光学治疗性角膜切削术治疗复发性翼状胬肉  

Phototherapeutic keratectomy for treatment of recurrent pterygium

作　　者：李良毛[1] 赵立全[1] 瞿玲辉[1] 李鹏[1] 

机构地区：[1]解放军181医院眼科中心,广西桂林541002

出　　处：《中华眼外伤职业眼病杂志》2013年第7期493-496,共4页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的探讨准分子激光治疗性角膜切削术（PTK）治疗复发性翼状胬肉的临床疗效。方法回顾性对照分析106例（106眼）复发性翼状胬肉。PTK治疗组53例：分离、切除胬肉及变性筋膜组织，用193nm准分子激光行PTK切削残余的角膜病变组织。对照组53例：进行自体角膜缘干细胞移植术。观察术后上皮愈合情况，记录角膜散光度及胬肉复发情况。结果PTK组术后平均上皮愈合时间为（3．96±0．78）d，较对照组的（4．67±1．01）d显著缩短（t=-4．071，P〈0．01）；PTK组术后角膜散光度数较术前减少（0．72±0．80）d，较对照组（0．42±0．43）d显著改善（t=-1．342，P=0．02）。平均随访（18．05±5．32）月，PTK组3例胬肉复发，复发率为5．66％，对照组4例胬肉复发，复发率为7．55％，两组相比差异无统计学意义（X2=0．368，P=0．70）。结论PTK治疗复发性翼状胬肉，可以安全、有效地清除残留胬肉及变性组织，减少手术创面，利于角膜上皮修复。取得与自体角膜缘干细胞移植术同样的治愈率。Objective To evaluate the treatment outcomes of excimer laser phototherapeutic kera- tectomy （PTK） for recurrent pterygium. Methods 106 eyes of 106 patients diagnosed with recurrent pte- rygium that underwent PTK or autologous limbal stem cell transplantation were retrospectively evaluated. PTK treatment group （53 eyes） ： Pterygia were treated by separating and excising eonjunctiva and pathologi- cal tissues. The residual pathological tissues underwent PTK with the Technolas 217z excimer laser. Control group （53 eyes） ： autologous limbal stem cell transplantation was performed. Data were analyzed for preoper- ative and postoperative reepitheliation, recurrence rate, and corneal astigmatism. Results The mean reep- itheliation time of PTK group was （3.96 ± 0.78 ） days, and it was significantly shorter than that of control group （4.67 ± 1.01 ） days （ t = - 4. 071, P 〈 0.01 ）. The mean postoperative corneal astigmatism in PTK group declined about （0.72 ± 0.80） D comparing to the preoperative one, and the improvement was signifi- cantly more than that of the control group （0.42 ± 0.43 D） （ t = - 1. 342, P = 0.02）. The mean follow-up time was （ 18.05 ±5.32） months. 3 cases recurred in PTK group, the recurrence rate was 5.66% ; 4 cases recurred in control group, the recurrence rate was 7.55%. There was no significant difference in recurrent rate between the two groups （X2 = 0. 368, P = 0.70）. Conclusion PTK can be a safe and effective thera- peutic alternative for recurrent pterygium. It can avoid excessive operative trauma, hasten reepitheliation, and reduce corneal astigmastism. It can effectively decrease the recurrence rate of pterygium as autologous limbal stem cell transplantation.

关 键 词：准分子激光角膜切削术 治疗性 翼状胬肉 干细胞 角膜缘 

分 类 号：R779.6[医药卫生—眼科]