翼状胬肉切除联合自体角膜缘干细胞移植和羊膜移植术治疗翼状胬肉

Curative effect of pterygium resection and autologous limbal stem cell transplantation combined with amniotic membrane transplantation in the treatment of pterygium

目的:分析翼状胬肉切除联合自体角膜缘干细胞移植术(LSCT)和羊膜移植术(AMT)治疗翼状胬肉的疗效观察。方法:前瞻性对照研究。将2017-01/2020-01在本院眼科门诊就诊的177例187眼翼状胬肉连续病例按随机区组设计原则分为A组(59例64眼)、B组(59例60眼)、C组(59例63眼)三组,三组均行翼状胬肉切除,A组联合LSCT、B组联合AMT、C组联合LSCT和AMT,术后均随访12mo;比较三组视力、角膜上皮修复及新生血管情况,并统计术后复发率、眼部症状、并发症及植片成活情况。结果:三组术后6、12mo时的视力及角膜上皮缺损修复时间均无差异(P>0.05),术后1mo时C组角膜荧光素染色(FL)值显著低于A组、B组(均P<0.05);三组患者角膜透明或有轻度薄翳,但均未见新生血管生长;三组均未见真性翼状胬肉复发现象,术后6、12mo时A组、C组结膜纤维增生分级与B组比较均有差异(P<0.05);三组SchirmerⅠ试验滤纸湿长的时间、组间及交互效应均无差异(P>0.05),但C组术后1mo泪膜破裂时间(BUT)显著高于A组、B组(均P<0.05);三组术后均有不同程度结膜水肿,拆线后2wk内均消失,三组植片均成活,羊膜存活,未见发生排斥、溶解反应。结论:LSCT、AMT、LSCT联合AMT治疗翼状胬肉均可取得良好的疗效,但LSCT联合AMT治疗术后短期角膜上皮修复相对更佳,结膜纤维增生及干眼症状更轻。

AIM:To observe the curative effect of pterygium resection and autologous limbal stem cell transplantation(LSCT)combined with amniotic membrane transplantation(AMT)in the treatment of pterygium.METHODS:Totally 177 patients(187 eyes)with pterygium treated in ophthalmology clinic of the hospital between January 2017 and January 2020 were selected and randomly divided into group A(59 cases,64 eyes),group B(59 cases,60 eyes),and group C(59 cases,63 eyes).All were treated with pterygium resection.On this basis,patients in the three groups were treated with autologous LSCT,AMT,and autologous LSCT combined with AMT,respectively.All subjects were followed up for 12mo after surgery.Visual acuity,corneal epithelial repair,and neovascularization of the three groups were comparatively analyzed.Postoperative recurrence rate,ocular symptoms,complications,and survival of grafts were statistically analyzed.RESULTS:Visual acuity changes and repair time of corneal epithelial defect showed no statistically significant difference among the three groups(P>0.05).1mo after surgery,the corneal fluorescein staining(FL)value of group C was significantly lower than that of group A or group B(all P<0.05).No angiogenesis or recurrent true pterygium was observed.6mo and 12mo after surgery,the grades of conjunctival fibroplasia in group A and group C were significantly different from that in group B(P<0.05).There was no statistically significant difference in the wet length of the filter paper in Schirmer I test in terms of time,inter-group and interaction effects(P>0.05).1mo after surgery,the tear film breakup time(BUT)of group C was significantly longer than that of group A or group B(all P<0.05).There were different degrees of conjunctival edema in the three groups after surgery,which disappeared within 2wk after suture removal.Grafts all survived,vascularization of amniotic membrane grafts ended.CONCLUSION:Autologous LSCT,AMT and autologous LSCT combined with AMT all are effective in the treatment of pterygium.However,autologous LSCT combined with AMT can achieve better short-term effect,with milder conjunctival fibroplasia and dry eye symptoms.