翼状胬肉切除联合自体角膜缘干细胞移植术后全眼散光的影响因素  

Influencing factors for whole-eye astigmatism after pterygium excision combined with autologous limbal stem cell transplantation

作　　者：何艳茹 李琬悦 刘佳 王颖维 张自峰 He Yanru;Li Wanyue;Liu Jia;Wang Yingwei;Zhang Zifeng(Department of Ophthalmology,Eye Institute of Chinese PLA,Xijing Hospital,Air Force Medical University,Xi'an 710032,Shaanxi Province,China;Department of Ophthalmology,Air Force Hospital of Eastern Theater Command,Nanjing 210002,Jiangsu Province,China;Department of Ophthalmology,Pucheng Hospital of Traditional Chinese Medicine,Pucheng 715500,Shaanxi Province,China)

机构地区：[1]空军军医大学西京医院眼科全军眼科研究所,陕西省西安市710032 [2]东部战区空军医院眼科,江苏省南京市210002 [3]中国陕西省蒲城县中医医院眼科,715500

出　　处：《国际眼科杂志》2025年第2期286-291,共6页International Eye Science

基　　金：陕西省重点研发计划项目(No.2024SF-YBXM-320);空军军医大学临床研究项目(No.2022LC2247);西京医院医务人员技术提升项目(No.2023XJSM20)。

摘　　要：目的:探索翼状胬肉切除联合自体角膜缘干细胞移植术后全眼散光的影响因素。方法:回顾性收集2023-01/10就诊于空军军医大学西京医院眼科的42例42眼接受翼状胬肉切除联合自体角膜缘干细胞移植手术的原发性翼状胬肉患者的病例资料。术前通过眼前节光学相干断层扫描(AS-OCT)测量翼状胬肉侵入角膜的最大深度,术中测量翼状胬肉侵入角膜长度、角膜缘宽度、计算侵入角膜的面积,并收集术前及术后1 wk,1 mo眼前节三维成像角膜散光值、角膜表面变异指数(ISV)、垂直不对称指数(IVA)、最佳矫正视力(BCVA)及全眼散光数据。将术后1 mo全眼散光≤0.50 D和>0.50 D患者分别纳入A、B两组,对比两组术前的数据差异,分析两组术前指标与术后1 mo全眼散光的相关性,利用决策树算法分析术后1 mo全眼散光的影响因素。结果:A组患者翼状胬肉侵入角膜的最大深度小于B组[80.00(40.00,180.00)μm vs 175.00(123.00,190.00)μm,P=0.002];术前BCVA(LogMAR)、全眼散光、角膜散光、ISV、IVA及翼状胬肉侵入角膜的最大深度与术后1 mo全眼散光呈正比(r_(s)=0.317,P=0.041;r_(s)=0.545,P<0.001;r_(s)=0.448,P=0.003;r_(s)=0.389,P=0.011;r_(s)=0.382,P=0.013;r_(s)=0.391,P=0.010);决策树算法筛选出翼状胬肉侵入角膜的最大深度及术前全眼散光两因素,翼状胬肉侵入角膜的最大深度>95μm者较侵入角膜的最大深度≤95μm者术后1 mo全眼散光>0.50 D的风险大,其中合并术前全眼散光>2.63 D者,术后残留全眼散光>0.50 D的概率为88.9%,预测模型AUC为0.804。结论:翼状胬肉切除术后全眼散光主要受翼状胬肉侵入角膜的最大深度及术前全眼散光影响,当患者翼状胬肉侵入角膜的最大深度>95μm,且术前全眼散光>2.63 D时,应建议其尽快接受手术治疗,以期获得良好的临床收益。AIM:To explore the factors affecting the whole-eye astigmatism after pterygium excision combined with autologous limbal stem cell transplantation.METHODS:A retrospective analysis was conducted on the medical records of 42 patients(42 eyes)with primary pterygium admitted in the ophthalmology department of Xijing Hospital from January 2023 to October 2023.They underwent pterygium excision combined with autologous limbal stem cell transplantation.The maximum invasion depth of pterygium into the cornea was measured with anteriorsegment optical coherence tomography(AS-OCT)before operation,the length of the pterygium invading cornea,the width of the limbus and the area of the invading cornea were measured during the operation,and three-dimensional values of corneal astigmatism of anteriorsegment,index of surface variance(ISV),index of vertical asymmetry(IVA),best corrected visual acuity(BCVA)and whole-eye astigmatism were collected before and at 1 mo aftersurgery.Patients with astigmatism≤0.50 D or>0.50 D of the whole eye at 1 mo aftersurgery were assigned to group A and B,respectively.The differences of clinical data before and at 1 mo aftersurgery between the two groups,and the correlation between pre-operative clinical indicators and whole-eye astigmatism were analyzed.The decision tree algorithm was performed to explore the influencing factors of whole-eye astigmatism at 1 mo postoperatively.RESULTS:The maximum invasion depth of pterygium in the group A was significantly less than that in the group B[80.00(40.00,180.00)μm vs 175.00(123.00,190.00)μm,P=0.002].Preoperative BCVA(LogMAR),whole-eye astigmatism,cornea astigmatism,ISV,IVA and maximum invasion depth of pterygium were positively correlated with whole-eye astigmatism at 1 mo aftersurgery(r_(s)=0.317,P=0.041;r_(s)=0.545,P<0.001;r_(s)=0.448,P=0.003;r_(s)=0.389,P=0.011;r_(s)=0.382,P=0.013;r_(s)=0.391,P=0.010).The decision tree algorithm screened out two influential factors:the maximum invasion depth of pterygium into the cornea and preoperative whole-eye ast

关 键 词：翼状胬肉 自体角膜缘干细胞移植 眼前节光学相干断层扫描 侵入角膜的最大深度 散光 影响因素 

分 类 号：R73[医药卫生—肿瘤]