氟米龙滴眼液联合角膜绷带镜在翼状胬肉切除伴结膜瓣移植术后的早期应用

Clinical Observation on Application of Fluorometholone Eye Drops Combined with Corneal Bandage Contact Lens after Pterygium Resection and Free Conjunctival Flap Transplantation

摘要: 目的：探讨氟米龙滴眼液联合角膜绷带镜在翼状胬肉切除伴结膜瓣移植术中的临床疗效。方法：回顾性分析2017年9月至2020年12月期间，在无锡市第一人民医院眼科就诊的51例(53眼)翼状胬肉。所有患者均门诊行翼状胬肉切除联合结膜瓣移植术。术后将51例(53眼)随机分为三组：A组(17例17眼)术后应用氟米龙滴眼液组；B组(17例18眼)术后应用角膜绷带镜组；C组(17例18眼)术后氟米龙滴眼液联合角膜绷带镜组。比较三组患者治疗前后角膜上皮修复时间、结膜水肿情况、疼痛评分(1、3、7D角膜刺激症状评分)、泪膜功能。随访时间为6个月。结果：C组角膜上皮修复时间(3.12 ± 0.60)天，明显短于A组(4.35 ± 0.78)天(P < 0.001)。C组术后第一天VAS评分(5.06 ± 0.89)分，术后第三天(3.12 ± 0.70)分，术后第七天(1.47 ± 0.51)分；均明显低于A组术后第一天VAS评分(8.25 ± 0.75)分，术后第三天(5.88 ± 0.69)分，术后第七天(3.35 ± 0.78)分(P < 0.001)。C组结膜移植片水肿消退时间(17.22 ± 0.88)天，明显短于B组(19.72 ± 0.75)天(P < 0.001)。C组术后一个月BUT (6.41 ± 0.62) s，稍长于A组(5.94 ± 0.82) s (P = 0.039)。结论：氟米龙滴眼液联合角膜绷带镜在翼状胬肉切除伴结膜瓣移植术后的早期应用有协调作用，可有效缩短角膜上皮修复时间，减轻术后眼部刺激症状，缩短结膜移植片水肿消退时间，对于眼部泪膜功能修复也有一定帮助。

Abstract: Aim: The aim was to evaluate the effectiveness of fluorometholone eye drops combined with corneal bandage contact lens in the early stage of pterygium resection and free conjunctival flap transplantation. Methods: 53 eyes of 51 patients with primary pterygium from Sep. 2017 to Dec. 2020 in Wuxi People’s Hospital were analyzed and all cases were treated with pterygium resection and free conjunctival flap transplantation. These patients were sorted into three groups randomly, named as Group A, Group B and Group C. Group A (17 cases, 17 eyes) was treated with fluorometholone eye drops after surgery; Group B (17 cases, 18 eyes) was treated with corneal bandage contact lens and Group C (17 cases, 18 eyes) was treated with fluorometholone eye drops combined with corneal bandage contact lens after surgery. The corneal epithelial healing time, conjunctival graft edema time, post-surgical pain and tear film function were analyzed after treatment. Post-surgical pain was evaluated by visual analogue scale (VAS). Tear film function was assessed by breakup time of tear film (BUT). The follow-up time was 6 months. Results: The corneal epithelial healing time in group C was (3.12 ± 0.60) days, which was significantly shorter than that in group A (4.35 ± 0.78) days (P < 0.001). VAS scores reported lower pain levels in the group C compared to group A (group C (5.06 ± 0.89) VS group A (8.25 ± 0.75) on the first postoperative day, group C (3.12 ± 0.70) VS group A (5.88 ± 0.69) on the third postoperative day, group C (1.47 ± 0.51) VS group A (3.35 ± 0.78) on the seventh postoperative day, all (P < 0.001). The conjunctival graft edema time in group C was (17.22 ± 0.88) days, which was significantly shorter than that in group B (19.72 ± 0.75) days (P < 0.001). BUT in group C was (6.41 ± 0.62) s on one month after surgery, which was slightly longer than that in group A (5.94 ± 0.82) s (P = 0.039). Conclusion: The combination of fluorometholone eye drops and corneal bandage contact lens has synergistic effect in the early stage of pterygium resection and free conjunctival flap transplantation. The combination of fluorometholone eye drops and corneal bandage contact lens could significantly promote the healing of the corneal epithelium, release post-surgical pain and reduce conjunctival graft edema time.