生物羊膜和角膜绷带镜作为辅助材料用于治疗翼状胬肉的临床效果对比分析

目的　对比分析生物羊膜和角膜绷带镜作为辅助材料用于治疗翼状胬肉的临床效果。方法　选取2015年4月至2016年12月我院收治的原发性翼状胬肉患者114例（114眼），按照随机数字表法将其分成2组，其中羊膜组61例，绷带镜组53例。所有患者均由同一主刀医师在局部麻醉下行翼状胬肉切除联合自体游离结膜瓣移植术。羊膜组:取10 mm×15 mm大小冻干生物羊膜，基底层面向下覆盖于患者角结膜创面，并用10-0尼龙线间断缝合固定；绷带镜组:取博士伦纯视一片，居中覆盖于患者角膜上。记录术前及术后1个月、3个月时患者的最佳矫正视力、角膜地形图表面不对称指数（surface asymmetry index，SAI）、表面规则指数（surface regularity index，SRI）以及角膜散光度。应用Wong-Baker脸评分疼痛强度。结果　术后2周时观察两组患者角膜创面荧光素染色情况，羊膜组7眼阳性，绷带镜组1眼阳性，羊膜组角膜创面染色阳性率高于绷带镜组，差异有统计学意义（P<0.05）。两组患者术前、术后各时间点最佳矫正视力差异均无统计学意义（均为P>0.05）。两组患者术前角膜散光度差异无统计学意义（P>0.05），术后1个月及3个月时，绷带镜组角膜散光度低于羊膜组，差异均有统计学意义（均为P<0.05）。术前羊膜组SRI、SAI分别为1.52±0.83、1.68±0.62，绷带镜组分别为1.61±0.66、1.73±0.59，两组差异均无统计学意义（均为P>0.05），术后1个月及3个月绷带镜组SRI（0.99±0.72、0.63±0.58）和SAI（0.61±0.53、0.54±0.28）均低于羊膜组［（1.28±0.67、0.85±0.47）和（0.97±0.47、0.82±0.35）］，差异均有统计学意义（均为P<0.05）。术后当天、术后第1天绷带镜组疼痛指数低于羊膜组，差异均有统计学意义（均为P<0.05）；术后2周时绷带镜组与羊膜组疼痛指数差异无统计学意义（P>0.05）。术后3个月羊膜组复发1眼（1.64%），绷带镜组复发2眼（3.77%），复发率差异无统计学意义（P>0.05）。结论　在翼状胬肉手术中配戴角膜绷带镜较贴敷生物羊膜更有利于患者角膜创面修复，降低术后角膜散光，减轻术后疼痛。

Comparison of efficacy of corneal bandage contact lens or amniotic membrane in the treatment of pterygium

Objective　To evaluate the efficacy of corneal bandage contact lens or amniotic membrane in the treatment of pterygium.Methods　A total of 114 patients (114 eyes) with primary pterygium treated in our hospital from April 2015 to December 2016 were randomly divided into amniotic membrane group (61 patients) and bandage contact lens group (53 patients).All patients underwent local anesthesia with pterygium excision combined with autologous free conjunctival flap transplantation by the same surgeon.In the amniotic membrane group，10 mm × 15 mm lyophilized biological amniotic membrane was used，and its basal plane was applied to cover the keratoconjunctival wound of the patient，followed by fixation with a 10-0 nylon thread.In the bandage contact lens group，a piece of Bausch & Lomb pure vision chip was used to cover the patient’s cornea.The best corrected visual acuity，surface asymmetry index (SAI)，surface regularity index (SRI) and corneal astigmatism were recorded before and at 1 month and 3 months after operation.Wong-Baker face was used to score the pain intensity.Results　Two weeks after operation，the fluorescein staining showed that positive staining presented in 7 eyes of the amniotic membrane group and in 1 eye of the bandage contact lens group，and the difference in the positive rate of both groups was statistically significant (P<0.05).There was no significant difference in the best corrected visual acuity between the two groups before and after the operation (all P>0.05).There was no significant difference in corneal astigmatism between the two groups before the surgery (P>0.05)，but at 1 month and 3 months after operation，the bandage contact lens group was lower than the amniotic membrane group，and the differences were statistically significant (both P<0.05).The preoperative SRI and SAI of the amniotic membrane group were 1.52±0.83 and 1.68±0.62，respectively，as well as 1.61±0.66 and 1.73±0.59 in the bandage contact lens group，respectively，and there was no significant difference between the two groups (all P>0.05).At 1 month and 3 months after the treatment，the SRI (0.99±0.72，0.63±0.58) and SAI (0.61±0.53，0.54±0.28) in the bandage contact lens group were lower than those in the amniotic membrane group ［(1.28±0.67，0.85±0.47) and (0.97±0.47，0.82±0.35)］，and the differences were statistically significant (all P<0.05).On the day of the surgery and on the first day after surgery，the pain index of the bandage contact lens group was lower than that of the amniotic membrane group，and the differences were statistically significant (all P<0.05).There was no significant difference in the pain index between the bandage contact lens group and the amniotic membrane group at 2 weeks postoperatively (P>0.05).Three months after operation，there was recurrence in one eye (1.64%) in the amniotic membrane group and two eyes (3.77%) in the bandage contact lens group，and the recurrence rate was not statistically different (P>0.05).Conclusion There are better improvment of corneal repair，lower corneal refraction and lower pain scores when the bandage contact lens is used in pterygium surgery when compared with amniotic membrane.