激光治疗性角膜切削术联合眼表干预治疗复发性角膜上皮糜烂的效果

Efficacy of phototherapeutic keratectomy combined with ocular surface intervention for recurrent corneal erosion

目的 观察激光治疗性角膜切削术联合眼表干预治疗复发性角膜上皮糜烂效果。设计回顾性病例系列。研究对象2018年11月至2021年6月佛山市第二人民医院复发性角膜上皮糜烂患者52例(52眼)。方法按入院先后顺序不同分为两组,单纯行激光治疗性角膜切削术治疗者26例(26眼)为A组,激光治疗性角膜切削术联合围手术期干眼治疗(人工泪液点眼、睑板腺按摩、热敷和典必殊眼膏涂睑缘)者26例(26眼)为B组,术后随访1年。裂隙灯检查角膜上皮完整、透明、荧光素染色阴性为角膜修复。术后7天进行刺激评分、术后3个月眼表综合分析仪检查泪液脂质和睑板腺、BUT和泪河高度。主要指标眼刺激反应评分、主观刺激症状评分,修复持续时间,眼表状态及术后并发症发生率。结果术后7天A组眼刺激反应评分5.38±1.30,主观刺激症状评分5.77±1.42,B组分别为4.35±1.23、4.5±1.45。A组角膜修复持续时间(8.19±1.86)天,明显长于B组的(6.19±1.23)天(P=0.001)。术后3个月A组泪液脂质评分、BUT、泪河高度分别为2.23±0.59、(7.50±2.29)s、(0.30±0.09)mm,均差于B组的1.46±0.51、(10.66±2.28)s、(0.47±0.08)mm(P均<0.05)。A组睑板腺缺失评分2.08±0.48,B组1.85±0.46,差异无统计学意义(P=0.08)。A组术后并发症发生率34.6%,高于B组的7.7%(P=0.038)。结论激光治疗性角膜切削术联合眼表干预治疗复发性角膜上皮糜烂效果良好,改善眼表状态,减少术后并发症。

Objective To observe the clinical efficacy of laser therapeutic keratectomy combined with ocular surface intervention in recurrent corneal epithelial erosion(RCE).Design Retrospective case series.Participants 52 cases(52 eyes)with RCE diagnosed in the Second People's Hospital of Foshan from November 2018 to June 2021.Methods RCE patients were divided into two groups based on their treatment methods.26 patients(26 eyes)were treated with phototherapeutic keratectomy alone as group A,and 26 patients(26 eyes)were treated with phototherapeutic keratectomy combined with perioperative dry eye treatment as group B.All patients completed 1 year follow-up.Corneal repair refers to complete and transparent corneal epithelium checked and negative fluorescein staining by slit lamp examination.On the 7th day after surgery,the stimulation score was questionnaired,and 3 months later,the tear lipid,meibomian gland,BUT,and tear river height were examined with ocular surface comprehensive analyzer.Main Outcome Measures Eye stimulation response score,subjective stimulation symptom score,repair duration,eye surface condition,and postoperative complication rate.Results Eye stimulation response score was 5.38±1.30 in group A and 4.35±1.23 in group B and the subjective stimulation symptom score was 5.77±1.42 in group A and 4.5±1.45 in group B at 7th day after surgery.The repair duration of group A was 8.19±1.86 days,and that of group B was 6.19±1.23 days(P=0.001).At 3 months after surgery,the lipid score of group A was 2.23±0.59,and that of group B was 1.46±0.51.BUT of group A was 7.50±2.29 s,and that of group B was 10.66±2.28 s.The tear river height of group A was 0.30±0.09 mm and that of group B was 0.47±0.08 mm(all P<0.05).The meibomian gland loss score was 2.08±0.48 in group A and 1.85±0.46 in group B(P=0.08).The incidence of postoperative complications was 34.6%in group A and 7.7%in group B(P=0.038).Conclusions Phototherapeutic keratectomy combined with ocular surface intervention is effective in the treatment of recurrent corneal erosion,improving ocular surface status and reducing postoperative complications.