翼状胬肉切除联合角膜缘干细胞移植治疗翼状胬肉的疗效及对泪膜功能的影响

Efficacy of pterygium resection combined with corneal limbal stem cell transplantation in the treatment of pterygium and the effect on tear film function

目的观察翼状胬肉切除联合角膜缘干细胞移植治疗翼状胬肉的疗效及对泪膜功能的影响。方法选取2019年8月—2021年7月我院眼科收治的翼状胬肉患者61例(80只眼),按照随机数字表法将其分为A组30例(42只眼)与B组31例(38只眼)。B组采用单纯翼状胬肉切除术,A组采用翼状胬肉切除术联合角膜缘干细胞移植术。观察比较两组术前、术后1周、术后1及3个月的泪膜破裂时间(BUT)、基础泪液分泌试验(SIT)、裸眼视力(UCVA)、角膜散光度(CAD)、轴向(CAA)及随访3个月内的复发情况,CAA包括顺规散光(WR)、逆规散光(AR)、斜轴散光(OA)。结果与治疗前比较,两组术后1周、1及3个月的BUT指标呈先降低后升高的变化趋势;两组术后1周、1及3个月的SIT指标组内比较差异均无统计学意义(F=0.104、0.338,均P>0.05),组间比较差异均无统计学意义(t=0.308、0.203、0.316、0.287,均P>0.05);两组术后1、3个月的UCVA指标均高于术前,组内比较差异均有统计学意义(t=7.357、8.263、4.357、3.147,均P<0.05);两组角膜CAD术后1周、术后1及3个月均显著降低,组内比较差异均有统计学意义(F=12.549、18.564,均P<0.05);CAA中WR比例显著降低,仅术后1、3个月时组内比较差异均有统计学意义,(Z=12.877、14.455,均P<0.05);CAA中AR、OA比例显著增加,仅术后1、3个月时组内比较差异均有统计学意义,(Z=3.759、7.835、3.788、3.327,均P<0.05);而两组术后1周、术后1及3个月的BUT、UCVA、CAD组间比较差异均无统计学意义(t=1.434、0.499、0.510、0.342、0.357、0.376、0.173、0.163、0.127,均P>0.05);CAA术后1周、术后1及3个月各指标组间比较差异均无统计学意义(χ2=0.005、0.529、0.346、0.622、1.118、0.343、0.602、0.179、0.080,均P>0.05);A组治疗后的复发率显著低于B组,两组比较差异有统计学意义(χ2=4.803,P<0.05)。结论翼状胬肉切除联合角膜缘干细胞移植术对患者泪膜功能影响较小,且能够改善裸眼视力和降低术后复发率。

Objective To observe the effecacy of pterygium excision combined with corneal limbal stem cell transplantation in the treatment of pterygium and the effect on the function of tear film.Methods A total of 61 patients with pterygium(80 eyes)admitted to the ophthalmic department of our hospital from August 2019 to July 2021 were selected and divided into group A(30 patients,42 eyes)and group B(31 patients,38 eyes)according to random number table method.Pterygium excision was performed in group B,and pterygium excision combined with corneal limbal stem cell transplantation was performed in group A.The tear film break-up time(BUT),basic tear secretion test(SIT),naked eye visual acuity(UCVA),corneal dispersion(CAD),axial orientation(CAA)and recurrence within 3 months of follow-up were observed and compared between the two groups before surgery,1 week after surgery,1 and 3 months after surgery,and the recurrence within 3 months after follow-up.CAA includes syntactic astigmatism(WR),antitactic astigmatism(AR)and oblique astigmatism(OA).Results Compared with before treatment,the BUT index of the two groups decreased first and then increased at 1 week,1 month and 3 months after operation.There were no statistically significant differences in SIT indexes between the two groups at 1 week,1 month and 3 months after surgery(F=0.104,0.338,all P>0.05),and no statistically significant differences between the two groups(t=0.308,0.203,0.316,0.287,all P>0.05).The UCVA indexes of the two groups 1 and 3 months after surgery were higher than those before surgery,and the differences within the two groups were statistically significant(t=7.357,8.263,4.357,3.147,all P<0.05).Corneal CAD was significantly decreased 1 week after surgery,1 month after surgery and 3 months after surgery in both groups,with statistical significance in intra-group comparison(F=12.549,18.564,all P<0.05).The proportion of WR in CAA was significantly decreased,with statistical significance only 1 and 3 months after surgery(Z=12.877,14.455,all P<0.05).The proportion of AR and OA in CAA increased significantly,and only 1 and 3 months after surgery,the intra-group differences were statistically significant(Z=3.759,7.835,3.788,3.327,all P<0.05).There was no statistical significance in BUT,UCVA and CAD between the two groups 1 week after surgery,1 and 3 months after surgery(t=1.434,0.499,0.510,0.342,0.357,0.376,0.173,0.163,0.127,all P>0.05);There were no statistically signific ant differences in all indexes at 1 week,1 month and 3 months after CAA surgery(χ2=0.005,0.529,0.346,0.622,1.118,0.343,0.602,0.179,0.080,all P>0.05).The recurrence rate of group A after treatment was significantly lower than that of group B,and the difference between the two groups was statistically significant(χ2=4.803,P<0.05).Conclusion Pterygium excision combined with limbal stem cell transplantation has little effect on tear film function,and can improve naked eye vision and reduce postoperative recurrence rate.