 cases of recurrence in the free group,and 1 case of recurrence in the bandage group.The recurrence rate was the lowest in the bandage group.Conclusion Pterygium excision combined with conjunctival flap transplantation and corneal bandage lens is effective in the treatment of pterygium.The postoperative corneal wound healing is fast,which can reduce postoperative discomfort and the recurrence rate of pterygium.