Involvement of bone marrow-derived stem and progenitor cells in the pathogenesis of pterygium

AIMS: To evaluate the involvement of multipotential stem and progenitor cells in the pathogenesis of pterygium. METHODS: Paraffin-embedded and snap-frozen primary pterygium (n = 10) were serially sectioned and analysed immunohistochemically to determine the expression level of AC133 (marker for the primitive haematopoietic progenitors), CD34 (marker for the haematopoietic progenitor cells and endothelium), c-Kit (marker for haematopoietic and stromal progenitor cells), and STRO-1 (a differentiation antigen present on bone marrow fibroblast cells and on various nonhaematopoietic progenitor cells). RESULTS: In all the primary pterygium, immunoreactivity of AC133 and STRO-1 was found in some of the epithelial and stromal cells, CD34 was observed in the vascular endothelium, and some scattered ovoidal cells were found in the subepithelial connective tissue. C-Kit was expressed mainly in the basal epithelium of the head portions, and some spindle-shaped stromal cells. There is no immunoreactivity of AC133, c-Kit, and STRO-1 in normal conjunctiva, whereas CD34 was mildly stained with vessel wall. CONCLUSION: Multipotential stem and progenitor cells may be involved in the pathogenesis of pterygium through its differentiation into fibroblasts and vascular endothelial cells.     

翼状胬肉组织中CD34、AC133、STRO-1、C—KIT的表达

目的评估源白骨髓的干细胞与翼状胬肉发病的相关性,探寻翼状胬肉的发病机制。方法选择翼状胬肉头部达到瞳孔缘的病例12例（12眼）,其中男6例,女6例;年龄51～66岁;原发性翼状胬肉8例,复发性翼状胬肉4例,均长于鼻侧。对照组材料来自同一眼球、距翼状胬肉边缘约10mm的正常球结膜组织。采用EnVision免疫组织化学法检测骨髓干细胞标志物来源的CD34、AC133、STRO-1、C-KIT的表达。结果光镜下可见翼状胬肉组织中有大量带有骨髓干细胞或祖细胞阳性标志物来源的细胞,翼状胬肉组织头部阳性表达更强。4种阳性细胞的分布及细胞形态类似。C—KIT阳性表达细胞聚集于翼状胬肉上皮基底组织和基质组织。上皮基底部阳性细胞呈圆形或椭圆形,而在基质组织中呈纺锤形且主要分布于血管周围。CD34阳性表达细胞主要分布于翼状胬肉组织上皮基底层,在血管内皮也有阳性表达,类似于C—KIT,但比C—KIT上皮层组织阳性细胞少。细胞形态在上皮基底部呈圆形或椭圆形。AC133阳性表达细胞主要分布于上皮层,基质和血管内皮中也有阳性表达,形态类似CD34和C-KIT。STRO-1阳性表达细胞的分布不同,主要见于基质层,阳性细胞形态呈纺锤形,而上皮层中未见表达。各种因子的表达在原发性和复发性翼状胬肉间无明显差别。对照组切片中标志物的表达均呈阴性。结论带有源白骨髓干细胞阳性标志物的细胞在翼状胬肉的发病和术后复发过程中可能起重要作用。     

翼状胬肉手术中羊膜移植与自体角膜缘干细胞移植的效果对比

目的观察翼状胬肉手术中羊膜移植术与自体角膜缘干细胞移植的临床疗效。方法翼状胬肉70例（76眼）,均在手术显微镜下切除。其中羊膜移植组40例（42眼）,自体角膜缘十细胞移植组30例（34眼）。术后随访观察12～18月。结果羊膜移植组有4眼复发,复发率为9．52％,自体角膜缘干细胞移植组有3眼复发,复发率8．82％。结论羊膜移植与角膜千细胞移植在治疗翼状胬肉中的疗效相近。     

胚胎角膜干细胞移植治疗翼状胬肉的远期临床观察

目的　探讨体外培养的异体人胚胎角膜干细胞移植治疗原发性翼状胬肉的远期临床疗效。方法　原发性进行期翼状胬肉 3 2例 (3 2眼 ) ,随机分为两组 ,每组 16例 (16眼 )。实验组行翼状胬肉切除 以羊膜为载体的体外培养的异体人胚胎角膜干细胞移植术 ;对照组行翼状胬肉切除巩膜暴露术。术后随访 3年。手术由同一人操作。结果　实验组较对照组角膜上皮愈合快。实验组 1眼术后 3月内翼状胬肉复发 (复发率 6.2 5 %)。对照组 7眼术后不等时间翼状胬肉复发 (复发率43 .75 %)。实验组复发率低于对照组 (Fisher精确概率检验法检验结果P =0 .0 186<0 .0 5 )。实验组所有病例均未见其它并发症的发生。结论　应用以保存羊膜为载体的体外培养的异体人胚胎角膜干细胞移植治疗原发性翼状胬肉安全、有效。     

Comparison of the Efficacy of Pterygium Resection Combined with Conjunctival Autograft versus Pterygium Resection Combined with Amniotic Membrane Transplantation

 PURPOSE:To compare the efficacy of pterygium resection combined with conjunctival autograft versus pterygium resection combined with amniotic membrane transplantation in the treatment of pterygium. METHODS:A total of 118 cases (133 eyes) were randomly assigned to receive pterygium resection combined with conjunctival autograft (n=81) or pterygium resection combined with amniotic membrane transplantation (n=52). Corneal wound healing and neovascularization and the presence or absence of conjunctival proliferation and hyperemia were analyzed at 12 months post-operatively. RESULTS:In the conjunctival autograft group, 6 eyes (7.4%) had recurrent pterygium, while in the amniotic membrane transplantation group, 10 eyes showed recurrence (19.2%, P<0.05, chi-square). Patients in the conjunctival autograft group recovered significantly faster compared with those in the amniotic membrane transplantation group. CONCLUSION:Patients receiving pterygium surgery combined with conjunctival autograft had lower recurrence rates and experience faster recovery compared with those undergoing pterygium resection combined with amniotic membrane transplantation.     

角膜缘干细胞移植和羊膜移植术治疗复发性翼状胬肉临床疗效比较

目的 比较角膜缘干细胞移植术和羊膜移植术治疗复发性翼状胬肉的临床疗效.方法 将66例(69只眼)患者随机分为两组,分别采用角膜缘干细胞移植术(33例34只眼)和羊膜移植术(33例35只眼)治疗,术后随访1～2年.结果 角膜缘干细胞移植组1只眼复发,复发率为2.94%;羊膜移植组8只眼复发,复发率为22.9%,两组比较差异有统计学意义(χ2=4.389,P<0.05).角膜创面上皮平均愈合时间角膜缘干细胞移植为3～5(4.5±2.4)d,羊膜移植组为5±8(6.5±2.6)d,两组比较差异有统计学意义,(t=3.317,P<0.05).结论 角膜缘干细胞移植术治疗复发性翼状胬肉复发率低,角膜创面修复快,是一种理想的手术方法,值得推广应用.     

The results of amniotic membrane transplantation for primary pterygium compared with conjunctival autograft

PURPOSE: To study the efficacy and safety of amniotic membrane transplantation as an adjunctive therapy after surgical excision of primary pterygium and to compare the clinical outcome with that of conjunctival autograft. METHODS: Eighty-six eyes of 78 patients with primary pterygium were operated on by a single surgeon (N.T.). All patients were randomized to undergo amniotic membrane or conjunctival autograft transplantation as an adjuvant therapy after pterygium excision. Forty-four eyes in 39 patients were treated with amniotic membrane transplantation (AM group), and 42 eyes of 41 patients were treated with conjunctival autograft (CG group). Patients were followed up at 1 week, 1, 3, 6, and 12 months postoperation. The main outcome measurement was a recurrence rate after surgery. RESULTS: The mean follow-up was 14.40 +/- 5.4 months in the AM group and 12.35 +/- 3.13 months in the CG group. There were 18 recurrences (40.9%) in the AM group and two (4.76%) in the CG group, which was significantly different among both groups (P < 0.007). The cumulative proportion that were recurrence-free at 12 months was 0.6 +/- 0.15 for the AM group and 0.95 +/- 0.07 for the CG group (P = 0.0003, Log-rank test). The cumulative nonrecurrence rate at 6 and 12 months in all patients stratified by age and sex was not significantly different (P = 0.28 and P = 0.9, Log-rank test). No major complications were observed in either group. CONCLUSION: The surgical results of primary pterygium excision followed by amniotic membrane and conjunctival autograft transplantation were compared. It was found that amniotic membrane transplantation for pterygium surgery has an unacceptably high recurrence rate.     

角膜缘干细胞移植治疗翼状胬肉切除联合羊膜移植术后羊膜溶解

目的：观察角膜缘干细胞移植术治疗翼状胬肉切除联合羊膜移植术后羊膜溶解的临床效果。方法：翼状胬肉切除术联合羊膜移植术后出现羊膜溶解的患者124例135眼随机分成A、B、C三组,A组36例38眼采取保守治疗, B组42例45眼再次行羊膜移植术, C组46例52眼行自体角膜缘干细胞移植术。术后随访6～18mo比较各组胬肉复发情况。结果：A组38眼中24眼复发,复发率63．2％。 B组45眼中术后7眼胬肉复发,复发率15．6％。 C组52眼2眼复发,复发率3．8％,A组与B组比较,B组与C组比较差异均有统计学意义（P＜0．05）。结论：自体角膜缘干细胞移植术是治疗翼状胬肉切除联合羊膜移植术后羊膜溶解的有效方法。     

不同手术方式治疗翼状胬肉的临床疗效分析

目的：探讨不同手术方式治疗翼状胬肉的临床效果。

方法：对我院2006-01/2010-12行不同手术方式治疗的164例206眼翼状胬肉患者的临床资料进行回顾性分析。A组(36例50眼)采用单纯切除术; B组(41例47眼)采用单纯切除联合丝裂霉素术; C组(42例52眼)采用胬肉切除联合丝裂霉素和羊膜移植术; D组(45例57眼)采用胬肉切除联合自体角膜缘干细胞移植术。记录每例手术时间,术后1wk; 3,6,12,24mo进行随访观察,观察结膜愈合及胬肉复发情况等。

结果：A组复发率最高,B组复发率有所降低,C、D 组复发率较A组及B组明显降低,C、D 组复发率无明显差异。手术时间方面,单纯切除组的手术时间明显短于其他组,羊膜移植及自体角膜缘干细胞移植组的手术时间较长。复发主要发生在术后1a内。

结论：丝裂霉素可以降低单纯胬肉切除术的复发率,角膜缘干细胞移植及羊膜移植术可以更有效的降低胬肉的复发率。     

自体角膜缘干细胞移植联合双层生物羊膜移植治疗翼状胬肉

目的：观察自体角膜缘干细胞移植联合双层生物羊膜移植治疗翼状胬肉的有效性和安全性。

方法：2010-06/2013-12我院手术的翼状胬肉患者,根据翼状胬肉分型分级不同,采取不同的手术方法,A组应用自体角膜缘干细胞移植术,B组应用自体角膜缘干细胞移植联合双层生物羊膜移植术,术后随访6～36mo,观察术后复发率。

结果：共有149例155眼纳入本研究。其中A组75眼应用自体角膜缘干细胞移植术：单薄型2级10眼中1眼复发,3级14眼中2眼复发; 肥厚型17眼中2眼复发; 复发型21眼中3眼复发。痊愈68眼,复发8眼,总复发率10.67%。B组80眼应用自体角膜缘干细胞移植联合双层生物羊膜移植,单薄型3级及4级以上无复发; 肥厚型21眼中1眼复发; 复发型37眼中2眼复发。痊愈77眼,复发3眼,总复发率3.75%。两组在肥厚型和复发型降低复发率方面有显著统计学意义(P<0.05)。

结论：提示不同类型的胬肉采取不同的手术方式其手术复发率不同。自体角膜缘干细胞移植术适合于无根型、单薄型2级以下的翼状胬肉; 自体角膜缘干细胞移植联合双层生物羊膜移植适合于单薄型2级以上、肥厚型、复发型的翼状胬肉手术治疗,复发率低,是一种理想的手术方法。