白内障合并翼状胬肉联合手术患者角膜参数及泪膜稳定性的变化

Changes of corneal astigmatism and tear film stability in patients with cataract and pterygium combined operation

目的:探讨白内障合并翼状胬肉联合手术患者术后角膜参数及泪膜稳定性的变化及临床意义。方法:选取我院2020-01/12收治的白内障合并翼状胬肉患者80例的临床资料进行回顾性研究,所有患者均行翼状胬肉切除+白内障超声乳化+人工晶状体植入+角膜缘干细胞移植术,比较手术前后视力、角膜Pentacam参数、角膜散光度和角膜曲率及泪膜稳定性变化,并计算人工晶状体(IOL)度数偏差。结果:术后3mo,本组患者角膜前表面平均屈光度与角膜平均屈光度均明显高于术前,角膜表面变异系数(ISV)与角膜前表面散光均显著低于术前,且泪膜稳定性各指标较术前明显改善(均P<0.01)。术后6mo,本组患者视力较术前显著改善,角膜散光度较术前显著降低,但角膜曲率显著高于术前(均P<0.001)。本组患者IOL度数偏差-5.5~+3.5D。结论:白内障合并翼状胬肉联合手术可有效改善患者视力,改善泪膜稳定性,但由于可能存在角膜散光,因此行翼状胬肉切除术后需应用对侧眼角膜屈光力计算IOL度数,待角膜屈光状态稳定后再行白内障超声乳化术,以确保其预后效果。

AIM:To investigate the changes and clinical significance of corneal parameters and tear film stability after cataract combined with pterygium surgery.METHODS:The clinical data of 80 patients with cataract and pterygium admitted to our hospital from January to December 2020 were retrospectively studied.All patients underwent pterygium excision+phacoemulsification+intraocular lens implantation+limbal stem cell transplantation.The changes of visual acuity,corneal Pentacam parameters,corneal astigmatism,corneal curvature and tear film stability before and after operation were compared,and the degree deviation of intraocular lens(IOL)was calculated.RESULTS:At 3mo after operation,the average corneal refractive index and average corneal refractive index of the patients in this group were significantly higher than those before operation.The index of surface variance(ISV)of corneal surface and astigmatism of anterior corneal surface were significantly lower than those before operation,and the indexes of tear film stability were significantly improved compared with those before operation(all P<0.01).At 6mo after operation,the visual acuity of the patients in this group was significantly improved compared with that before operation,and the corneal astigmatism was significantly decreased compared with that before operation,but the corneal curvature was significantly higher than that before operation(all P<0.001).The IOL degree deviation of the patients in this group was-5.5-+3.5D.CONCLUSION:Cataract combined with pterygium surgery can effectively improve the visual acuity of patients and improve the stability of tear film,but there may be corneal astigmatism.Therefore,the contralateral corneal refractive power should be used to calculate the IOL degree after pterygium excision.When the corneal refractive state is stable,cataract phacoemulsification is performed to ensure its prognosis.