OCT在评估翼状胬肉切除术后疗效中的应用  

Efficacy after pterygium excision with optical coherence tomograph

作　　者：杨丽萍 刘林[2] 邹俊 殷义平[1] 汪鸿 Yang Liping;Liu Ling;Zou Jun;Yin Yiping;Wang Hong(The Dpartment of Ophthalmology,Chizhou People’s Hospital of Wannan Medical College,Chizhou 247100,China;Dpartment of Ophthalmology,Shanghai Tenth People’s Hospital of Tongji Universit,Shanghai 200000,China)

机构地区：[1]皖南医学院附属池州市人民医院眼科,安徽池州247100 [2]同济大学附属上海市第十人民医院眼科,上海200000

出　　处：《临床眼科杂志》2020年第1期14-17,共4页Journal of Clinical Ophthalmology

基　　金：上海市科学技术委员会科研计划项目(项目编号16ZR1426700)

摘　　要：目的用相干光层析成像术(OCT)对翼状胬肉术后组织修复过程中的断层成像变化序列进行分析,提出更新更早的疗效评估指标。方法对2018年11月至2019年1月于池州市人民医院行手术治疗的原发性鼻侧翼状胬肉患者,共33例(45只眼),用显微镜及OCT对病损切除后的病例分别在术后1周、1个月、3个月、6个月时进行评估,随访期间显微镜下发现纤维血管侵入角膜的病例纳入复发组,其余病例纳入愈合组。用OCT对正常的眼表解剖结构:角膜上皮、结膜上皮和角膜缘分界区进行结构确定并比较分析。结果有7只眼表现为病灶复发(复发组),38只眼表现为未复发(愈合组)。两组之间的差异开始于术后1个月,在愈合组角膜上皮的识别更多(P=0.02),当时还未有病例在显微镜下被发现临床复发。术后3个月,角膜(P<0.001)和结膜上皮(P=0.002)的识别在愈合组更多。术后6个月,这样的趋势得到延续,并在愈合组中确定了更多分界明确的角膜缘区域(P=0.01),但在复发组中尚未发现这种正常结构化的角膜缘标志。结论用OCT检测是否出现正常结构化的角膜缘区域是更好、更积极的预测翼状胬肉术后愈后情况的方法。Objective To analyze the sequence of tomographic changes in the tissue recovery process after pterygium excision by OCT and to propose update and earlier healing indicators.Methods OCT images and Biomicroscopy were taken at 1 week,1,3 and 6 months after lesion excision in 45 eyes of 33 patients with primary nasal pterygium,which received the surgery at the Dpartment of Ophthalmology,Chizhou People’s Hospital in November 2018 to January 2019.Recurrence were considered when the fibrovascular tissue invaded the cornea,the rest of the cases in the no recurrence group.The presence of well demarcated corneal epithelium,conjunctival epithelium and limbal demarcation area were analysed by OCT.Comparisons between tomographic data of both clinical situations were made at each time point.Results 7 eyes displayed lesion recurrence(R group)and 38 eyes showed no recurrence(NR group).Differences between groups started at 1 month,when no eye had yet presented clinical recurrence,with greater identification of corneal epithelium in the NR group(P=0.04).At 3 months,corneal and conjunctival epithelium identification tended to be more frequent in the NR than in the R group(P=0.0001).Finally,At 6 months these different patterns consolidated,with a significantly higher number of limbal demarcation areas being identified in the NR group(P=0.001).In fact,this landmark of a normally structured limbus was never found in the R group.Conclusions Identification of the limbal demarcation area,as a normal limbal pattern in OCT images,seems to be a better positive predictive value in diagnosing healing.

关 键 词：相干光层析成像术 翼状胬肉 复发 愈合过程 

分 类 号：R779.6[医药卫生—眼科]