生物羊膜和角膜绷带镜对翼状胬肉手术后角膜创面修复的作用

Effect of biotic amniotic membrane and corneal bandage lens on corneal wound repair after pterygium surgery

背景:有文献报道,生物羊膜与角膜绷带镜应用于翼状胬肉术中均可明显减轻翼状胬肉切除术后疼痛反应、促进角膜创面愈合。目的:对比生物羊膜与角膜绷带镜对翼状胬肉术后角膜创面修复与神经性疼痛的影响。方法:选择南阳市第二人民医院2020年8月至2022年5月收治的原发性翼状胬肉患者121例(142眼),均接受翼状胬肉切除联合自体游离结膜瓣移植手术,其中63例(68眼)采用生物羊膜修复角膜创面(生物羊膜组),58例(74眼)采用硬性透氧性角膜接触镜修复角膜创面(绷带镜组)。术后随访,观察患者术后2周内的角膜创面修复情况;术后当天及术后1 d、2周,采用Wong-Baker脸评估神经性疼痛情况;术前、术后1个月、术后3个月,检测患者角膜地形图表面不对称指数、最佳矫正视力、角膜散光度及表面规则指数。结果与结论:①绷带镜组患者术后2周的角膜创面愈合率高于生物羊膜组(P<0.05),创面愈合时间短于生物羊膜组(P<0.01);②绷带镜组患者术后当天及术后1 d的神经性疼痛程度低于生物羊膜组(P<0.001),两组术后2周的神经性疼痛比较差异无显著性意义(P>0.05);③两组患者术后1,3个月的角膜地形图表面不对称指数、最佳矫正视力、角膜散光度及表面规则指数均较术前明显改善(P<0.05),绷带镜组患者术后1,3个月的角膜散光度、角膜地形图表面不对称指数及表面规则指数均低于生物羊膜组(P<0.05);④术后3个月内,生物羊膜组复发1眼(1.47%),绷带镜组复发3眼(4.05%),组间比较差异无显著性意义(P>0.05);⑤结果表明,与生物羊膜相比,角膜绷带镜修复翼状胬肉手术后角膜创面的效果更佳。

BACKGROUND:It has been reported that the application of biotic amniotic membrane and corneal bandage lens in pterygium surgery can significantly reduce the pain reaction after pterygium excision and promote the healing of corneal wounds.OBJECTIVE:To compare the efficacy of biotic amniotic membrane and corneal bandage lens on the repair of corneal wounds and neuropathic pain after pterygium surgery.METHODS:A total of 121 cases(142 eyes)of primary pterygium patients admitted to Nanyang Second People’s Hospital from August 2020 to May 2022 were retrospectively selected.They all underwent pterygium excision combined with autogenous free conjunctival flap transplantation.Among them,63 cases(68 eyes)of pterygium postoperative wound repair with biotic amniotic membrane were classified as the amniotic membrane group,and 58 cases(74 eyes)of pterygium wound repair with corneal bandage lens were classified as the bandage lens group.Postoperative follow-up was conducted,and the corneal wound repair of the patients within 2 weeks after surgery was recorded.Neuropathic pain was quantified by Wong-Baker face on the day after surgery,1 day,and 2 weeks after surgery.The corneal topographic map indicating asymmetry index,best corrected visual acuity,corneal refractive index,and surface rule index were recorded before surgery,1 and 3 months after surgery.RESULTS AND CONCLUSION:(1)2 weeks after treatment,the wound repair rate in the bandage lens group was significantly higher than that in the amniotic membrane group(P<0.05).The wound healing time was shorter in the bandage lens group than that in the amniotic membrane group(P<0.01).(2)The degree of neuropathic pain in the bandage lens group was lower than that in the amniotic membrane group on the day and 1 day after surgery(P<0.001),and there was no significant difference between the two groups in neuropathic pain at 2 weeks after surgery(P>0.05).(3)The corneal topographic map indicating asymmetry index,best corrected visual acuity,corneal refractive index,and surface rule index were significantly improved in both groups 1 and 3 months after surgery(P<0.05).The corneal topographic map indicating asymmetry index,corneal refractive index,and surface rule index of the bandage lens group were lower than those of the amniotic membrane group 1 and 3 months after surgery(P<0.05).(4)Recurrence occurred in 1 eye(1.47%)in the amniotic membrane group and 3 eyes(4.05%)in the bandage lens group within 3 months after operation,and there was no significant difference between the groups(P>0.05).(5)These findings suggest that the corneal bandage lens is more effective than the biotic amniotic membrane in the repair of corneal wounds after pterygium surgery.