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[摘要]
目的:探讨翼状胬肉切除术中应用亲水性软性角膜接触镜减轻异物感和刺激症状的安全性及有效性。
方法:选取2011-05/2013-06在南京市高淳人民医院就诊的翼状胬肉患者86例86眼,均接受翼状胬肉切除联合自体角膜缘干细胞移植术,其翼状胬肉长入角膜缘内2.5~7mm,随机分为两组:软性角膜接触镜和对照组,每组43例43眼。亲水性软性角膜接触镜组在手术结束时涂入氧氟沙星眼膏于角膜结膜表面,配戴角膜接触镜,不用纱布敷眼,术后2d取下亲水性软性角膜接触镜,对照组不作任何处理。术后用纱布覆眼,比较术后2、6、8、24、48、72h两组患者疼痛程度,术后3d角膜上皮荧光素染色评分及角膜上皮缺损面积的差异,并观察并发症的发生情况。
结果:两组患者年龄、性别及翼状胬肉大小差异均无统计学意义(P>0.05)。术后2、6、8、24、48、72h两组患者疼痛程度评分,软性角膜接触镜组分别为0.80±0.41、0.89±0.52、0.42±0.49、0.28±045、0.30±0.43、0.25±0.35分; 对照组分别为2.56±0.52、2.57±0.25、1.85±0.67、1.44±0.50、1.42±0.52、0.85±0.53分; 亲水性软性角膜接触镜组患者疼痛评分均较对照组显著降低(P<0.01)。术后角膜上皮染色评分对照组为1.58±1.35分,亲水性软性角膜接触镜组为0.89±1.12分,两组间差异无统计学意义(P=0.140)。角膜上皮缺损面积:对照组为2.69±4.34mm2,亲水性软性角膜接触镜组为0.18±0.46mm2,两组间差异有统计学意义(P=0.048)。随访3~12(平均4.50±1.25)mo,未见感染、复视、植片愈合不良,有2眼发生鼻侧伤口处球形肉芽,经表面麻醉下切除后未复发。
结论:软性角膜接触镜可明显减轻翼状胬肉术后疼痛反应,促进角膜上皮愈合,是一种安全、有效的辅助治疗措施。
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[Abstract]
AIM: To explore the safety and efficacy of hydrophilic soft contact lenses in pterygium surgery.
METHODS: A total of 86 eyes(86 patients)with a diagnosis of pterygium and received pterygium excision combined with conjunctival autograft transplantation were enrolled between May 2011 and Jun. 2013 at People's Hospital of Nanjing Gaochun. The pterygium grown onto the corner about 2.5mm-7.0mm each patient. They were divided into two groups according to operation time: hydrophilic soft contact lenses group and control group. There were 43 eyes(43 patients)in each group. Patients in hydrophilic soft contact lens group wore hydrophilic soft contact lens without gauze after surgery for 3d. And they were bandaging with gauze in control group. The degree of pain after surgery were evaluated at 2h, 6h, 8h, 12h, 24h, 48h and 72h after surgery.
RESULTS: The difference of age, sex and pterygium size were statistically significant between two groups. The pain index scores at 2h, 6h, 8h, 24h, 48h and 72h after surgery were as follows: Hydrophilic soft contact lenses group were 0.80±0.41 scores, 0.89±0.52 scores, 0.42±0.49scores, 0.28±0.45 scores, 0.30±0.43 scores, and 0.25±0.35 scores; control group were 2.56±0.52 scores, 2.57±0.25 scores, 1.85±0.67 scores, 1.44±0.50 scores, 1.42±0.52scores and 0.85±0.53 scores. The pain index scores of the hydrophilic soft contact lens group were significantly less than control group(P<0.01). The corneal epithelial fluorescein staining scores was 0.89±1.12 scores of hydrophilic soft contact lenses group, 1.58±1.35 scores in control group(P=0.140). There was no significant difference between the two groups. The cornel epithelial defect areas were 0.18±0.46mm2 in hydrophilic soft contact lens group, significantly less than control group(2.69±4.34mm2)(P=0.048). There were no infection, relapse and implant healing badness during the followed up from 3 to 12mo(4.5±1.25mo). Subconjunctival cyst was observed in 2 patients(2 eyes)during the follow-up times, and they were excised by surface anesthetic.
CONCLUSION: Hydrophilic soft contact lens was an efficacious and safe treatment. It can significantly release pain response after pterygium excision and promote the healing of the corneal epitheliums.
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