两种手术方案对年龄相关性白内障并翼状胬肉的临床效果评估

Evaluation of the Clinical Effect of Two Kinds of Operation Schemes on Senile Cataract with Pterygium

目的:评估两种手术方案对年龄相关性白内障并翼状胬肉的临床效果。方法:随机选取35例(35眼)老年性白内障并翼状胬肉患者为观察组,据白内障并翼状胬肉情况,采用1∶1匹配同期收治35例(35眼)患者作为对照组。观察组实施分次手术:一期行翼状胬肉切除联合角膜缘干细胞移植术,术后7d,二期行白内障超声乳化摘除(PHACO)+多焦点非球面IOL植入术。对照组实施联合手术:单纯翼状胬肉切除联合PHACO+单焦点非球面IOL植入术,术后随访6个月,比较术前及术后组内组间裸眼近视力(UNVA)、裸眼远视力(UDVA)、眼拟调节力、泪膜破裂时间(BUT)、泪液分泌试验(SIT)、角膜散光、平均角膜曲率、视功能和生存质量及并发症等指标。结果:组内比较,UNVA、UDVA、BUT、SIT、角膜散光及曲率、视功能和生存质量等指标两组术后均较术前显著改善,有统计学意义(P<0.05);组间比较,观察组术后UNVA、视近和视远拟调节力、BUT、SIT、视功能和生存质量、视近时满意度及视近戴镜评分均显著优于对照组(P<0.05),两组并发症无显著性差异(P>0.05)。结论:两种手术方案均能改善视功能和生存质量,分次手术方案疗效更佳,但其实施要求高,临床应据实际情况,选择适当的手术方案。

Objective:To evaluate the clinical effect of two surgical schemes on senile cataract with pterygium.Methods:35 cases(35 eyes)of senile cataract with pterygium were randomly selected as the observation group.According to the condition of cataract with pterygium,35 cases(35 eyes)were treated with 1∶1 matching at the same time as the control group.The observation group underwent two-stage operation:first pterygium resection,combined with corneal limbal stem cell transplantation,and then PHACO+Multifocal aspheric IOL implantation 7 days after the operation.The control group was real one stage operation:pterygium resection combined with PHACO+Single focus aspherical IOL implantation.The patients were followed up for 6 months.Comparison of the near visual acuity(UNVA),far visual acuity(UDVA),pseudo-accommodation,tear rupture time(BUT),tear secretion test(SIT),corneal astigmatism,mean corneal curvature,quality of life,satisfaction with visual function and complications between the groups before and after the operation.Results:Intragroup comparison,UNVA,UDVA,BUT,corneal astigmatism,corneal curvature,visual function,quality of life and other indicators,the two groups were significantly improved after operation,with statistical significance(P<0.05);compared between the two groups,the observation group was significantly better than the control group in terms of UNVA,pseudo-accommodation,BUT and SIT,the scores of visual function-relatedquality of life scales,satisfaction with near vision and glass-wearing at near vision of observation group were significantly better than those of control group(P<0.05),there was no significant difference in complications between the two groups(P>0.05).Conclusion:Two kinds of operation schemes can improve visual function and quality of life.The second stage operation scheme has better effect,but it requires high implementation.The clinical operation scheme should be selected according to the actual situation.