【作者】 刘杰；

【导师】 俞益丰；

【作者基本信息】 南昌大学 ， 眼科学（专业学位）， 2023， 硕士

【摘要】 目的观察自体微结膜瓣移植联合羊膜移植术治疗复发性翼状胬肉术后的眼表恢复情况、复发率、眼表及干眼相关症状等并发症情况。方法非随机对照试验。入选40例(43眼)复发性翼状胬肉患者,其中试验组20例(21眼)接受自体微结膜瓣移植(2.0mm×3.0mm)联合羊膜移植术,对照组20例(22眼)接受常规自体结膜瓣移植术(结膜瓣面积等于翼状胬肉切除后暴露的巩膜面积)。所有患者检测并记录视力、眼压、翼状胬肉大小、角膜上皮修复时间、结膜增生等级、Schirmer test I和眼表症状评分(干燥感、异物感、烧灼感、疼痛感)。数据采用SPSS 25.0软件进行分析。结果自体微结膜瓣移植联合羊膜移植术和常规的自体结膜移植术治疗复发性翼状胬肉于术后6个月随访时,均无复发,术后6个月两组间结膜增生等级无统计学差异(P>0.05)。角膜上皮均在术后3～5天愈合,组间无差异(P>0.05)。所有患者术后视力稍有改善,眼压平稳,组间无差异(P>0.05)。术后3d、7d试验组患者异物感高于对照组(p<0.05),此后,两组间异物感无统计学差异(P>0.05)。术后3d、7d、14d、1m、3m时,两组间干燥感无差异(P>0.05),而在术后6个月时,对照组干燥感评分高于试验组(P<0.05)。Schirmer Test I、烧灼感和疼痛感在各个时间点均无组间差异性(P>0.05)。在观察期间没有其他严重并发症。结论自体微结膜瓣移植联合羊膜移植术相对于常规的结膜移植术复发率无差异性,但眼表损伤相对较小,对于结膜缺乏或合并干眼症、房角关闭风险等有结膜保留需求的复发性翼状胬肉患者,可作为手术优选方案。更多还原

【Abstract】 Aims: To observe the effect of micro-conjunctival autografting combined with amniotic membrane transplantation on the ocular surface recovery,the postoperative recurrence,ocular surface and dry eye related symptoms among patients with recurrent pterygium.Methods: A non-randomized controlled trial including 40 patients(43 eyes)with recurrent pterygium.The experimental group(n?=?20,21 eyes)received micro-conjunctival autograft(2.0mm×3.0mm)combined with amniotic membrane transplantation while the control group(n?=?20,22 eyes)was given conventional autologous conjunctival transplantation(depending on the area of the exposed sclera after the pterygium been removed).Except for postoperative recurrence,complications and pterygium size,ocular surface symptoms measured with Schirmer test Ⅰ,partial ocular surface symptom score.Data were analyzed by SPSS version25.0.Results: At 6 months after surgery,there were no recurrences of recurrent pterygium treated with micro-conjunctival autografting combined with amniotic membrane transplantation and conventional autologous conjunctival transplantation,and there was no statistically significant difference in the grade of conjunctival hyperplasia between the two groups(P>0.05).The corneal epithelium healed 3 to 5days after surgery,and there was no difference between the groups(P>0.05).All patients showed a slight improvement in visual acuity with a smooth intraocular pressure after operation,which didn’t differ between groups(P > 0.05).Patients in the experimental group achieved a significant increase in foreign body sensation in 3and 7 days after surgery(p?<?0.05)than the control group,and thereafter,there was no statistical difference between the two groups(P>0.05).At 3,7,14,30,and 90 days after operation,there was no difference in dryness between the two groups(P>0.05),whereas at 6 months postoperatively,the dryness scores of the control group were higher than that of the experimental group(P<0.05).There was a decrease in Schirmer test Ⅰ,burning sensation and pain,without statistical significance across different time point measurements at p?<?0.05 between the groups.During the observational period,there was no other serious complications.Conclusions: There is no difference in the recurrence rate between micro-conjunctival autografting combined with amniotic membrane transplantation and conventional autologous conjunctival transplantation,and the ocular surface injury is relatively small.For patients with recurrent pterygium who have conjunctival preservation needs such as conjunctival deficiency or combined with dry eye disease and the risk of angle closure,it can be used as the optimal surgical plan.更多还原