自体角膜缘干细胞移植与翼状胬肉单纯切除后眼表泪膜稳定性的对比观察

背景：翼状胬肉的治疗主要有翼状胬肉单纯切除、翼状胬肉切除联合局部使用丝裂霉素、翼状胬肉切除联合结膜瓣转移以及翼状胬肉切除联合自体角膜缘干细胞移植等，许多患者在翼状胬肉切除后会出现不同程度的干眼症表现。目的：对比观察自体角膜缘干细胞移植与翼状胬肉单纯切除对眼表泪膜稳定性的影响。方法：翼状胬肉患者共80例(80眼)，随机分为2组，单纯切除组40例40眼在10倍显微镜下行翼状胬肉单纯切除；自体角膜缘干细胞移植组40例40眼在10倍显微镜下行翼状胬肉切除联合自体角膜缘干细胞移植，即切除翼状胬肉组织后在手术区移植自体颞上方带角膜缘干细胞的游离球结膜。于术前、术后1周，3个月行裂隙灯及泪膜破裂时间检查以及干眼症状询问。结果与结论：术后两组患者中均有部分患者有干涩感、异物感、烧灼感，单纯切除组干眼症患者明显多于自体角膜缘干细胞移植组(P < 0.05)。自体角膜缘干细胞移植组1周后植片红润，并开始融合生长，无感染或排斥等异常现象出现。术后1周自体角膜缘干细胞移植组泪膜破裂时间较翼状胬肉单纯切除组延长，术后3个月，两组之间差异无显著性意义。结果说明自体角膜缘干细胞移植较传统单纯性胬肉切除效果好，术后早、中期可明显减少患者干眼症状，保持较好的眼表泪膜稳定性。

Tear film stability after pterygium excision and autologous corneal limbal stem cells transplantation versus simple pterygium excision

BACKGROUND: Treatment methods of pterygium mainly include pterygium excision, pterygium excision combined with local application of mitomycin, pterygium excision combined with conjunctival flap transfusion and pterygium excision combined with autologous corneal limbus stem cell transplantation. Dry eye commonly occurred in many patients following pterygium excision. OBJECTIVE: To evaluate the effects of stem cell transplantation of limbus cornea and simple excision of pterygium on tear film stability.METHODS: Eighty patients (eighty eyes) with pterygium were involved in this clinical experiment. All patients were randomly divided into 2 groups: Group A accepted simple excision of pterygium in 40 patients with 40 eyes under a 10-fold microscope, and Group B accepted excision of pterygium with stem cell transplantation of limbus cornea in 40 patients with 40 eyes under a 10-fold microscope, in which a free transplantation of the superotemporal limbus stem with an adjacent piece of conjunctiva was transplanted in the excision area. Slit-lamp examination, tear film break-up time and questionnaire on dry eye were performed before operation, at one week post-operation, and at three months post-operation.RESULTS AND CONCLUSION: In both groups, following surgery, some patients affected dryness, foreign body sensation, burning sensation. These symptoms were more in the group A compared with group B (P < 0.05). Implant was red 1 week following surgery in the group B, and confluence was found, without infection or rejection. The tear film break-up time was prolonged in the group B compared with the group A at 1 week following surgery, and no significant difference was determined at 3 months. Results indicated that compared with simple excision of pterygium, combined excision of pterygium with stem cell transplantation of limbus cornea obtained better outcomes, and could decrease the manifestations of dry eye and maintain better tear film stability in patients with pterygium.