目的：探究软性角膜接触镜联合自体血清对角膜异物术后修复的效果。

方法：前瞻性研究。纳入2023年1月到2024年12月在我院拟行角膜异物术患者102例102眼，采用随机数字表法将患者随机分为对照组51例51眼术后给予软性角膜接触镜治疗和联合治疗组51例51眼术后给予软性角膜接触镜联合自体血清治疗。比较两组患者角膜上皮愈合情况、视觉模拟(VAS)评分、眼表疾病指数(OSDI)评分、泪膜功能、泪液中干扰素-γ(IFN-γ)、肿瘤坏死因子 -α(TNF-α)及白细胞介素-17(IL-17)水平、角膜创面规则形态及并发症发生情况。

结果：本研究纳入患者102例102眼均完成全程治疗及术后1 mo随访。联合治疗组51例中男30例、女21例，年龄20-64(平均40.89±5.86)岁，异物嵌入角膜深度为平均0.21±0.04 mm，对照组51例中男32例、女19例，年龄21-63(平均41.22±5.81)岁，异物嵌入角膜深度为平均0.22±0.03 mm(P>0.05)。联合治疗组总有效率高于对照组(P<0.05)。联合治疗组术后角膜上皮愈合时间短于对照组(4.15±0.66 vs 5.07±0.79 d，P<0.05)。术后1、7 d联合治疗组VAS和OSDI评分均低于对照组(均P<0.05)。术后1 mo，联合治疗组患者泪液分泌试验(SⅠt)、泪膜破裂时间(BUT)大于对照组(均P<0.05)，联合治疗组患者泪液中IFN-γ、TNF-α及IL-17均低于对照组(均P<0.05)，联合治疗组患者表面不对称指数(SAI)、表面规则指数(SRI)均低于对照组(均P<0.05)。联合治疗组并发症发生率低于对照组(P<0.05)。

结论：软性角膜接触镜联合自体血清联合应用可缩短角膜上皮愈合时间，有效减轻患者术后早期的眼部疼痛及眼表不适症状，改善泪膜分泌及稳定性等泪膜功能，降低泪液中炎症因子水平，同时能优化术后角膜表面的规则性与对称性，且减少并发症的发生，整体修复疗效优于单纯使用软性角膜接触镜。

METHODS:The prospective study included 102 patients(102 eyes)who were scheduled to undergo corneal foreign body surgery in the hospital from January 2023 to December 2024. The patients were randomly divided into two groups by the random number table method: a control group of 51 patients(51 eyes)who received soft contact lens treatment after surgery and a combination therapy group of 51 patients(51 eyes)who received soft contact lens combined with autologous serum treatment after surgery. Corneal epithelial healing status, visual analog scale(VAS)score, ocular surface disease index(OSDI)score, tear film function, interferon gamma(IFN-γ), tumor necrosis factor alpha(TNF-α), and interleukin-17(IL-17)levels, regular morphology of corneal wounds, and the occurrence of complications between two groups of patients were compared.

RESULTS:This study included 102 patients(102 eyes)who completed the full course of treatment and were followed up for 1 mo after surgery. There were 30 males and 21 females in the combination therapy group, with an age range of 20-64 y(mean age 40.89±5.86 y), with an average depth of 0.21±0.04 mm for foreign bodies embedded in the cornea. There were 32 males and 19 females in the control group, with an age range of 21-63 y(mean age 41.22±5.81 y). All 102 patients completed the full course of treatment and were followed up for 1 mo after surgery, with no cases lost to follow-up or dropped out. There were 32 males and 19 females in the control group, with an age range of 21-63 y and a mean age of 41.22±5.81 y. The average depth of foreign body embedding in the cornea was 0.22±0.03 mm(P>0.05). The total effective rate of the combination therapy group was higher than that of the control group(all P<0.05). The postoperative corneal epithelial healing time in the combination therapy group was shorter than that in the control group(4.15±0.66 vs 5.07±0.79 d, P<0.05). The VAS and OSDI scores of the combination therapy group were lower than those of the control group on postoperative days 1 and 7(both P<0.05). One month after surgery, the combination therapy group had a higher tear secretion test(SIt)and tear film breakup time(BUT)than the control group(all P<0.05). The levels of IFN-γ, TNF-α, and IL-17 in the tears of the combination therapy group were lower than those of the control group(all P<0.05), and the surface asymmetry index(SAI)and surface regularity index(SRI)of the combination therapy group were lower than those of the control group(all P<0.05). The incidence of complications in the combination therapy group was lower than that in the control group(P<0.05).

CONCLUSION:The combination of soft contact lenses and autologous serum can effectively shorten the corneal epithelial healing time, alleviate early postoperative ocular pain and ocular surface discomfort symptoms, improve tear film secretion, stability and other tear film functions, and reduce the levels of local ocular inflammatory factors. Meanwhile, the combined therapy can optimize the regularity and symmetry of the corneal surface after surgery and decrease the incidence of complications. Its overall repair efficacy is superior to that of soft contact lenses alone.