Yin Chuan-Jie, Bao Yin-Lei, Zhang Qi-Chen, Kang Sui-Fang, Chen Guo-Ling
Department of Ophthalmology, The Second Hospital of Shandong University Jinan 250033, Shandong, China.
Department of Ophthalmology, Linyi People's Hospital Linyi 276000, Shandong, China.
Am J Transl Res. 2023 Feb 15;15(2):641-652. eCollection 2023.
To compare the postoperative recovery of primary pterygium excision combined with either limbal stem cell transplantation (LSCT) or amniotic membrane transplantation (AMT).
All relevant studies on the primary pterygium excision combined with either LSCT or AMT conducted before August 2022 were extracted from PubMed, EMBASE, Web of Science, and Cochrane Library databases. The main outcomes compared were tear film stability at 1, 3, and 6 months after surgery, postoperative corneal epithelial healing time, recurrence rate, and complications.
Sixteen randomized controlled trials (RCTs) with 1390 eye cases were included in this meta-analysis. We found that patients of the AMT group improved significantly in the results of the tear break-up time (BUT) and Schirmer I test at 1 month after surgery (BUT: MD=-0.37, 95% CI: -0.62, -0.12, <0.05; Schirmer I test: MD=-0.32, 95% CI: -0.57, -0.07, <0.05) compared with those of the LSCT group, suggesting that the early stage of tear film stability after primary pterygium excision combined with AMT was superior to the LSCT combination. However, according to the Schirmer I test result, the patients in the LSCT group showed increased tear production compared to the AMT group at 3 and 6 months after surgery (3 months: MD=0.36, 95% CI: 0.08, 0.64, <0.05; 6 months: MD=0.33, 95% CI: 0.07, 0.60, <0.05), suggesting that the LSCT combination was superior to the AMT combination in long-term postoperative tear film stability. As for postoperative corneal epithelial healing time, the LSCT group exhibited shorter time than the AMT group (MD=-1.17, 95% CI: -2.15, -0.19, <0.05). Furthermore, the recurrence rate was lower in the LSCT group than in the AMT group (RR=0.42, 95% CI: 0.30, 0.59, <0.05). Lastly, there was no statistical difference in BUT and complication rate at 3 and 6 months after surgery between the LSCT and AMT groups.
Our analysis suggests that primary pterygium excision combined with LSCT may be a better choice compared to the combination with AMT in postoperative recovery.
比较原发性翼状胬肉切除联合角膜缘干细胞移植（LSCT）或羊膜移植（AMT）后的术后恢复情况。
从PubMed、EMBASE、Web of Science和Cochrane图书馆数据库中提取2022年8月之前进行的所有关于原发性翼状胬肉切除联合LSCT或AMT的相关研究。比较的主要结局指标为术后1、3和6个月时的泪膜稳定性、术后角膜上皮愈合时间、复发率及并发症。
本荟萃分析纳入了16项随机对照试验（RCT），共1390眼病例。我们发现，与LSCT组相比，AMT组患者在术后1个月时泪膜破裂时间（BUT）和泪液分泌试验（Schirmer I试验）结果有显著改善（BUT：MD=-0.37，95%CI：-0.62，-0.12，<0.05；Schirmer I试验：MD=-0.32，95%CI：-0.57，-0.07，<0.05），这表明原发性翼状胬肉切除联合AMT后的泪膜稳定性早期优于联合LSCT。然而，根据Schirmer I试验结果，在术后3个月和6个月时，LSCT组患者的泪液分泌量高于AMT组（3个月：MD=0.36，95%CI：0.08，0.64，<0.05；6个月：MD=0.33，95%CI：0.07，0.60，<0.05），这表明在术后泪膜稳定性方面，LSCT联合优于AMT联合。至于术后角膜上皮愈合时间，LSCT组比AMT组短（MD=-1.17，95%CI：-2.15，-0.19，<0.05）。此外，LSCT组的复发率低于AMT组（RR=0.42，95%CI：0.30，0.59，<0.05）。最后，LSCT组和AMT组在术后3个月和6个月时的BUT及并发症发生率无统计学差异。
我们的分析表明，在术后恢复方面，原发性翼状胬肉切除联合LSCT可能比联合AMT是更好的选择。
