自体血清滴眼液对翼状胬肉术后眼表重建及预防复发的疗效分析

Clinical effect of autologous serum eye drops in promoting postoperative ocular surface reconstruction and preventing recurrence after pterygium surgery

背景翼状胬肉以手术治疗为主,但手术会对结膜和角膜造成损伤,且术后仍可能复发。目的观察并比较自体血清对翼状胬肉术后眼表重建及预防复发的疗效。方法将2018年6月-2020年12月于我科需行手术治疗的75例翼状胬肉患者随机分为三组,每组25例。手术方法均为翼状胬肉切除联合自体角膜缘干细胞移植。三组术后联合不同的滴眼液治疗,A组为聚乙二醇滴眼液,B组为小牛血去蛋白提取物眼用凝胶,C组为自体血清滴眼液。分别于术前及术后1 d、3 d、1周、2周、6个月、12个月检测并记录患者的泪膜破裂时间和基础泪液分泌量,观察并记录患者的自觉症状、结膜瓣充血消退、角膜创面上皮修复和复发情况。结果A组、B组、C组均包括25例患者。A组平均年龄分别为(57.8±7.3)岁,男性13例;B组平均年龄(58.8±6.9)岁,男性11例;C组平均年龄(59.1±6.6)岁,男性14例。三组性别、年龄差异均无统计学意义(P均>0.05)。B组、C组术后自觉症状消退时间、结膜瓣充血完全消退时间、角膜创面上皮完全修复时间均低于A组,差异均有统计学意义(P均<0.05);术后6个月和12个月,B组和C组的泪膜破裂时间、基础泪液分泌量高于A组,差异均有统计学意义(P均<0.05);C组结膜瓣充血完全消退时间、泪膜破裂时间优于B组,差异有统计学意义(P均<0.05)。术后12个月,A组、B组各有1例复发(4.0%),C组复发为0,但差异无统计学意义(P>0.05)。结论小牛血去蛋白提取物和自体血清对于翼状胬肉术后的眼表重建效果优于聚乙二醇。且自体血清可降低复发率,相比小牛血去蛋白提取物更有优势。

Background Surgery is the main treatment method for pterygium,but it may cause damage to the conjunctiva and cornea,with the possibility of recurrence after surgery.Objective To observe and compare the effect of autologous serum on postoperative ocular surface reconstruction and prevention of recurrence after pterygium surgery.Methods Seventy-five patients with pterygium who required surgical treatment in our department from June 2018 to December 2020 were randomly divided into three groups,with 25 cases in each group.Pterygium excision combined with corneal limbal stem cell transplantation was performed in all patients.Patients in the three groups were treated with various eye drops after operation.Group A was treated with polyethyleneglycol eye drops,group B with deproteinized bovine blood extract eye gel and group C with autologous serum eye drops.The tear film rupture time and basic tear secretion,the conscious symptoms,hyperemia of conjunctival flap,repair of corneal wound epithelium and recurrence were observed and recorded at pre-operation,1 d,3 d,1 week,2 weeks,6 months and 12 months after operation.Results There were 25 patients in each group,with a mean age of 57.8±7.3 years in group A,58.8±6.9 years in group B,and 59.1±6.6 years in group C,and there were 13 male patients in group A,11 male patients in group B,and 14 male patients in group C;there were no significant differences in sex and age between the three groups(all P>0.05).Compared with group A,groups B and C had significantly shorter regression time of subjective symptoms,complete regression time of conjunctival flap congestion,and time to complete corneal epithelial wound repair(all P<0.05).At 6 and 12 months after surgery,groups B and C had significantly longer tear break-up time and significantly higher basal tear secretion than group A(all P<0.05),and compared with group B,group C had significantly better complete regression time of conjunctival flap congestion and tear break-up time(both P<0.05).There was 1 case of recurrence(4%)in each of groups A and B at 12 months after surgery,with no case of recurrence in group C,and there was no significant difference in recurrence between the three groups(P>0.05).Conclusion Deproteinized extract of calf blood and autologous serum shows better effect than polyethylene glycol in promoting postoperative ocular surface reconstruction,and compared with deproteinized extract of calf blood,autologous serum has significant advantages and can reduce recurrence rate.