Evaluation of the clinical efficacy of modified LSC transplantation plus BCL implantation in the treatment of pterygium.

Objective: To explore the clinical efficacy of modified limbal stem cell transplantation(Modified LSC transplantation) and bandage contact lens(BCL) implantation in pterygium surgery.

Methods: A total of 479 patients with primary pterygium who were admitted to our hospital from March 2019 to March 2023 were randomly divided into three groups: the normal group (Group A: 89 patients), the control group (Group B: 195 patients), and the modified group (Group C: 195 patients). Each group received different intervention measures. Group A did not undergo surgical treatment and were required to follow up as outpatients. Group B received LSC transplantation combined with interrupted suturing plus BCL, whereas Group C received modified LSC transplantation combined with BCL. The degree of corneal irritation symptoms, wound healing and graft status under slit lamp, incidence and recurrence rate of complications, tear film rupture time, tear secretion test, intraocular pressure, ocular surface inflammation response(IL-1β, PGE2, TNF-α, VEGF), and visual quality were compared and analyzed at various time points after surgery.

Results: Compared with those in the Group B, patients in the Group C experienced faster normalization of corneal epithelium recovery, fewer corneal irritation symptoms, and better wound healing. The break-up time (BUT) of the tear film at 1 week to 1 year postoperatively was significantly greater in the Group C than Group B, with values approaching those of Group A by 3 months (P < 0.05). The Schirmer test results revealed a similar trend to that of the BUT. Further analysis of intraocular pressure (IOP) at different time points revealed no significant differences among the three groups at postoperative Day 1. However, due to the use of corticosteroid eye drops postoperatively, IOP was greater in both the Group B(17.24 ± 2.12 mmHg) and Group C (17.02 ± 2.37 mmHg) than Group A (13.92 ± 1.57 mmHg) at 1 week. By 1 month, Group C had a lower IOP (15.77 ± 1.63 mmHg) than Group B(17.78 ± 2.41 mmHg). There were no significant differences in IOP among the three groups from 3 months to 1 year (P > 0.05). The ELISA results indicated that the expression levels of the ocular surface inflammatory factors IL-1β, TNF-α, PEG2, and VEGF in the Group C were lower than those in Group B from 1 week to 1 year post surgery. Under both natural light and low-light conditions (spatial frequency/6 cd), Group C had better best-corrected visual acuity and contrast sensitivity than Group B at 1 week to 1 year postoperatively. Additionally, Group C had lower corneal higher-order aberrations (including astigmatism, spherical aberrations, and total higher-order aberrations) and superior vision-related quality of life scores at 1 year postoperatively than Group B, with statistically significant differences (P < 0.05).

Conclusion: Modified LSC transplantation combined with BCL implantation provided superior treatment outcomes for patients with pterygium, which was worthy of further clinical promotion.