目的:评价不同翼状胬肉手术技术在不同随访时期对眼表(OS)的影响。
方法:PubMed,科克伦图书馆,WebofScience,中国国家知识基础设施,万芳,和中国生物医学光盘进行了研究,报告了翼状胬肉术前和术后OS参数。
结果:最终共纳入33篇。三个OS参数在手术后显示出相对一致的变化趋势,包括眼表疾病指数(OSDI),泪膜破裂时间(BUT),角膜荧光素染色(SCFS)评分。术后1w时明显恶化,然后逐渐好转:术后1m时OSDI和BUT明显改善(SMD=-0.58,95CI=[-1.04,-0.13];SMD=0.42,95CI=[0.06,0.78]);术后3m时SCFS恢复至术前水平(SMD=-0.54,95CI=[-1.16,0.07]。另一个参数,无麻醉Schirmer试验(SIT),术后1w出现瞬时增加(SMD=0.87,95CI=[0.27,1.47]),术后1m出现相对稳定的改善(SMD=0.52,95CI=[0.16,0.89])。与自体结膜移植(CAG)相比,羊膜移植(AMT)的所有参数在早期均显示出更好的改善,并且在长期内显示出非较差的改善。从长远来看,自体角膜缘结膜移植术(LCAG)对OS有很好的改善,而翼状胬肉切除术(PE)的OS最差。翼状胬肉的类型(原发性和继发性),糖尿病(DM)状态,固定方法对结果有一定的影响。
结论:翼状胬肉的OS在术后1w时恶化,然后在术后1m后逐渐改善至术前水平。在各种手术技术中,LCAG对OS有最好的改进,特别是在长期结果中表现出来。
OBJECTIVE: To evaluate the effects of different pterygium surgery techniques on ocular surface (OS) in different follow-up periods.
METHODS: PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wan Fang, and China Biology Medicine disc were searched for studies reporting pre- and post-operative OS parameters in pterygium.
RESULTS: A total of 33 articles were finally included. Three OS parameters showed relatively consistent changing trends after surgery including ocular surface disease index (OSDI), tear film break-up time (BUT), and score of corneal fluorescein staining (SCFS). They worsened significantly at 1w post-operation and then gradually improved: OSDI and BUT showed obvious improvement in 1 m post-operation (SMD = - 0.58, 95%CI = [- 1.04, - 0.13]; SMD = 0.42, 95%CI = [0.06, 0.78]); SCFS was restored to preoperative levels in 3 m after surgery (SMD = - 0.54, 95%CI = [- 1.16, 0.07]). Another parameter, Schirmer test without anesthesia (SIT), presented transient increase at 1w post-operation (SMD = 0.87, 95%CI = [0.27, 1.47]) and presented a relatively stable improvement after 1 m post-operation (SMD = 0.52, 95%CI = [0.16, 0.89]). All parameters in amniotic membrane graft (AMT) showed better improvement in early stage and they showed non-inferior improvements in the long term compared with conjunctival autograft (CAG). Limbal-conjunctival autograft (LCAG) made excellent improvement to OS in the long term while pterygium excision (PE) showed the worst OS. The type of pterygium (primary and secondary), diabetes mellitus (DM) status, and fixation method had certain effects on the results.
CONCLUSIONS: OS of pterygium is deteriorated at 1w post-operation then gradually improved to preoperative levels after 1 m post-operation. Among various surgery techniques, LCAG had the best improvement to OS which especially displayed in the long-term outcomes.