目的：探讨翼状胬肉患者围手术期角膜显著散光的相关性因素。

方法：选取2025年2月至2025年6月期间于山西省眼科医院就诊的原发性翼状胬肉患者纳入研究，所有患者均进行病史采集，使用Pentacam、眼前段照相系统、Image J软件以及光学相干断层扫描(AS-OCT)收集患者术前术后的相关数据，并接受局部浸润麻醉下翼状胬肉切除联合自体球结膜瓣移植术。

结果：最终纳入患者76例76眼，其中男30例，女46例，平均年龄62.2±8.2岁。翼状胬肉侵入角膜的平均长度为3.61±0.89 mm，翼状胬肉侵入前表面的平均深度为0.15±0.09 mm，翼状胬肉侵入角膜的面积为10.25(6.90，18.75)mm²，术前角膜散光为1.50(0.70，5.45)D，术后2 wk角膜散光为0.80(0.40，1.28)D，术后1 mo角膜散光为0.60(0.30，1.15)D。翼状胬肉患者年龄与术前散光、术后2 wk残余角膜散光及术后1 mo残余角膜散光之间呈正相关(均P<0.05)； 翼状胬肉侵入角膜的长度与术前角膜散光、术后2 wk残余角膜散光及术后1 mo残余角膜散光之间呈正相关(P<0.01)； 翼状胬肉侵入角膜前表面的深度与术前角膜散光、术后2 wk残余角膜散光及术后1 mo残余角膜散光之间无显著线性相关关系(P=0.250、0.761、0.686)。翼状胬肉侵入角膜的面积与术前角膜散光、术后2 wk残余角膜散光及术后1 mo残余角膜散光之间呈正相关(P<0.01)。以角膜散光度数≥1.0 D为发生显著散光，<1.0 D为未发生显著散光进行分组，在控制其他变量后，年龄(P=0.031)与翼状胬肉侵入角膜的面积(P=0.004)是翼状胬肉患者发生显著散光的危险因素； 翼状胬肉侵入角膜长度未发现是显著影响因素(P>0.05)。曲线下面积(AUC)结果显示，翼状胬肉侵入角膜面积的AUC最高(AUC=0.915)。

结论：翼状胬肉患者术前发生显著角膜散光与患者年龄、翼状胬肉侵入角膜的长度和面积有相关关系。其中，翼状胬肉侵入角膜的面积是术前发生显著散光的最佳预测指标。

METHODS: Patients with primary pterygium presenting at Shanxi Eye Hospital between February and June 2025 were enrolled. All patients underwent medical history collection. Pre- and postoperative data were obtained using Pentacam, anterior segment photography, Image J software, and anterior segment optical coherence tomography(AS-OCT). All patients underwent pterygium excision combined with autologous bulbar conjunctival flap transplantation under local infiltration anesthesia.

RESULTS: A total of 76 patients(76 eyes)with pterygium were finally enrolled(30 males, 46 females)with a mean age of 62.2±8.2 y. The mean length of corneal invasion by pterygium was 3.61±0.89 mm, the mean depth of invasion into the anterior corneal surface was 0.15±0.09 mm, and the median area of corneal invasion was 10.25(6.90, 18.75)mm². The median preoperative corneal astigmatism was 1.50(0.70, 5.45)D. Median astigmatism was 0.8(0.40, 1.28)D at 2 wk postoperatively and 0.60(0.30, 1.15)D at 1 mo postoperatively. Patient age showed a positive correlation with preoperative astigmatism, and with residual astigmatism at 2 wk and 1 mo postoperatively(all P<0.05). The length of corneal invasion was positively correlated with preoperative astigmatism and residual astigmatism at both postoperative timepoints(P<0.01). The depth of invasion showed no significant linear correlation with astigmatism at any stage(P=0.250, 0.761, 0.686). The area of corneal invasion was positively correlated with astigmatism at all stages(P<0.01). Patients were grouped based on significant astigmatism(≥1.0 D)and non-significant astigmatism(<1.0 D), after adjusting for other variables, age(P=0.031)and the area of corneal invasion(P=0.004)were identified as risk factors for significant astigmatism. Pterygium invasion length was not significant factors(P>0.05). Receiver operating characteristic(ROC)analysis showed the highest area under the curve(AUC)for the invasion area(AUC=0.915).

CONCLUSION: Significant preoperative corneal astigmatism in pterygium patients is correlated with patient age, the length of corneal invasion, and the area of invasion. The area of pterygium invasion into the cornea is the strongest predictor of significant preoperative corneal astigmatism.