翼状胬肉术后角膜绷带镜的应用效果

摘要

目的:观察翼状胬肉手术后配戴绷带型接触镜的应用效果.方法:病例对照研究.选取2017年2-6月期间在浙江省天台县人民医院行"翼状胬肉切除+自体角膜缘干细胞移植术"患者,按术后处理方式分为2组,术后配戴绷带型接触镜20例(20眼)作为观察组,常规包盖眼20例(20眼)作为对照组.观察2组患者的角膜刺激症状、角膜上皮愈合时间,光学相干断层扫描(OCT)评估角膜上皮愈合情况,最终愈合情况通过荧光素染色确认.数据采用t检验、秩和检验进行比较.结果:观察组患者疼痛程度评分均较对照组低(术后2 h:Z=-3.986,P<0.001;术后1 d:Z=-3.153,P=0.002;术后2 d:Z=-3.216,P=0.001;术后3 d:Z=-2.377,P=0.017;术后5 d:Z=-2.333,P=0.020).观察组术后角膜上皮荧光素染色角膜上皮恢复时间明显较对照组短(Z=-3.714,P<0.001).随诊2～6个月2组患者均未见感染、复发、植片愈合不良、结膜下囊肿等并发症发生.结论:翼状胬肉术后应用绷带型角膜接触镜,可缓解患者疼痛和刺激症状,促进术后恢复,降低术后复发率,改善术后生活质量.%Objective: To study the effect of bandage corneal contact lenses after pterygium surgery. Methods: This was a case-control study. Patients with an excised pterygium combined with autologous corneal limbal stem cell transplantation were selected at Tiantai People's Hospital of Zhejiang Province between February and June 2017. Patients were divided into two groups based on postoperative treatment: Experimental group was treated with autologous corneal limbal stem cell transplants combined with bandage corneal contact lenses, control group had routine treatment by covering the eyes after autologous limbal stem cell transplantation. There were 20 patients (20 eyes) in each group. After the operation, corneal irritation symptoms and healing time for the corneal epithelium were observed in the two groups. The data were compared using a t test, and a rank sum test. Results: The pain scores of the patients in the experimental group were significantly lower than the pain scores in the control group, and the difference between the two groups was statistically significant (2 hours postoperative: Z=-3.986, P<0.001; 1 day postoperative:Z=-3.153, P=0.002; 2 days postoperative: Z=-3.216, P=0.001; 3 days postoperative: Z=-2.377, P=0.017;5 days postoperative: Z=-2.333, P=0.020). The recovery time for the corneal epithelium stainedwith fluorescein after surgery was clearly shortened in the experimental group, and the difference was statistically significant (Z=-3.714, P<0.001). No infection, recurrence, poor implant healing, subconjunctival cyst or other complications occurred after 2 to 6 months of follow-up. Conclusions:The application of bandage corneal contact lenses after pterygium surgery can relieve pain and irritation symptoms in patients, promote postoperative recovery, reduce the postoperative recurrence rate and improve postoperative quality of life.