Pujol Pere, Julio Gemma, de Carvalho Amelia M, Kostov Belchin, Martí-Huguet Tomàs
*MsOphth †PhD ‡MD §MSc Department of Ophthalmology, Terrassa Hospital, Terrassa Health Consortium, Terrassa, Spain (PP, GJ, AMdC); Ocular Surface Research Group, Optics and Optometry Department, Universitat Politècnica de Catalunya, Terrassa, Spain (PP, GJ, TM-H); Transverse Group for Research in Primary Care, IDIBAPS, Barcelona, Spain (BK); Department of Statistics and Operational Research, Universitat Politècnica de Catalunya, Barcelona, Spain (BK); and Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain (TM-H).
Optom Vis Sci. 2014 Jul;91(7):747-51. doi: 10.1097/OPX.0000000000000307.
To compare corneal astigmatism after pterygium excision, using limbal-conjunctival autograft (LCA) with and without mitomycin C (MMC) and to establish a threshold for postoperative astigmatism reduction.
Sixty-eight eyes with primary pterygium were consecutively sampled and assigned to LCA with MMC (MMC+) or LCA without MMC (MMC-). Corneal lesion length, corneal lesion area, preoperative corneal astigmatism (PRCA), and postoperative corneal astigmatism (POCA) at 1, 3, and 6 months were assessed.
Thirty-six men and 24 women (60 eyes), aged between 24 and 65 years (mean ± SD, 41 ± 8.2 years), completed the study. Thirty-one eyes were included in the MMC+ group and 29 were in the MMC- group. Both groups showed astigmatism reduction (p < 0.05; paired, two-tailed t test) 1 month after the surgery and remained stable. No differences were found between groups in corneal lesion length, corneal lesion area, or astigmatism results at the four time points (p > 0.05, independent t test). Preoperative corneal astigmatism showed a significant correlation with POCA at 6 months (r = 0.529; p < 0.01). According to receiver operating characteristic curve analysis, the better threshold for astigmatism reduction with the surgery was 1.05 diopters of PRCA, with 82.5% sensitivity and 80.5% specificity.
Both surgical procedures could have similar astigmatism results. Pterygium patients with more than 1.05 diopters of PRCA could reduce it after the surgery. Direct relationship between PRCA and POCA revealed that postoperative astigmatism reduction was partial. Therefore, for minimizing final astigmatism, preoperative values should be slightly above the threshold.
比较采用含与不含丝裂霉素C（MMC）的角膜缘结膜自体移植术（LCA）切除翼状胬肉后的角膜散光情况，并确定术后散光降低的阈值。
连续选取68例原发性翼状胬肉患者的患眼，分为含MMC的LCA组（MMC+）和不含MMC的LCA组（MMC-）。评估角膜病变长度、角膜病变面积、术前角膜散光（PRCA）以及术后1、3和6个月时的角膜散光（POCA）。
36例男性和24例女性（共60只眼），年龄在24至65岁之间（平均±标准差，41±8.2岁）完成了本研究。MMC+组纳入31只眼，MMC-组纳入29只眼。两组在术后1个月均出现散光降低（p<0.05；配对双尾t检验）且保持稳定。两组在四个时间点的角膜病变长度、角膜病变面积或散光结果方面均未发现差异（p>0.05，独立t检验）。术前角膜散光与术后6个月时的POCA呈显著相关性（r = 0.529；p<0.01）。根据受试者工作特征曲线分析，手术降低散光的较好阈值为PRCA 1.05屈光度，敏感性为82.5%，特异性为80.5%。
两种手术方式的散光结果相似。PRCA超过1.05屈光度的翼状胬肉患者术后散光可降低。PRCA与POCA之间的直接关系表明术后散光降低是部分性的。因此，为使最终散光最小化，术前值应略高于阈值。
