翼状胬肉切除术后干眼症应用环孢素和玻璃酸钠治疗的临床疗效及其复发的危险因素分析  

Clinical efficacy of cyclosporine and sodium hyaluronate in the treatment of dry eye disease after pterygium excision and its risk factors for postoperative recurrence

作　　者：黄守强 杨芳[1] 姜茂华 HUANG Shouqiang;YANG Fang;JIANG Maohua(Department of Ophthalmology,Wuhu Hospital Affiliated to East China Normal University(Wuhu Second People's Hospital),Wuhu 241000,Anhui,China)

机构地区：[1]华东师范大学附属芜湖医院(芜湖市第二人民医院)眼科,安徽芜湖241000

出　　处：《中国现代手术学杂志》2024年第6期495-501,共7页Chinese Journal of Modern Operative Surgery

基　　金：华东师范大学附属芜湖医院院内新技术项目(2022YWSX49)。

摘　　要：目的探讨环孢素和玻璃酸钠联合治疗翼状胬肉切除术后干眼症的临床疗效,并分析术后复发的相关危险因素。方法选取2022年7月~2023年9月我院收治的124例翼状胬肉切除术后干眼症患者作为研究对象,随机分为观察组和对照组,每组各62例。所有患者均行翼状胬肉切除术,对照组术后采用0.1%玻璃酸钠滴眼液点眼,观察组加用0.05%环孢素滴眼液进行治疗。分别于治疗前及治疗后4周对所有患者进行泪膜破裂时间(tear break-up time,BUT)、角膜荧光素染色(fluorescent test,FL)、泪液分泌试验Ⅰ(SchirmerⅠtest,SⅠt)、眼表疾病指数(ocular surface disease index,OSDI)测量及睑板腺功能评分评估。收集患者相关临床资料,对所有患者随访1年,记录患者复发情况,并根据患者术后有无复发分为复发组和未复发组。采用单因素分析和多元Logistic回归模型分析影响患者术后复发的危险因素。结果两组治疗后BUT、SⅠt水平均高于治疗前,FL、OSDI水平均低于治疗前;治疗后观察组BUT、SⅠt水平高于对照组,FL、OSDI水平低于对照组(P<0.001)。两组治疗后睑板腺缺失面积、睑脂性状、睑脂排除难易程度评分均低于治疗前,且观察组均低于对照组(P<0.05)。单因素分析显示,病程、胬肉性质、糖尿病史、工作环境、术后眼部感染、治疗方法与翼状胬肉切除术后复发有关(P<0.05)。多元Logistic回归分析表明,病程≥10年、户外工作环境、术后有眼部感染、单独玻璃酸钠治疗均是翼状胬肉切除术后复发的危险因素(P<0.05)。结论环孢素和玻璃酸钠联合治疗翼状胬肉切除术后干眼症的疗效显著,能够有效缓解干眼症状。病程≥10年、户外工作环境、术后有眼部感染、单独玻璃酸钠治疗均是翼状胬肉切除术后复发的危险因素。Objective To investigate the clinical efficacy of combined treatment with cyclosporine and sodium hyaluronate for dry eye disease following pterygium excision and to analyze the associated risk factors for postoperative recurrence.Methods A total of 124 patients with dry eye syndrome following pterygium exci-sion,who were admitted to our hospital from July 2022 to September 2023,were selected for the study.These patients were randomly divided into two groups,the control group(n=62)and the observation group(n=62).All patients underwent pterygium excision surgery.In the control group,0.1%sodium hyaluronate eye drops were used postoperatively,while the observation group received additional treatment with 0.05%cyclosporine eye drops.Break-up time of tear film(BUT),fluorescein corneal staining(FL),ShirmerⅠtest(SⅠt),ocu-lar surface disease index(OSDI)and meibomian gland function score were measured for all patients before treatment and 4 weeks after treatment.Relevant clinical data were collected,and all patients were followed up for one year.Recurrence was recorded,and patients were divided into two groups based on whether recurrence occurred:the recurrence group and the non-recurrence group.Univariate analysis and multivariate logistic re-gression were used to analyze the risk factors for postoperative recurrence.Results After treatment,the BUT and SⅠt levels in both groups were higher than before treatment,while the FL and OSDI levels were lower than before treatment(P<0.05).The observation group had higher BUT and SⅠt levels,and lower FL and OSDI levels compared to the control group(P<0.001).After treatment,the scores for meibomian gland loss area,meibum quality,and the ease of meibum expression in both groups were lower than before treatment,with the observation group showing significantly lower scores than the control group(P<0.05).Univariate analysis re-vealed that disease duration,pterygium characteristics,history of diabetes,work environment,postoperative ocular infections and treatment methods were as

关 键 词：翼状胬肉 干眼症 环孢素 玻璃酸钠 复发 

分 类 号：R73[医药卫生—肿瘤]