翼状胬肉术后应用角膜绷带镜的疗效观察

Observation on the efficacy of corneal bandage lens after pterygium surgery

目的观察翼状胬肉术后佩戴角膜绷带镜(CBL)的效果。方法前瞻性随机对照研究。纳入浙江普陀医院2020年6月至2022年6月行翼状胬肉切除术的80例(80只眼)患者, 按随机数字表法分为两组, 术后佩戴CBL者为试验组, 未佩戴者为对照组, 每组各40例(40只眼)。两组患者均行翼状胬肉切除联合自体角膜缘干细胞移植术, 术后以妥布霉素地塞米松滴眼液滴眼。分别于术后1 d、3 d及1周采用视觉模拟评分(VAS)评估所有患者疼痛程度, 记录两组术后角膜愈合情况、两组角膜创面充血消退时间和角膜创面上皮覆盖时间。对比两组角膜表面规则指数(SRI)、角膜表面不对称指数(SAI)、角膜散光、眼部舒适度、胬肉复发情况和和并发症情况。结果试验组术后3 d及1周的VAS评分[(3.27±0.87)、(1.39±0.43)分]均低于对照组[(4.18±0.63)和(2.52±0.57)分](t=5.36、10.01, 均P<0.001)。试验组术后3 d及1周的角膜愈合评分[(2.36±0.27)、(1.08±0.11)分]均低于对照组[(3.18±0.34)、(1.96±0.23)分](t=11.95、21.83, 均P<0.001)。试验组角膜创面充血消退时间和角膜创面上皮覆盖时间[(4.12±0.74)d、(4.15±0.81)d]均短于对照组[(5.33±0.65)、(5.45±0.86)d](t=7.77、6.96, 均P<0.05)。术后试验组角膜SRI、SAI和角膜散光值[(0.85±0.15)、(0.43±0.12)和(0.53±0.16)D]均低于对照组[(1.16±0.19)、(0.81±0.15)和(1.04±0.13)D](t=8.10、12.51、15.65, 均P<0.05)。试验组术后的畏光、异物感、流泪、眼痛、眼痒和分泌物症状评分[(2.13±0.14)、(2.21±0.23)、(1.86±0.13)、(1.89±0.26)、(1.94±0.31)、(1.83±0.22)和(1.45±0.26)分]均低于对照组[(3.06±0.15)、(2.35±0.24)、(2.19±0.27)、(2.18±0.24)、(2.23±0.46)、(2.42±0.31)和(1.56±0.28)分](t=28.67、2.66、6.97、5.18、3.31、9.82;均P<0.05)。试验组复发率为5.00%(2/40), 对照组复发率为25.00%(10/40), 试验组低于对照组(χ^(2)=6.28, P<0.001)。结论翼状胬肉术后应用CBL可减轻术后疼痛, 促进角膜愈合, 改善患者术后不适感, 并降低复发率。

Objective To observe the efficacy of wearing corneal bandage lens(CBL)after pterygium surgery.Methods This was a prospective randomized controlled study.Eighty eyes of 80 patients who underwent pterygium excision in Putuo Hospital of Zhejiang from Jun.2020 to Jun.2022 were included.They were divided into two groups based on random mumber table methods.In the trial group,40 cases wore CBL after operation,40 cases did not wear CBL were included in the control group.Pterygium excision combined with limbal stem cell transplantation was performed for both groups,and tobramycin dexamethasone eye drops were used after operation.Visual analogue scale(VAS)was used to evaluate the pain degree of all patients at 1,3 days and 1 week after operation,and the corneal healing condition of the two groups was recorded with the time of corneal wound congestion regression and corneal wound epithelial coverage.The corneal surface regularity index(SRI),corneal surface asymmetry index(SAI),corneal astigmatism,eye comfort,pterygium recurrence and complications were compared between the two groups.Results The VAS scores of the trial group at 3 days and 1 week after operation[(3.27±0.87),(1.39±0.43)points]were lower than those of the control group[(4.18±0.63)and(2.52±0.57)points](t=5.36,10.01;all P<0.001).The corneal healing scores at 3 days and 1 week after operation in the trial group[(2.36±0.27),(1.08±0.11)points]were lower than those in the control group[(3.18±0.34),(1.96±0.23)points](t=11.95,21.83;all P<0.001).The corneal wound congestion regression time and corneal wound epithelial coverage time in the trial group[(4.12±0.74)days,(4.15±0.81)days]were shorter than those in the control group[(5.33±0.65),(5.45±0.86)days](t=7.77,6.96;all P<0.05).After operation,the corneal SRI,SAI and corneal astigmatism in the trial group[(0.85±0.15),(0.43±0.12)and(0.53±0.16)D]were lower than those in the control group[(1.16±0.19),(0.81±0.15)and(1.04±0.13)D](t=8.10,12.51,15.65;all P<0.05).After operation,the scores of photophobia,foreign body sensation,tears,eye pain,eye itching and secretion symptoms in the trial group[(2.13±0.14),(2.21±0.23),(1.86±0.13),(1.89±0.26),(1.94±0.31),(1.83±0.22)and(1.45±0.26)points]were lower than those in the control group[(3.06±0.15),(2.35±0.24),(2.19±0.27),(2.18±0.24),(2.23±0.46),(2.42±0.31)and(1.56±0.28)points](t=28.67,2.66,6.97,5.18,3.31,9.82;all P<0.05).The recurrence rate of the trial group was 5.00%(2/40),and the recurrence rate of the control group was 25.00%(10/40).It was lower in the trial group than in the control group(χ^(2)=6.28,P<0.001).Conclusion CBL can relieve postoperative pain,promote corneal healing,improve postoperative discomfort and reduce the recurrence rate of pterygium.