翼状胬肉对角膜屈光状态的影响及自体角膜缘干细胞移植术的治疗效果研究  

Autologous Corneal Limbal Stem Cell Transplantation in the treatment of pterygium

作　　者：贾长伟[1] 张玉枝[1] 周阴娥[1] 尹靓瑶[1] 

机构地区：[1]山东省滨州市中心医院眼科,251700

出　　处：《中华眼科医学杂志（电子版）》2015年第3期11-13,共3页Chinese Journal of Ophthalmologic Medicine(Electronic Edition)

摘　　要：目的探讨翼状胬肉进入角膜的长度与角膜散光的关系及自体角膜缘干细胞移植术对其角膜散光屈光度和视力的改善效果。方法收集山东省滨州市中心医院眼科2011年1月至2013年1月收治的100例(144只眼)翼状胬肉患者的临床资料。按照胬肉侵入角膜缘内的长度将患者分为A组43例(65只眼)和B两组57例(79只眼)。A组患者胬肉侵入角膜缘内<2.5 mm,B组患者胬肉侵入角膜缘内≥2.5 mm。手术彻底切除胬肉,然后将自体处于游离状态的角结膜瓣逐渐滑移至对应巩膜的暴露区。采用10/0尼龙线行上侧、下侧、内侧移植瓣固定缝合,其供区不进行任何处理。手术前、后两组患者的屈光度以均数±标准差(x珋±s)的形式表示,并采用配对t检验的方法进行组内比较,采用独立样本t检验的方法进行组间比较。结果术前A组患者的屈光度为(1.55±0.24),术后患者的屈光度为(1.48±0.21),A组患者术后屈光度较术前下降,差异无统计学意义(t2=1.76,P2>0.05)。术前B组患者的屈光度为(2.98±1.35),术后患者的屈光度为(1.67±0.56),B组患者术后屈光度较术前明显下降,差异有统计学意义(t3=17.63,P3<0.05)。手术前、后A组和B组患者的屈光度比较,差异有统计学意义(t1=8.42,2.59;P1<0.05)。结论翼状胬肉可以引起顺规性散光,胬肉的大小与散光程度密切相关。翼状胬肉侵入角膜<2.5 mm的患者可暂缓手术,对翼状胬肉侵入角膜≥2.5 mm的患者行自体角膜缘干细胞移植术进行治疗不仅可降低翼状胬肉的复发率,还可使患者的散光情况得到明显改善。Objective To evaluate the therapeutic potential of autologous corneal limbal stem cells for pterygium of different sizes. Methods A total of 100 patients （ 144 eyes） with pterygium admitted to the Department of Ophthalmology, Binzhou Central Hospital between January, 2011 and January, 2013 were recruited. Patients were stratified into two pterygium size groups ： intrusion 〈2.5 mm beyond the edge of the cornea （ Group A） and intrusion ≥ 2.5 mm beyond the edge of the cornea （ Group B）. Complete surgical excision of pterygium was performed in all patients in a way that the free autologous keratoconjunctival flaps were exposed and sutured to the corresponding edges of the sclera. The severity of keratometric astigmatism and visual acuity before and after surgery were assessed. Results The mean keratometric astigmatism was （ 1.55±0.24 ） and （ 1.48 ±0.21 ） diopters, respectively, before and after surgery in Group A （ t2 = 1.76,P2 〉 0. 05）,and was （2.98±1.35） and （1.67±0.56） diopter,respectively, before and after surgery in Group B （ t3 = 17.63, P3 〈0.05 ）. Visual acuity was improved significantly in both groups （ t1 = 8.42,2.59 ; P1 〈 0. 05 ）. Conclusion Pterygium can cause astigmatism in a size-dependent manner. While surgery may not be urgently necessary for patients with pterygium〈2.5 mm, autologous corneal limbal stem cell transplantation can significantly decrease the degree of astigmatism and visual acuity in patients with pterygium ≥2.5 mm.

关 键 词：翼状胬肉 角膜缘干细胞移植 屈光 视力 

分 类 号：R779.6[医药卫生—眼科]