目的：分析角膜缘自体结膜移植和羊膜移植对行翼状胬肉手术患者视力、角膜散光(CAD)、泪膜功能的影响。

方法：前瞻性研究。选取2018-08/2020-03我院眼科收治的翼状胬肉手术患者96例96眼，依据随机数字表法将其分为观察组(48例48眼，行翼状胬肉切除联合角膜缘自体结膜移植治疗)、对照组(48例48眼，行翼状胬肉切除联合羊膜移植治疗)，比较两组患者手术时间、角膜上皮愈合时间、结膜充血及水肿消退时间、术后裸眼视力(UCVA)、泪膜功能\〖泪膜破裂时间(BUT)、泪液分泌试验(SⅠt)\〗、CAD、眼表疾病指数(OSDI)、复发率、并发症发生率。

结果：观察组患者手术时间较对照组长，而角膜上皮愈合时间短于对照组(P<0.001)，两组患者结膜充血及水肿消退时间比较无差异(P>0.05)； 术后1、3、6mo两组患者UCVA、BUT、SⅠt均较术前改善(P<0.05)，CAD、OSDI评分较术前降低(P<0.05)，且观察组术后1mo BUT、SⅠt较对照组低，术后3、6mo BUT、SⅠt较对照组长，术后1、3、6mo OSDI评分低于对照组(P<0.05)，两组患者术后UCVA和CAD比较无差异(P>0.05)； 观察组术后6mo内复发率低于对照组(P<0.05)，而两组术后6mo内并发症发生率无差异(P>0.05)。

结论：与羊膜移植相比，角膜缘自体结膜移植联合翼状胬肉切除术治疗翼状胬肉患者可明显缩短角膜上皮愈合时间，减少对泪膜功能的影响及复发率，且不影响视力与CAD，安全性可靠。

METHODS: Totally 96 patients(96 eyes)who had undergone pterygium surgery in the Department of Ophthalmology at Pengzhou People's Hospital were enrolled in this retrospective study between August 2018 and March 2020. According to random number table method, the patients were divided into observation group(48 patients with 48 eyes treated with pterygium excision combined with limbal conjunctival autograft)and control group(48 patients with 48 eyes treated with pterygium excision combined with amniotic membrane transplantation). General surgical indicators, uncorrected visual acuity(UCVA), tear film function \〖break-up time(BUT), SⅠt\〗, CAD, ocular surface disease index(OSDI), recurrence rate and incidence of complications were compared between the two groups.

RESULTS: The surgical time of observation group was longer than that of the control group, and the corneal epithelial healing time was shorter than that of the control group(P<0.001). There was no significant difference in hospital stay or conjunctival hyperemia and edema remission time between the two groups(P >0.05). The UCVA of the two groups increased at 1, 3 and 6mo after surgery(P<0.05), without statistically significant difference between groups(P >0.05). Compared with pre-operation, the BUT and SⅠt of both groups also increased, while CAD and OSDI scores decreased at 1, 3 and 6mo after surgery(P<0.05). Besides, the BUT and SⅠt of observation group at 1mo after surgery were shorter/lower than control group, which were longer/higher than control group at 3 and 6mo after surgery(P<0.05). However, there was no significant difference in CAD between the two groups(P >0.05). OSDI scores of the observation group were lower than those of the control group at 1, 3 and 6mo after surgery(P<0.05). The recurrence rate of observation group within 6mo after surgery was lower than that of control group(P<0.05), but the difference in incidence of complications was not significant(P>0.05).

CONCLUSION: Compared with amniotic membrane transplantation, limbal conjunctival autograft combined with pterygium excision applied in treatment of patients with pterygium can significantly shorten the corneal epithelial healing time, and reduce the influence on tear film function and recurrence rate, without affecting vision and corneal astigmatism. It is also safe and reliable.