自体角膜缘干细胞移植对翼状胬肉患者视觉质量及泪膜功能的影响
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摘要
目的探讨翼状胬肉切除术联合自体角膜缘干细胞移植对翼状胬肉患者视觉质量、角膜屈光及泪膜功能的影响。方法选取2016年2月～2017年1月在我院治疗的翼状胬肉患者110例,随机分为对照组和观察组,每组55例。对照组给予翼状胬肉切除术治疗,观察组在对照组的基础上给予角膜缘干细胞移植,之后对两组患者视力、角膜屈光度、泪膜功能及术后巩膜并发症进行评估。结果与治疗前相比,治疗后两组患者视力、角膜水平曲度及角膜垂直曲度均显著增加,角膜散光度较治疗之前显著下降,且观察组治疗后视力、角膜水平曲度及角膜垂直曲度显著大于对照组,角膜散光度显著低于对照组,差异有统计学意义(P<0.05);与治疗前相比,治疗后两组患者基础泪液分泌试验(SIT)及泪膜破裂时间(BUT)水平均显著上升,且观察组治疗后显著高于对照组,差异有统计学意义(P<0.05);术后6个月,观察组眼部刺激症状、巩膜溶解软化及巩膜坏死发生率均显著低于对照组,差异有统计学意义(P<0.05)。结论角膜缘干细胞移植联合翼状胬肉切除能有效提高患者视力,增加角膜屈光度,降低患者散光程度,并能有效改善泪膜功能,降低巩膜并发症的发生率。
Objective To investigate the effect of corneal limbal stem cell transplantation on visual quality, corneal refractive power and tear film function in patients with pterygium. Methods A total of 110 patients with pterygium treated in our hospital from February 2016 to January 2017 were randomly divided into control group and observation group,55 cases in each group. The control group was treated with pterygium excision. The observation group was given limbal stem cell transplantation on the basis of the control group. Visual acuity, corneal refractive power, tear film function and postoperative scleral complication were evaluated in both groups. Results Compared with those before treatment, the visual acuity, corneal horizontal curvature and corneal vertical curvature were significantly increased in both groups after treatment, and corneal astigmatism decreased significantly compared with those before treatment. The visual acuity, corneal horizontal curvature and cornea vertical curvature was significantly greater than that of the control group, and the corneal astigmatism was significantly lower than that of the control group(P<0.05). Compared with those before treatment, the levels of schimer Ⅰ test(SIT) and break-up time(BUT) significantly increased in both groups after treatment, and the scores in the observation group were significantly higher than those in the control group after treatment(P<0.05). At the 6 th month after operation, the eye irritation symptoms, scleral softening and scleral necrosis incidence in observation group were significantly lower than the control group, the difference was statistically significant(P<0.05). Conclusion The limbal stem cell transplantation combined with pterygium excision can effectively improve the patient's visual acuity, increase the corneal refractive power and reduce the degree of astigmatism, and can effectively improve the tear film function, reduce the incidence of scleral complications, reliable, and worthy of further clinical application.
Objective To investigate the effect of corneal limbal stem cell transplantation on visual quality, corneal refractive power and tear film function in patients with pterygium. Methods A total of 110 patients with pterygium treated in our hospital from February 2016 to January 2017 were randomly divided into control group and observation group,55 cases in each group. The control group was treated with pterygium excision. The observation group was given limbal stem cell transplantation on the basis of the control group. Visual acuity, corneal refractive power, tear film function and postoperative scleral complication were evaluated in both groups. Results Compared with those before treatment, the visual acuity, corneal horizontal curvature and corneal vertical curvature were significantly increased in both groups after treatment, and corneal astigmatism decreased significantly compared with those before treatment. The visual acuity, corneal horizontal curvature and cornea vertical curvature was significantly greater than that of the control group, and the corneal astigmatism was significantly lower than that of the control group(P<0.05). Compared with those before treatment, the levels of schimer Ⅰ test(SIT) and break-up time(BUT) significantly increased in both groups after treatment, and the scores in the observation group were significantly higher than those in the control group after treatment(P<0.05). At the 6 th month after operation, the eye irritation symptoms, scleral softening and scleral necrosis incidence in observation group were significantly lower than the control group, the difference was statistically significant(P<0.05). Conclusion The limbal stem cell transplantation combined with pterygium excision can effectively improve the patient's visual acuity, increase the corneal refractive power and reduce the degree of astigmatism, and can effectively improve the tear film function, reduce the incidence of scleral complications, reliable, and worthy of further clinical application.
引文
[1] Zhong H, Chen Q, Li J, et al. Ethnic variations in pterygium in a rural population in southwestern China: the Yunnan minority eye studies[J]. Ophthal Epidemiol, 2016, 23(2):116-121.
[2] Toker E, Eraslan M. Recurrence after primary pterygium excision: amniotic membrane transplantation with fibrin glue versus conjunctival autograft with fibrin glue[J]. Curr Eye Res, 2016, 41(1):1-8.
[3] Sun LL, Wu AH. Effect of pterygium excision combined with autologous limbal stem cell transplantation for the treatment of pterygium and the effect of refractive changes[J]. Zhejiang Journal of Traumatic Surgery, 2017, 22(2): 273-275. (in Chinese)孙亮亮, 吴爱华. 翼状胬肉切除联合自体角膜缘干细胞移植术治疗翼状胬肉患者的疗效及屈光变化的影响[J]. 浙江创伤外科, 2017, 22(2):273-275.
[4] Fan HY, Chen ZL, Song QSh. Resection of pterygium with pterygium excision and conjunctival transplantation with autologous limbal stem cells [J]. International Journal of Ophthalmology, 2014, 14(5): 961-963. (in Chinese)范惠雅, 陈子林, 宋青山. 翼状胬肉切除联合带自体角膜缘干细胞的结膜移植治疗复发性翼状胬肉[J]. 国际眼科杂志, 2014, 14(5):961-963.
[5] Chen R, Huang G, Liu S, et al. Limbal conjunctival versus amniotic membrane in the intraoperative application of mitomycin C for recurrent pterygium: a randomized controlled trial[J]. Graefes Arch Clin Exp Ophthal, 2017, 255(2):1-11.
[6] Yang JH, Xu ShP, Lu XM, et al. Limbal stem cell transplantation combined with closed fascia sac space for prevention of postoperative recurrence of pterygium[J]. International Journal of Ophthalmology, 2016, 16(1): 160-162. (in Chinese)杨建华, 许淑平, 卢雪梅, 等. 角膜缘干细胞移植联合封闭筋膜囊间隙预防翼状胬肉术后复发[J].国际眼科杂志, 2016, 16(1): 160-162.
[7] Tao LH, Song FW. Analysis of postoperative corneal healing and pain in pterygium excision combined with conjunctival flap autograft[J]. International Journal of Ophthalmology, 2017, 17(10): 1960-1962. (in Chinese)陶丽惠, 宋峰伟. 翼状胬肉切除联合自体结膜瓣移植术中两种缝合方式对术后角膜愈合及疼痛分析[J].国际眼科杂志, 2017,17(10):1960-1962.
[8] Das P, Gokani A, Bagchi K, et al. Limbal epithelial stem-microenvironmental alteration leads to pterygium development[J]. Mol Cell Biochem, 2015, 402(1-2):123-139.
[9] Zakaria N, Possemiers T, Dhubhghaill SN, et al. Results of a phase Ⅰ/Ⅱ clinical trial: standardized, non-xenogenic, cultivated limbal stem cell transplantation[J]. J Transl Med, 2014, 12(1):1-13.
[10] Zhu TT, Sun S. Progress in surgical treatment of pterygium[J]. New Advances in Ophthalmology, 2011, 31(3): 293-296. (in Chinese)朱婷婷, 孙松. 翼状胬肉手术治疗方法研究进展[J]. 眼科新进展, 2011, 31(3):293-296.
[2] Toker E, Eraslan M. Recurrence after primary pterygium excision: amniotic membrane transplantation with fibrin glue versus conjunctival autograft with fibrin glue[J]. Curr Eye Res, 2016, 41(1):1-8.
[3] Sun LL, Wu AH. Effect of pterygium excision combined with autologous limbal stem cell transplantation for the treatment of pterygium and the effect of refractive changes[J]. Zhejiang Journal of Traumatic Surgery, 2017, 22(2): 273-275. (in Chinese)孙亮亮, 吴爱华. 翼状胬肉切除联合自体角膜缘干细胞移植术治疗翼状胬肉患者的疗效及屈光变化的影响[J]. 浙江创伤外科, 2017, 22(2):273-275.
[4] Fan HY, Chen ZL, Song QSh. Resection of pterygium with pterygium excision and conjunctival transplantation with autologous limbal stem cells [J]. International Journal of Ophthalmology, 2014, 14(5): 961-963. (in Chinese)范惠雅, 陈子林, 宋青山. 翼状胬肉切除联合带自体角膜缘干细胞的结膜移植治疗复发性翼状胬肉[J]. 国际眼科杂志, 2014, 14(5):961-963.
[5] Chen R, Huang G, Liu S, et al. Limbal conjunctival versus amniotic membrane in the intraoperative application of mitomycin C for recurrent pterygium: a randomized controlled trial[J]. Graefes Arch Clin Exp Ophthal, 2017, 255(2):1-11.
[6] Yang JH, Xu ShP, Lu XM, et al. Limbal stem cell transplantation combined with closed fascia sac space for prevention of postoperative recurrence of pterygium[J]. International Journal of Ophthalmology, 2016, 16(1): 160-162. (in Chinese)杨建华, 许淑平, 卢雪梅, 等. 角膜缘干细胞移植联合封闭筋膜囊间隙预防翼状胬肉术后复发[J].国际眼科杂志, 2016, 16(1): 160-162.
[7] Tao LH, Song FW. Analysis of postoperative corneal healing and pain in pterygium excision combined with conjunctival flap autograft[J]. International Journal of Ophthalmology, 2017, 17(10): 1960-1962. (in Chinese)陶丽惠, 宋峰伟. 翼状胬肉切除联合自体结膜瓣移植术中两种缝合方式对术后角膜愈合及疼痛分析[J].国际眼科杂志, 2017,17(10):1960-1962.
[8] Das P, Gokani A, Bagchi K, et al. Limbal epithelial stem-microenvironmental alteration leads to pterygium development[J]. Mol Cell Biochem, 2015, 402(1-2):123-139.
[9] Zakaria N, Possemiers T, Dhubhghaill SN, et al. Results of a phase Ⅰ/Ⅱ clinical trial: standardized, non-xenogenic, cultivated limbal stem cell transplantation[J]. J Transl Med, 2014, 12(1):1-13.
[10] Zhu TT, Sun S. Progress in surgical treatment of pterygium[J]. New Advances in Ophthalmology, 2011, 31(3): 293-296. (in Chinese)朱婷婷, 孙松. 翼状胬肉手术治疗方法研究进展[J]. 眼科新进展, 2011, 31(3):293-296.