目的：探讨翼状胬肉厚度及面积对角膜屈光状态的影响。

方法：前瞻性纵向研究。随机选取2024年1月至2024年9月我院收治的翼状胬肉患者60例60眼，所有患者均行翼状胬肉切除联合带蒂结膜瓣移植术治疗。使用光学相干断层成像(OCT)测量患者术前翼状胬肉厚度，使用数码裂隙灯显微镜测量翼状胬肉面积。比较患者术前，术后1 d，1、3 mo的角膜屈光状态(角膜散光及平均曲率)及裸眼视力变化情况。分析患者术前翼状胬肉厚度及面积与术后不同时间点角膜屈光状态指标的关系，通过Logistic回归分析翼状胬肉厚度及面积对患者术后视力改善的影响。

结果：所有患者均完成术后3 mo随访。术后3 mo，21眼(35%)视力改善。双变量Pearson相关性分析结果显示，翼状胬肉厚度及面积与术前，术后1 d，1、3 mo的角膜散光、裸眼视力均呈正相关(均P<0.05)，与术前，术后1 d，1、3 mo的角膜平均曲率均呈负相关(均P<0.05)。经Logistic回归分析显示，术前翼状胬肉厚度厚、面积大、角膜散光高、裸眼视力低(LogMAR值大)均是患者术后视力改善不佳的危险因素(OR>1，P<0.05)，术前角膜平均曲率大是患者术后视力改善不佳的保护因素(OR<1，P<0.05)。

结论：翼状胬肉厚度及面积增大可在一定程度上提高角膜散光程度，降低角膜平均曲率，影响术后视力恢复。

METHODS: Prospective longitudinal study. A total of 60 cases(60 eyes)of pterygium patients admitted to our hospital from January 2024 to September 2024 were randomly selected. All patients underwent pterygium excision combined with pedicle conjunctival flap transplantation for treatment. Optical coherence tomography(OCT)was used to measure the preoperative thickness of patient's pterygium, and a digital slit lamp microscope was used to measure the area of pterygium. The corneal refractive status(degree of corneal astigmatism and average curvature)and changes in uncorrected visual acuity of patients before surgery, 1 d, 1, and 3 mo after surgery were compared. The relationship between preoperative thickness and area of pterygium in patients and corneal refractive status indicators at different postoperative time points were analyzed, and Logistic regression was used to analyze the impact of pterygium thickness and area on postoperative visual improvement in patients.

RESULTS: All patients completed follow-up after surgery for 3 mo. At 3 mo after surgery, visual acuity improved in 21 eyes(35%). The results of bivariate Pearson correlation analysis showed that the thickness and area of pterygium positively correlated with the degree of corneal astigmatism and uncorrected visual acuity before surgery and 1 d, 1, and 3 mo after surgery(all P<0.05), and negatively correlated with the average corneal curvature before surgery and 1 d, 1, and 3 mo after surgery(all P<0.05). Logistic regression analysis showed that the thickness and area of pterygium before surgery, high degree of corneal astigmatism, and low uncorrected visual acuity(large LogMAR value)were all risk factors for poor postoperative visual improvement in patients(OR>1, P<0.05). The large average corneal curvature before surgery was a protective factor for poor postoperative visual improvement in patients(OR<1, P<0.05).

CONCLUSION: The increase in thickness and area of pterygium can, to some extent, improve corneal astigmatism, reduce the average curvature of the cornea, and affect postoperative visual recovery.