目的：探索翼状胬肉切除联合自体角膜缘干细胞移植术后全眼散光的影响因素。

方法：回顾性收集2023-01/10就诊于空军军医大学西京医院眼科的42例42眼接受翼状胬肉切除联合自体角膜缘干细胞移植手术的原发性翼状胬肉患者的病例资料。术前通过眼前节光学相干断层扫描(AS-OCT)测量翼状胬肉侵入角膜的最大深度，术中测量翼状胬肉侵入角膜长度、角膜缘宽度、计算侵入角膜的面积，并收集术前及术后1 wk，1 mo眼前节三维成像角膜散光值、角膜表面变异指数(ISV)、垂直不对称指数(IVA)、最佳矫正视力(BCVA)及全眼散光数据。将术后1 mo全眼散光≤0.50 D和>0.50 D患者分别纳入A、B两组，对比两组术前的数据差异，分析两组术前指标与术后1 mo全眼散光的相关性，利用决策树算法分析术后1 mo全眼散光的影响因素。

结果：A组患者翼状胬肉侵入角膜的最大深度小于B组\〖80.00(40.00，180.00)μm vs 175.00(123.00，190.00)μm，P=0.002\〗； 术前BCVA(LogMAR)、全眼散光、角膜散光、ISV、IVA及翼状胬肉侵入角膜的最大深度与术后1 mo全眼散光呈正比(r_s=0.317，P=0.041； r_s=0.545，P<0.001； r_s=0.448，P=0.003； r_s=0.389，P=0.011； r_s=0.382，P=0.013； r_s=0.391，P=0.010)； 决策树算法筛选出翼状胬肉侵入角膜的最大深度及术前全眼散光两因素，翼状胬肉侵入角膜的最大深度>95 μm者较侵入角膜的最大深度≤95 μm者术后1 mo全眼散光>0.50 D的风险大，其中合并术前全眼散光>2.63 D者，术后残留全眼散光>0.50 D的概率为88.9%，预测模型AUC为0.804。

结论：翼状胬肉切除术后全眼散光主要受翼状胬肉侵入角膜的最大深度及术前全眼散光影响，当患者翼状胬肉侵入角膜的最大深度>95 μm，且术前全眼散光>2.63 D时，应建议其尽快接受手术治疗，以期获得良好的临床收益。

METHODS: A retrospective analysis was conducted on the medical records of 42 patients(42 eyes)with primary pterygium admitted in the ophthalmology department of Xijing Hospital from January 2023 to October 2023. They underwent pterygium excision combined with autologous limbal stem cell transplantation. The maximum invasion depth of pterygium into the cornea was measured with anterior segment optical coherence tomography(AS-OCT)before operation, the length of the pterygium invading cornea, the width of the limbus and the area of the invading cornea were measured during the operation, and three-dimensional values of corneal astigmatism of anterior segment, index of surface variance(ISV), index of vertical asymmetry(IVA), best corrected visual acuity(BCVA)and whole-eye astigmatism were collected before and at 1 mo after surgery. Patients with astigmatism ≤0.50 D or >0.50 D of the whole eye at 1 mo after surgery were assigned to group A and B, respectively. The differences of clinical data before and at 1 mo after surgery between the two groups, and the correlation between pre-operative clinical indicators and whole-eye astigmatism were analyzed. The decision tree algorithm was performed to explore the influencing factors of whole-eye astigmatism at 1 mo postoperatively.

RESULTS: The maximum invasion depth of pterygium in the group A was significantly less than that in the group B \〖80.00(40.00, 180.00)μm vs 175.00(123.00, 190.00)μm, P=0.002\〗. Preoperative BCVA(LogMAR), whole-eye astigmatism, cornea astigmatism, ISV, IVA and maximum invasion depth of pterygium were positively correlated with whole-eye astigmatism at 1 mo after surgery(r_s=0.317, P=0.041; r_s=0.545, P<0.001; r_s=0.448, P=0.003; r_s=0.389, P=0.011; r_s=0.382, P=0.013; r_s=0.391, P=0.010). The decision tree algorithm screened out two influential factors: the maximum invasion depth of pterygium into the cornea and preoperative whole-eye astigmatism. The risk of whole-eye astigmatism >0.50 D at 1 mo after operation was higher with maximum invasion depth of pterygium into the cornea >95 μm than that with ≤95 μm. Among the patients with whole-eye astigmatism >2.63 D before operation, the probability of residual whole-eye astigmatism >0.50 D was 88.9%, and the predictive model AUC was 0.804.

CONCLUSION: The whole-eye astigmatism after pterygium resection is mainly affected by the maximum invasion depth of pterygium into the cornea and preoperative whole-eye astigmatism. When the maximum invasion depth of pterygium into the corneal is >95 μm and the whole-eye stigmatism is >2.63 D before surgery, the patient should receive surgical treatment as soon as possible in order to obtain good clinical benefits.