Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China.
Peking Union Medical College Hospital, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China.
BMC Ophthalmol. 2019 Nov 21;19(1):238. doi: 10.1186/s12886-019-1248-1.
Repeated surgery excisions could induce obvious irregular astigmatism in patients with recurrent pterygium. Our study is aimed to illustrate the effect of adjunct excimer laser phototherapeutic keratectomy (PTK) in limbal-conjunctival autograft transplantation on visual quality for patients with recurrent pterygium.
Retrospective case-control study. Eyes that underwent pterygium excision with (PTK group) or without (control group) PTK from 2006 to 2017 were retrospectively included. Recurrence rate, preoperative and postoperative surface regularity index (SRI), surface asymmetry index (SAI), cylinder and LogMAR vision were collected. Postoperative anterior segment optical coherence topography and in vivo confocal microscopy were performed to monitor the cornea epithelium healing and cellular recovery process respectively.
A total of 99 eyes of 99 patients were collected, of which 39 were treated with PTK and 60 without PTK. The mean follow-up time was 50.4 ± 38.1 months. The recurrence rate was 10.3% (4 eyes) in the PTK group and 13.3% (8 eyes) in the control group (p = 0.759). The SRI decreased 0.53 (range: - 0.88, 2.81), SAI decreased 0.53 (range: - 0.64, 2.94), and the cylinder decreased 2.08 (range:-0.16, 9.40) D in the PTK group, and the corresponding values were 0.48 (range:-0.45, 2.27), 0.27 (range:-1.06, 2.21) and 0.71 (range:-1.75, 3.55) D in the control group, respectively (Z = 1.76, 2.15, and 3.97, p = 0.005, 0.016, and 0.000 respectively). LogMAR vision improved in both groups after surgery, with an improvement of 0.18 (range: 0.00, 0.70) in the PTK group and 0.06 (range: - 0.12, 0.50) in the control group (Z = 4.08, p = 0.000). Besides, the eyes treated with PTK showed faster re-epithelization and better cellular recovery.
For recurrent pterygium, surgical excision with adjunct PTK might be a better option with improved corneal surface and vision outcomes.
复发性翼状胬肉的多次手术切除可能导致明显的不规则散光。我们的研究旨在说明在复发性翼状胬肉的角膜缘结膜自体移植中，准分子激光光化学角膜切削术（PTK）辅助治疗对患者视觉质量的影响。
回顾性病例对照研究。回顾性纳入 2006 年至 2017 年间行翼状胬肉切除术的患者，分为行（PTK 组）或不行（对照组）PTK 两组。收集复发率、术前和术后表面规则指数（SRI）、表面不对称指数（SAI）、柱镜和 LogMAR 视力。术后行眼前节光学相干断层扫描和共聚焦显微镜检查，分别监测角膜上皮愈合和细胞恢复过程。
共纳入 99 例 99 眼患者，其中 39 眼行 PTK 治疗，60 眼未行 PTK 治疗。平均随访时间为 50.4±38.1 个月。PTK 组的复发率为 10.3%（4 眼），对照组为 13.3%（8 眼）（p=0.759）。PTK 组 SRI 降低 0.53（范围：-0.88，2.81），SAI 降低 0.53（范围：-0.64，2.94），柱镜降低 2.08（范围：-0.16，9.40）D，对照组相应值分别为 0.48（范围：-0.45，2.27）、0.27（范围：-1.06，2.21）和 0.71（范围：-1.75，3.55）D（Z=1.76、2.15 和 3.97，p=0.005、0.016 和 0.000）。两组术后 LogMAR 视力均提高，PTK 组提高 0.18（范围：0.00，0.70），对照组提高 0.06（范围：-0.12，0.50）（Z=4.08，p=0.000）。此外，行 PTK 治疗的眼具有更快的上皮再形成和更好的细胞恢复。
对于复发性翼状胬肉，手术切除联合 PTK 治疗可能是一种更好的选择，可以改善角膜表面和视力结果。
