目的:比较翼状胬肉切除联合角膜缘干细胞移植术(LSCT)和羊膜移植术(AMT)的术后恢复情况。
方法:所有在2022年8月之前进行的翼状胬肉切除联合LSCT或AMT的相关研究均来自PubMed,EMBASE,WebofScience,和Cochrane图书馆数据库。比较的主要结果是术后1、3和6个月的泪膜稳定性,术后角膜上皮愈合时间,复发率,和并发症。
结果:本荟萃分析包括16项随机对照试验(RCT),共1390例。我们发现,与LSCT组相比,AMT组的患者在术后1个月的泪液破裂时间(BUT:MD=-0.37,95%CI:-0.62,-0.12,P<0.05;SchirmerI检验:MD=-0.32,95%CI:-0.57,-0.07,P<0.05),提示原发性翼状胬肉切除联合AMT后泪膜稳定性的早期阶段优于LSCT联合。然而,根据SchirmerI的测试结果,与AMT组相比,LSCT组患者在术后3和6个月时泪液产生增加(3个月:MD=0.36,95%CI:0.08,0.64,P<0.05;6个月:MD=0.33,95%CI:0.07,0.60,P<0.05),提示LSCT组合在长期术后泪膜稳定性方面优于AMT组合。至于术后角膜上皮愈合时间,LSCT组时间短于AMT组(MD=-1.17,95%CI:-2.15,-0.19,P<0.05)。此外,LSCT组的复发率低于AMT组(RR=0.42,95%CI:0.30,0.59,P<0.05)。最后,LSCT组和AMT组术后3个月和6个月的BUT和并发症发生率无统计学差异。
结论:我们的分析表明,与联合AMT相比,原发性翼状胬肉切除联合LSCT可能是术后恢复的更好选择。
OBJECTIVE: To compare the postoperative recovery of primary pterygium excision combined with either limbal stem cell transplantation (LSCT) or amniotic membrane transplantation (AMT).
METHODS: 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.
RESULTS: 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, P<0.05; Schirmer I test: MD=-0.32, 95% CI: -0.57, -0.07, P<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, P<0.05; 6 months: MD=0.33, 95% CI: 0.07, 0.60, P<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, P<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, P<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.
CONCLUSIONS: Our analysis suggests that primary pterygium excision combined with LSCT may be a better choice compared to the combination with AMT in postoperative recovery.