Pujol Pere, Julio Gemma, Barbany Miriam, Asaad Mouafk
Department of Ophthalmology, Hospital de Terrassa, Terrassa, Spain; Ocular Surface Research Group, Optics and Optometry Department, Universitat Politècnica de Catalunya-Barcelona Tech, Terrassa, Spain.
Ophthalmic Physiol Opt. 2015 May;35(3):308-14. doi: 10.1111/opo.12206. Epub 2015 Mar 31.
To establish the sequence of tomographic changes in the tissue recovery process after pterygium excision and to propose healing indicators.
Optical coherence tomography (OCT) images were taken at 1 week, 1, 3 and 6 months after lesion excision in 73 eyes of 73 patients (33 male, 40 female; mean age 50, S.D. 5.0, range 40-70 years) with primary nasal pterygium. Biomicroscopy was performed at each visit and at 12 months, to diagnose clinical healing or lesion recurrence. The presence of well demarcated corneal epithelium, conjunctival epithelium, limbal demarcation area, and graft thickening were analysed. Comparisons between tomographic data of both clinical situations were made at each time point using contingency tables.
Eleven eyes displayed lesion recurrence (R group) and 62 eyes showed no recurrence (NR group). Normal anatomical structures, corneal and conjunctival epithelium and limbal demarcation area, were identified by OCT images in a higher percentage of NR cases over time, compared to the R group where most of the cases presented without these markers of tissue recovery. In contrast, the variable graft thickening, which analysed a pathological event, revealed similar results in both groups (p > 0.05; Fisher's exact statistic), with a clear decrease of cases which showed graft thickening over time. Differences between groups started at 1 month, when no eye had yet presented clinical recurrence, with greater identification of corneal epithelium in the NR group (p = 0.04; Fisher's exact statistic). At 3 months, corneal and conjunctival epithelium identification tended to be more frequent in the NR than in the R group (in both cases, p = 0.0001; Fisher's exact statistic). Finally, at 6 months these different patterns consolidated, with a significantly higher number of limbal demarcation areas being identified in the NR group (p = 0.001; Fisher's exact statistic). In fact, this landmark of a normally structured limbus was never found in the R group.
The sequence of tissue restoration, according to OCT images, seems to start in the cornea and end in the limbal area, similar to the process of pterygium injury in reverse. Although the visualisation of corneal epithelium could be an early indicator of successful surgery, identification of the limbal demarcation area, as a normal limbal pattern in OCT images, seems to be a better positive predictive value in diagnosing healing.
确定翼状胬肉切除术后组织恢复过程中的断层扫描变化顺序，并提出愈合指标。
对73例（男33例，女40例；平均年龄50岁，标准差5.0，年龄范围40 - 70岁）原发性鼻侧翼状胬肉患者的73只眼在病变切除后1周、1个月、3个月和6个月进行光学相干断层扫描（OCT）成像。每次就诊时及12个月时进行生物显微镜检查，以诊断临床愈合或病变复发。分析界限清晰的角膜上皮、结膜上皮、角膜缘界限区域和移植片增厚情况。使用列联表在每个时间点对两种临床情况的断层扫描数据进行比较。
11只眼出现病变复发（R组），62只眼未复发（NR组）。随着时间推移，与R组相比，NR组中通过OCT图像识别出正常解剖结构、角膜和结膜上皮以及角膜缘界限区域的比例更高，R组中的大多数病例没有这些组织恢复的标志。相反，分析病理事件的移植片增厚变量在两组中显示出相似的结果（p>0.05；Fisher精确检验），随着时间推移显示移植片增厚的病例明显减少。两组之间的差异在1个月时开始出现，此时尚无眼出现临床复发，NR组中角膜上皮的识别率更高（p = 0.04；Fisher精确检验）。在3个月时，NR组中角膜和结膜上皮的识别往往比R组更频繁（两种情况均为p = 0.0001；Fisher精确检验）。最后，在6个月时，这些不同模式得以巩固，NR组中识别出的角膜缘界限区域数量明显更多（p = 0.001；Fisher精确检验）。事实上，R组中从未发现这种正常结构角膜缘的标志。
根据OCT图像，组织修复顺序似乎从角膜开始并在角膜缘区域结束，类似于翼状胬肉损伤过程的逆过程。虽然角膜上皮的可视化可能是手术成功的早期指标，但在OCT图像中作为正常角膜缘模式识别角膜缘界限区域似乎在诊断愈合方面具有更好的阳性预测价值。
