软性接触镜和重组牛碱性成纤维生长因子滴眼液对自体角膜缘干细胞移植胬肉术后疗效对比

Comparison of the Effect of Soft Contact Lens and rb-bFGF Eye Drops on the Efficacy of Autologous Corneal Limbal Stem Cell Transplantation after Pterygium Surgery

目的比较软性接触镜(SCL)和重组牛碱性成纤维生长因子(rb-bFGF)滴眼液对自体角膜缘干细胞移植(LSCT)胬肉术后疗效的影响。方法通过前瞻性对照研究,收集行手术治疗的翼状胬肉患者150例共150眼,按照随机数字表法分为3组,除每例术后予左氧氟沙星滴眼液、氟米龙滴眼液和典必殊眼膏(妥布霉素地塞米松眼膏)外,A组术后予佩戴SCL、B组术后予加滴rb-bFGF滴眼液、C组为对照组,比较3组患者术后疼痛、异物感、畏光症状的视觉模拟量表(VAS)评分、泪膜破裂时间(BUT)、泪液分泌试验(SIt)、最佳矫正视力(BCVA)、角膜上皮修复时间及复发率情况。结果观察3组患者术后1、7和30 d疼痛、异物感、畏光症状的VAS评分,术后不适症状明显好转,且A、B组患者的VAS评分低于C组,进一步比较A、B组,差别也有统计学意义(P<0.05)。3组患者术前的BUT和SIt比较,差别均无统计学意义(P>0.05);术后3个月,3组患者的BUT和SIt比较,差别有统计学意义(P<0.05),且A、B组患者的BUT和SIt值高于C组,但A、B组间差别无统计学意义(P>0.05)。术后3个月,3组患者的BCVA均较术前明显改善,差别有统计学意义(P<0.05),且A、B组患者的BCVA高于C组,但A、B组间差别无统计学意义(P>0.05)。3组患者角膜上皮修复时间比较,差别有统计学意义(F=55.115,P<0.05),且A、B组患者角膜上皮修复快于C组,但A、B组间差别无统计学意义(P>0.05)。术后6个月,3组患者的术后复发率比较,差别均无统计学意义(χ2=1.288,P>0.05)。结论SCL在早期可有效缓解LSCT胬肉术后的不适症状,rb-bFGF滴眼液和SCL治疗LSCT胬肉术后的疗效确切、安全可靠,均可以改善眼表的状态,维持泪膜的稳定性,促进术后角膜修复。

Objective It is to compare the efficacy of soft contact lens(SCL)and rb-bFGF eye drops on the treatment of autologous corneal limbal stem cell transplantation(LSCT).Methods In a prospective controlled study,150 eyes from 150 cases of pterygium patients diagnosed and treated surgically in ophthalmology were collected and divided into three groups according to the randomized numerical table method.In addition to the levofloxacin eye drops,flumirone eye drops and Tobradex eye ointment,the patients in group A were given with SCL,the patients in group B were given with rb-bFGF eye drops,and group C was the control group.The postoperative pain,foreign body sensation,photophobia,the visual analogue scale(VAS)score,tear film break up time(BUT),Schirmer I test(SIt),best corrected visual acuity(BCVA),corneal epithelial repair time and recurrence rate of the patients in the three groups were compared.Results The VAS scores of pain,foreign body sensation and photophobia in the three groups of paitents were observed at one day,one week and one month after operation,and the symptoms of discomfort improved obviously after operation,and the difference was statistically significant(P<0.05),and the VAS scores of the patients in groups A and B were lower than those of patients in group C.There were significant differences between group A and group B(P<0.05).The comparison of BUT and SIt of the three groups of patients at preoperative were no significant difference(P>0.05),but the three months after operation were statistically significant differences(P<0.05),and BUT and SIt in group A and B were higher than those in group C.But there was no significant difference in BUT and SIt between group A and B(P>0.05).The BCVA of the three groups was significantly improved compared with that before operation,and the difference was statistically significant(P<0.05).The BCVA in group A and B was higher than that in group C.But there was no significant difference between group A and B(P>0.05).The repair time of corneal epithelium in three groups was statistically significant(F=55.115,P<0.05),and the repair time of group A and B were significantly faster than that of group C.But there was no significant difference in corneal epithelial repair time between group A and group B(P>0.05).There was no significant difference in the recurrence rate among the three groups at six months after operation(χ2=1.288,P>0.05).Conclusion SCL can effectively alleviate the discomfort after LSCT of pterygium at an early stage.SCL and rb-bFGF eye drops are effective,safe and reliable in the treatment of autologous corneal limbal stem cell transplantation of pterygium,and both of them can improve the state of the ocular surface,and maintain the stability of tear film,and promote corneal repair after surgery.