翼状胬肉患者手术前后角膜屈光状态及角膜表面规则性的研究

陶丽惠 杨卫华

[摘要] 目的 探討翼状胬肉患者手术治疗前后的角膜屈光状态及角膜表面规则性的改变。 方法 回顾性分析2016年3月～2017年6月就诊于湖州师范学院附属第一医院并行手术治疗的翼状胬肉患者126例的临床资料，根据翼状胬肉的大小分为三组，Ⅰ组患者翼状胬肉<1/3角膜（50例，50眼），Ⅱ组患者胬肉接触瞳孔缘（46例，46眼），Ⅲ组患者胬肉部分侵入或遮盖瞳孔区（30例，30眼）。采用角膜地形图系统检测平均角膜曲率（ACP）、角膜散光（CA）、角膜表面规则指数（SRI）和角膜表面不对称指数（SAI）。采用单因素方差分析对术前三组患者的ACP、CA、SRI和SAI进行比较，并比较翼状胬肉患者术前、术后3个月及6个月的ACP、CA、SRI和SAI。 结果 随着胬肉大小等级的增加，CA、SRI和SAI值逐渐增加，ACP值逐渐降低，单因素方差分析显示，三组CA、SRI、SAI和ACP值比较，差异均有高度统计学意义（均P < 0.01）。进一步两两比较显示，Ⅱ组、Ⅲ组CA、SRI、SAI值高于Ⅰ组，Ⅲ组高于Ⅱ组，差异均有统计学意义（均P < 0.05）。Ⅲ组ACP值明显低于Ⅰ组和Ⅱ组，差异均有统计学意义（P < 0.05）；但Ⅰ组和Ⅱ组比较，差异无统计学意义（P > 0.05）。单因素方差分析显示，三组翼状胬肉患者术前、术后3个月及6个月ACP、CA、SRI、SAI值比较，差异均有统计学意义（均P < 0.01）。进一步两两比较显示，术后3个月及6个月CA、SRI、SAI值均明显低于术前，ACP值高于术前，差异均有统计学意义（均P < 0.01）；术后6个月ACP、CA、SRI和SAI值与术后3个月比较，差异均无统计学意义（均P > 0.05）。 结论 ACP、CA、SRI和SAI值与翼状胬肉大小有关，CA、SRI和SAI随着翼状胬肉的增大而增大，而ACP则相应减小。翼状胬肉患者行手术治疗能够降低角膜的散光，改善角膜表面规则性。

[关键词] 角膜地形图；角膜平均曲率；角膜散光；角膜表面规则指数；角膜表面不对称指数

[中图分类号] R777.33 [文献标识码] A [文章编号] 1673-7210（2018）05（c）-0115-04

A study on changes in corneal refractive and corneal surface regularity before and after pterygium excision surgery

TAO Lihui1，2 YANG Weihua1▲

1.Department of Ophthalmology， the First Affiliated Hospital of Huzhou University， Zhejiang Province， Huzhou 313000， China；2.Department of Nursing， the First Affiliated Hospital of Huzhou University， Zhejiang Province， Huzhou 313000， China

[Abstract] Objective To assess the corneal refractive and corneal surface regularity changes before and after pterygium excision surgery. Methods A total of 126 clinical data of patients with pterygium who received surgery in the First Affiliated Hospital of Huzhou University from March 2016 to June 2017 were analyzed retrospectively and were divided into three groups according to the position of the advancing pterygium edge with respect to corneal diameter： less than one third of corneal diameter （group Ⅰ， 50 cases， 50 eyes）， between one third of corneal diameter and the pupil （group Ⅱ， 46 cases， 46 eyes） and within the pupillary area （group Ⅲ， 30 cases， 30 eyes）. Average corneal power （ACP）， corneal astigmatism （CA）， surface regularity index （SRI） and surface asymmetry index （SAI） were analyzed by topographic modeling system using one-way analysis of variance （ANOVA）. Statistical analysis of ACP， CA， SRI and SAI were done by corneal topography before， 3 months and 6 months after pterygium excision surgery using one-way analysis of variance （ANOVA）. Results With the increase in the grades of pterygium， CA， SRI and SAI were increased， ACP was decreased. ANOVA showed that there were highly statistically significant differences in CA， SRI， SAI and ACP among the three groups （all P < 0.01）. CA， SRI and SAI in group Ⅱ and group Ⅲ were all higher than those of group Ⅰ， group Ⅲ was higher than that of group Ⅱ， with statistically significant differences （all P < 0.05）. ACP in group Ⅲ were lower than those of group Ⅰ and group Ⅱ， with statistically significant differences （P < 0.05）， but there was no statistically significant difference between group Ⅰ and group Ⅱ（P > 0.05）. ANOVA showed that there were highly statistically significant differences in CA， SRI， SAI and ACP before operation， 3 month and 6 month after operation （all P < 0.01）. After operation of 3 month and 6 month， CA， SRI and SAI were significantly lower than those before operation， ACP was higher than that of before operation， with statistically significant differences （all P < 0.01）； there were no statistically significant differences in CA， SRI， SAI and ACP between 3 month and 6 month after operation （ all P > 0.05）. Conclusion The topographic indices of ACP， CA， SRI and SAI are associated with pterygium size. With increasing size of pterygium， CA， SRI and SAI were increased， ACP was decreased. The regularity of corneal surface can be improved and CA can be reduced after pterygium excision surgery.

[Key words] Topographic modeling system； Average corneal power； Corneal astigmatism； Surface regularity index； Surface asymmetry index

翼状胬肉是眼科临床常见的眼表疾病，可累及单眼或双眼，通常发生于睑裂区，鼻侧的局部球结膜纤维血管逐渐向角膜侵犯甚至遮盖瞳孔区。以往的研究显示，翼状胬肉在发展过程中会导致角膜表面形态及屈光状态的异常，当翼状胬肉未侵及光学区时，鼻侧翼状胬肉对于角膜的牵拉会导致水平方向的角膜曲率更为平坦，而对应的垂直经线隆起，导致顺规性散光的产生[1-3]，而当翼状胬肉发展至遮盖瞳孔区时会直接影响屈光路径而引起视物模糊，部分严重的患者甚至因其牵拉作用可妨碍眼球运动。

目前翼状胬肉的治疗以手术为主，主要有单纯翼状胬肉切除术、翼状胬肉切除联合自体角膜缘干细胞移植术[4-5]、翼状胬肉联合羊膜移植术[6-7]等。……