Simple Pterygium Excision And Limbal-conjunctival Autograft Clinical Control Study

Objective: To study and compare the simple pterygium excision (SPE)with the simple pterygium excision+limbal-conjunctival autograft(LCAU)on the postoperative function of ocular surface, visual quality and theinfluence of the relapse of postoperative3months, In order to guide ourclinical work, select the better surgical method.Methods: The64eyes with pterygium were randomly divided into twogroups: A patients with SPE;B patients with LCAU. Measured the break uptime(BUT), schirmer Ⅰ test(S Ⅰt), uncorrected visual acuity (UCVA),cornealastigmatism degree(CAD), corneal astigmatism axial (CAA),total high orderaderration(t-HOA), third order, forth order and The relapse of postoperative3months at the preoperative,5days of postoperative,2weeks after operation,1month after operation,3months after operation. By statistically analyzing theindex of each point in time.Results:1. Ocular surface function:①BUT: BUT in group A5daysafter the preoperative significantly shortened (P=0.04), then rising and equalto the preoperative at2weeks after operation (P=0.49).1month afteroperation compared with preoperative BUT with a little longer，a significantdifference (P=0.01), at the1month after operation BUT stabilization. BUT ingroup B on5days after operation compared with preoperative had nosignificant difference (P=0.76),2weeks after operation compared withpreoperative had no significant difference (P=0.29).1month after operationcompared with preoperative BUT with a little longer，a significant difference (P=0.01); at the1month after operation BUT stabilization. Comparisonbetween groups: on the5days after surgery, there exists significant differencebetween group A and group B, had statistically significant (P <0.05); The restof the time had no obvious difference between two groups (P>0.05).②S Ⅰt:The findings of the two groups was no significant change in results in thepreoperative,5days of postoperative,2weeks after operation,1month afteroperation,3months after operation, there were no statistically significantdifference.2.Visual function:①UCVA: UCVA in the group A on5days afteroperation compared with preoperative had no significant difference (P=0.37),2weeks after operation compared with preoperative had no significantdifference (P=0.22);1month after operation compared preoperative UCVAwith a little longer，a significant difference(P=0.01). At the1month afteroperation UCVA stabilization. The change of group B the5days,2weeksafter surgery compared with preoperative had no significant difference (P>0.05).1month after operation compared preoperative with a little longer, asignificant difference(P=0.01). At the1month after operation UCVAstabilization. Comparison between groups: A, B two groups has no obviousdifference between preoperative and postoperative time points (P>0.05).②CAD: CAD in the group A on the each time after surgery compared withpreoperative were significantly lower (P <0.05); Each time Pairwisecomparison:1month,3months after operation compared with5days,2weeks after operation were still a big decline, had statistically significant(P <0.05);1month after operation CAD stabilization.The change of group B isroughly as group A, Compare each time after the operation with thepreoperative were significantly decreased (P=0.00),1month,3months after operation compared with5days,2weeks after operation were still a bigdecline, had statistically significant(P <0.05);1month after operation CADstabilization. Comparison between groups: A, B two groups has no obviousdifference between preoperative and postoperative time points (P>0.05).③CAA: The preoperative CAA on the group A with the rule (WR)18peopleaccounted for58%, against the rule (AR)5people accounted for16%,oblique astigmatism (OA)8people accounted for26%; However CAA on thePostoperative have distribution changes, WR decreases, AR, OA relativelyincreased, when the change has statistical significance on the1month,3months postoperatively (P <0.05). The preoperative CAA on the group B WR21people (64%), AR5people (15%),OA7people(21%), no astigmatism1people. CAA on the Postoperative have distribution changes, WR decreases,AR,OA relatively increased (1people have no astigmatism on the1monthand3months postoperatively), when the change has statistical significance onthe1month,3months postoperatively (P <0.05). Comparison betweengroups:A, B two groups has no obvious difference between preoperative andpostoperative time points (P>0.05).④high order aderration: The totalt-HOA,third order and forth order on A and B of postoperative are significantchanges (P <0.05); Each time Pairwise comparison: high order aderration inthe group A on5days,2weeks after operation (P>0.05) compared withpreoperative have no statistically significant; Then reducing,1month,3months after operation compared with preoperative have statisticallysignificant(P <0.05);1month after operation high order aderrationstabilization. Group B in the same change trend in group A, on5days,2weeks after operation (P>0.05) compared with preoperative have nostatistically significant;1month,3months after operation compared with preoperative have statistically significant(P <0.05);1month after operationhigh order aderration stabilization.A, B two groups has no obvious differencebetween preoperative and postoperative time points (P>0.05).3. Therapeutic effect and The morphological observation after theoperation:5days postoperatively in patients with two groups have differentlevels of discomfort such as: foreign body sensation, photophobia, tears. Agroup of patients with inflammatory reaction is heavier on the5dayspostoperatively, Two weeks after conjunctival congestion still obvious;Conjunctival congestion significantly reduce on the1month postoperatively;3months after surgery in patients with eye basic normal, congestion is notobvious. B group of patients at the three days after surgery began to appear allthe conjunctival flap edema of different level.2weeks postoperative edemasignificantly reduce;After1month, the conjunctival flap still there withoutedema.3months after surgery the conjunctival blood vessels ingrowthtransplant flap,no patients with rejection, flap transplantation all survived.Group A,31eyes postoperative recurrence of9eyes, the recurrence rate was29%; Group B,33eyes postoperative recurrence of2eyes, the recurrence ratewas6%; The recurrence compared two groups of surgery have obviousdifference, the difference statistically significant (P <0.05).Conclusions:1. SPE and LCAU have great influence to ocular surfacefunction in the early postoperative, the influence of one month after surgery tostabilize.2. Both surgical procedure does not affect the amount of tearsecretion.3. SPE and LCAU have certain influence for postoperative UCVA,can improve the some patient’s UCVA.4. SPE and LCAU can reduce theCAD, and change the direction of CAA. With the rule(WR) in the majority onpreoperative, and WR decreased significantly on postoperative.5. SPE and LCAU had a corresponding decrease with high order aderration, and caneffectively improve the quality of the visual.6. However compared with SPE,LCAU had little effect on Ocular surface function in the early postoperative,and can effectively reduce the recurrence rate.