不同手术方式对翼状胬肉患者泪液功能的影响

目的:探讨不同手术方式对翼状胬肉患者泪液功能的影响及其可能机制。方法:翼状胬肉患者50例50眼,随机分成两组,A组30例30眼行翼状胬肉切除联合带蒂结膜瓣移植术,B组20例20眼行翼状胬肉切除联合自体角膜缘干细胞移植术,分别于术前和术后1,3mo检查泪膜破裂时间(BUT)、SchirmerI试验、角结膜荧光素染色(CFS)、泪液羊齿状物试验(TFT),采用眼表疾病指数(OSDI)评价胬肉及胬肉切除术后泪液功能变化对患者生活质量的影响,并作统计学分析。结果:两组术后1moBUT缩短、CFS增多、OSDI变高、泪液羊齿结晶形成较差,和术前比较差异有显著意义(P<0.05),而术后1moSchirmerI和术前比较差异无显著意义。两组术后3moBUT,SchirmerI,CFS,OSDI,TFT和术前比较差异无显著意义。术后1moB组BUT较A组长,CFS较A组少,OSDI较A组高,泪液羊齿结晶形成较A组良好,差异有显著意义(P<0.05),而术后1mo两组SchirmerI比较差异均无显著意义。术后3mo两组BUT,SchirmerI,CFS,OSDI,TFT比较差异均无显著意义。结论:翼状胬肉切除术后早期对泪膜功能有影响,术后3mo泪膜功能恢复至术前水平。行翼状胬肉切除联合自体角膜缘干细胞移植术后早期对泪膜功能的影响小于翼状胬肉切除联合带蒂结膜瓣移植术。

Effects of different surgical methods on tear function in patients with pterygium

AIM:To explore the different surgical methods on tear function in patients with pterygium and its possible mechanism.·METHODS:Fifty cases of pterygium patients (50 eyes) were randomly divided into two groups,A group of 30 patients (30 eyes) underwent pterygium excision combined with pedicle conjunctival flap,B group of 20 patients (20 eyes) underwent wing-shaped pterygium excision combined with autologous limbal stem cell transplantation.Respectively before and 1 month,3 months after surgery the tear film break-up time (BUT),Schirmer I test,conjunctiva fluorescein staining (CFS),tear fern tilting test (TFT) were checked.Ocular surface disease index (OSDI) was used to evaluate the effects of tear function changes in pterygium and on quality of patients life after pterygium excision and to make statistical analysis.·RESULTS:Of two groups of patients 1 months posto-peration BUT shortened,CFS increased,OSDI become high,tear fern crystallization was poor,and the differences were significant (P<0.05),while the difference between postoperative and preoperative Schirmer I was insignifi-cant.As for 3 months postoperation BUT,Schirmer I,CFS,OSDI,TFT postoperative and preoperative difference of the two groups was not significant.BUT after 1 month of B group was longer than the A group,CFS less than the A group,OSDI higher than the A group,tear fern crystals better than A group,the difference was signifi-cant (P<0.05),while for the two groups SchirmerI 1mo after surgery,there was no significant difference.There was no significant difference between both groups on BUT,Schirmer I,CFS,OSDI,TFT 3 months after surgery.·CONCLUSION:Pterygium excision affected tear film function at the early postoperative stage.Tear film function returned to preoperative levels 3 months after surgery.Influence of pterygium excision combined with autologous limbal stem cell transplantation on function of the tear film is less than that of pterygium excision combined with conjunctival pedicle flap grafting at early postoperative stage.