| Pterygium is a common ophthalmic disease.It is a chronic inflammatory disease caused by external stimuli,which may involve one or both eyes.The characteristic is local conjunctival fiber hyperplasia vascular tissue which is triangular membrane and infringed on corneal limbus,extends to the surface of the cornea.Pterygium causing patients with jealous,eye sore,dry,tears and discomfort such as vision loss.Surgical excision is considered to be the only effective treatment and can repair the damaged ocular surface.In order to study the effects of pterygium on the ocular surface and the changes of ocular surface after pterygium excision.This study will comprehensively observe the differences between preoperative ocular surface and normal population and the changes after pterygium surgery from the aspects of ocular surface structure and function.Objective:1.To compared and analyzed the differences of ocular surface between pterygium patients and normal population2.To observe the changes of ocular surface after the excision of pterygium combined with conjunctival autograft transplantation,and to compare the differences between pterygium and normal population before surgery.So as to observe the effect of surgery on ocular surface and whether there is difference between pterygium patients and normal population after surgery.Methods:This was a prospective,single-center case-control study.June 2019 to March 2020 in ophthalmic center of the second affiliated hospital of guangzhou medical university,29patients(29 eyes)with unilateral primary nasal lateral pterygium who met the requirements of surgical treatment and the inclusion criteria were selected as the experimental group.This group underwent the pterygium excision combined with conjunctival autograft transplantation.Preoperative and postoperative drug use follows the expert consensus on perioperative drug use of pterygium in China(2017).In addition,26patients(28 eyes)who needed small incision lenticule extraction surgery or cataract extraction surgery in the outpatient clinic were selected as the control group.Data were collected before operation in the experimental group without medication.All patients filled out the ocular surface disease index.And then using Keratograph 5M to record the tear meniscus height,non-invasive tear break-up time(NIBUT),lipid layer,R-scan and meibo-scan of all patients preoperative and 3 days,7 days,1 month after surgery.At the same time,the nasal conjunctival thickness of the control group,the preoperative pterygium thickness and the postoperative conjunctival flap thickness of the experimental group were collected and measured by anterior segment optical coherence tomography.(AS-OCT).The differences of ocular surface between the experimental group and the control group were compared,and the ocular surface of the experimental group before and3 days,7 days,1 month after surgery.Fluorescein tear break-up time(BUT)and NIBUT data of all patients in the experimental group and the control group were compared.To understand the consistency of Keratograph 5M and traditional dry eye examination for ocular surface evaluation.Results:1.The preoperative OSDI of the experimental group and the control group were11.24±11.39 and 2.40±4.06,and the difference between the two groups was statistically significant(P<0.01).The nasal conjunctival thickness of the two groups was418.71±135.58μm and 220.37±50.35μm,and the difference was statistically significant(P<0.01).The R-scan of the two groups was 1.97±0.49 and 0.88±0.27,and the difference was statistically significant(P<0.01).The average NIBUT of the two groups was9.35±8.32s and 13.76±7.75s,with a statistically significant difference(P=0.044).However,the differences in tear meniscus height,Schirmer I test(SIt),first NIBUT and fluorescein BUT between the two groups were not statistically significant(P>0.05).2.The preoperative and postoperative OSDI of the experimental group were11.24±11.39 and 1.56±3.69,with statistically significant differences(P<0.01).The nasal conjunctival thickness was 471.30±177.34μm,498.10±153.20μm and 321.29±141.65μm 3days,7 days,1 month after surgery.There was no statistical difference between preoperative and postoperative 3 days(P=0.097),but there was a statistical difference between preoperative and postoperative 7 days and 1 month(P=0.009,P=0.004).The R-scan was 3.32±0.71,2.82±0.76,1.71±0.50 3 days,7 days,1 month after surgery.There were statistically significant differences between preoperative and postoperative 3 days and 7 days(P<0.01),but no statistically significant differences between preoperative and postoperative 1 month(P=0.113).The tear meniscus height was 0.38±0.20mm,0.28±0.11mm,0.29±0.12mm 3 days,7 days,1 month after surgery.The difference between preoperative and postoperative 3 days was statistically significant(P=0.010),while the difference between preoperative and postoperative 7 days and 1 month was not statistically significant(P=0.714,P=0.180).The first NIBUT were 5.43±4.54s and6.06±5.05s 7 days,1 month after surgery,showing no statistically significant difference Compared to preoperative(P=0.420,P=0.778).The average NIBUT were 7.51±4.80s and 7.91±5.45s 7 days,1 month after surgery,showing no statistically significant difference Compared to preoperative(P=0.983,P=0.975).The fluorescein BUT were4.72±2.14s and 6.00±2.86s 7 days,1 month after surgery,showing no statistically significant difference Compared to preoperative(P=0.586,P=0.077).The preoperative and postoperative SIt of the experimental group were 10.52±8.05mm and13.54±8.44mm,and the difference was not statistically significant(P=0.281).At the same time,we observed no significant changes in lipid layer and meibo-scan before and 1month after surgery.3.The first NIBUT,the average NIBUT and fluorescein BUT were 7.70±6.89s,9.62±6.70s and 6.32±5.13s.The first NIBUT and the average NIBUT were positively correlated with fluorescein BUT(r_s=0.416,P<0.01;r_s=0.405,P<0.01).Conclusion:1.Pterygium can obviously cause ocular discomfort and affect ocular surface.2.Pterygium excision combined with conjunctival autograft transplantation can significantly reduce the ocular discomfort of pterygium patients and improve the structure and function of eye surface.3.The results of fluorescein tear break-up time and noninvasive tear break-up time were consistent. |
PDF Full Text Request