翼状胬肉切除联合不同移植术式后干眼症的临床观察

目的：探讨翼状胬肉切除联合移植的不同手术方法术后干眼症的情况。
　　方法：选取翼状胬肉患者78例81眼,随机分成3组, A组：行翼状胬肉切除联合大块自体球结膜瓣移植术；B组：行翼状胬肉切除联合小块自体球结膜瓣移植术；C组：行翼状胬肉切除术联合小块带自体角膜缘干细胞结膜瓣移植术。观察三组患者术后角膜上皮修复时间,术前和术后1,3mo检查泪膜破裂时间(BUT)以及眼表疾病指数(ocular surface disease index,OSDI)问卷调查,来评价翼状胬肉及胬肉切除术后引起干眼症的情况。
　　结果：BUT：术后15d,A组较B,C组明显缩短(P<0.05),术后1mo,A组与B,C组间无明显差异(P>0.05),但术后1mo时并发干眼症阳性率均较B,C组高(P<0.05)；B,C 组间术后并发干眼症阳性率比较无显著差异( P>0.05),但C组有阳性率低的趋势。上皮修复时间A组较B,C组长(P<0.05)；B,C组间无显著差异(P>0.05),但C组有时间更短的趋势。
　　结论：胬肉切除联合小块自体角膜缘干细胞移植术术后角膜上皮修复更快,引起干眼症的几率最小,术式最佳。

Clinical observation of different surgical methods on dry eyes in patients with pterygium excision combined transplantation

AIM: To observe the situations of different surgical methods on dry eyes in patients with pterygium excision combined transplantation.

METHODS: Seventy-eight cases ofpterygium patients(81 eyes)were randomly divided into three groups. Group A underwent pterygium excision combined large autologous conjunctival flap transplantation; group B underwent pterygium excision combined with small conjunctival flap; group C underwent pterygium excision combined with small conjunctival flap with autologous limbal stem cell. Repair of postoperative corneal epithelium, 1, 3mo preoperation and postoperation tear film break up time(BUT)and questionnaire of ocular surface disease index(OSDI)were observed among three groups, which caused the situation of dry eyes by pterygium and pterygium excision were evaluated.

RESULTS: BUT: Group A was shorter than that in groups B and C at 15d postoperation(P<0.05); at 1mo postoperation, group A was no statistical difference with groups B and C(P>0.05). Postoperative dry eye ratio of group A was higher than that in groups B and C at 1mo postoperation(P<0.05). There was no statistical difference between group B and group C(P>0.05), but group C showed lower postoperative dry eye ratio. Corneal epithelium recover time of group A was longer than that in groups B and C(P<0.05). There was no statistical difference between group B and group C(P>0.05), but group C showed a tendency to be shorter recover time.

CONCLUSION: Pterygium excision combined with small conjunctival flap and autologous limbal stem cell shows guickly corneal epithelium recover and low dry eye ratio and deserve to recommended.