Li Ning, Wang Tao, Wang Ruixue, Duan Xuanchu
Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
Aier School of Ophthalmology, Central South University, Changsha 410000, China.
J Ophthalmol. 2019 Dec 3;2019:5935239. doi: 10.1155/2019/5935239. eCollection 2019.
This study aimed to evaluate the effects of excision on dry eye and meibomian gland dysfunction (MGD) in individuals with pterygium, before and after surgery. It also aimed to investigate how these effects correlate with the size and thickness of the pterygium.
63 eyes from 63 patients with primary nasal pterygium and 45 eyes from 45 healthy volunteers without ocular pathologies were enrolled in this study. 63 eyes from 63 patients underwent pterygium surgery. ImageJ software was used to calculate the pterygium size based on images of the anterior segments. Anterior segment spectral domain optical coherence tomography (SD-OCT) was performed preoperatively to measure the thickness of the pterygium 1 mm anterior to the nasal scleral spur. The ocular surface disease index (OSDI), Schirmer I Test (SIT), and MGD grade were used to evaluate the eyes, and the eyes were imaged using the noninvasive keratograph average tear film breakup time (NIBUTav), tear meniscus height (TMH), meiboscore, and lipid layer grading tools of the Oculus® Keratograph 5M, preoperatively and at 1, 3, and 6 months postoperatively.
The OSDI, NIBUTav, lid margin abnormality, meiboscore, and lipid layer grading values differed significantly in the pterygium patients in comparison with the controls ( < 0.01 for all scores). However, the SIT and TMH values were unchanged between the two groups (all > 0.05). Multivariate regression analysis demonstrated that the NIBUTav, meiboscore, and lipid layer grading score was significantly correlated with the pterygium parameters, such as size and thickness. The postoperative OSDI, NIBUTav, lid margin abnormality, and lipid layer grading values improved significantly ( < 0.05 for all scores). The SIT, TMH, and meiboscore results did not differ significantly between the pre- and postoperative values ( > 0.05). Among the conventional and automated indexes, at 1 month postoperatively, SIT and TMH were significantly correlated with the pterygium parameters, but no correlation was observed at 3 and 6 months postoperatively. The OSDI, NIBUTav, meiboscore, and lipid layer grading values at 1, 3, and 6 months postoperatively were significantly correlated with the pterygium parameters.
Abnormal tear film and meibomian gland (MG) function improved following pterygium excision in the patients with primary pterygium, which was associated with uncomfortable ocular symptoms. Pterygium parameters, such as size and thickness, correlated with the dry eye and MGD indexes in patients pre- and postoperatively, potentially offering a novel strategy for clinical implementation of pterygium excision surgery.
本研究旨在评估翼状胬肉患者手术前后切除翼状胬肉对干眼和睑板腺功能障碍（MGD）的影响。同时还旨在研究这些影响如何与翼状胬肉的大小和厚度相关。
本研究纳入了63例原发性鼻侧翼状胬肉患者的63只眼以及45例无眼部病变的健康志愿者的45只眼。63例患者的63只眼接受了翼状胬肉手术。使用ImageJ软件根据眼前节图像计算翼状胬肉大小。术前进行眼前节谱域光学相干断层扫描（SD - OCT）以测量鼻侧巩膜嵴前方1mm处翼状胬肉的厚度。采用眼表疾病指数（OSDI）、Schirmer I试验（SIT）和MGD分级来评估眼部情况，并在术前以及术后1、3和6个月使用Oculus® Keratograph 5M的无创角膜地形图平均泪膜破裂时间（NIBUTav）、泪河高度（TMH）、睑板腺评分和脂质层分级工具对眼部进行成像。
与对照组相比，翼状胬肉患者的OSDI、NIBUTav、睑缘异常、睑板腺评分和脂质层分级值存在显著差异（所有评分均P < 0.01）。然而，两组间的SIT和TMH值无变化（均P > 0.05）。多因素回归分析表明，NIBUTav、睑板腺评分和脂质层分级评分与翼状胬肉的大小和厚度等参数显著相关。术后OSDI、NIBUTav、睑缘异常和脂质层分级值显著改善（所有评分均P < 0.05）。术前和术后的SIT、TMH和睑板腺评分结果无显著差异（P > 0.05）。在传统指标和自动化指标中，术后1个月时，SIT和TMH与翼状胬肉参数显著相关，但术后3个月和6个月未观察到相关性。术后1、3和6个月时的OSDI、NIBUTav、睑板腺评分和脂质层分级值与翼状胬肉参数显著相关。
原发性翼状胬肉患者切除翼状胬肉后，泪膜和睑板腺（MG）功能异常得到改善，这与眼部不适症状相关。翼状胬肉的大小和厚度等参数与患者术前和术后的干眼及MGD指标相关，这可能为翼状胬肉切除手术的临床实施提供一种新策略。
