逆行撕剥术治疗初发翼状胬肉的临床观察

目的:了解翼状胬肉手术采用逆行撕剥方法对术后角膜上皮修复时间和远期预后的影响。方法:对56眼原发性翼状胬肉患者随机分成2组,常规剥离组采用从头部到体部的常规剥离方式,逆向剥离组采用从体部到头部的逆向剥离方式,2组均同时联合带蒂结膜瓣转移,术中均使用丝裂霉素棉片浸润巩膜暴露区,术后观察角膜上皮修复时间和远期愈合情况。结果:逆向剥离组比常规剥离组角膜上皮完成修复时间明显提前(t=4.79,P<0.05),逆向剥离组复发率(1.6%)明显低于常规剥离组(10.2%,χ2=4.06,P<0.05)。结论:翼状胬肉手术采用逆向剥离方式可以实现加快角膜上皮修复、减少术后复发的目的。     

自体结膜移植术联合丝裂霉素C治疗复发性翼状胬肉

目的:观察自体角膜缘干细胞移植联合丝裂霉素C治疗复发性翼状胬肉的效果。方法:复发性翼状胬肉68例79眼患者均在手术显微镜下切除并做角膜缘干细胞移植联合应用丝裂霉素C,术后随访6mo。结果:患者68例79眼,术后1例复发,余角膜上皮稳定,无新生血管长入,结膜创面愈合正常,无组织增生。结论:常规切除胬肉联合自体角膜缘干细胞移植并术中应用丝裂霉素C治疗复发性翼状胬肉的效果满意。     

酒精分离联合自体带蒂角膜缘结膜瓣转位移植治疗翼状胬肉

目的探讨酒精分离联合自体带蒂角膜缘结膜瓣转位移植治疗翼状胬肉的手术技巧和临床疗效。方法对初发和复发性翼状胬肉120例（140眼）采用加％酒精浸泡胬肉头部后,剥离、切除胬肉,再联合自体带蒂角膜缘结膜瓣转位移植手术。术后随访3-12月,平均10月。比较术前术后视力、BUT情况,观察角膜上皮修复及自体带蒂角膜缘结膜瓣转位移植后存活情况,胬肉复发情况。结果酒精分离法使胬肉纤维血管组织与其下角膜基质分离更加容易。术后角膜上皮修复快,带蒂角膜缘结膜瓣转位移植后100％存活,视力、BUT值较术前不同程度的提高,胬肉治愈138眼（98．57％）,胬肉复发2眼（复发倾向1眼,真性复发1眼）。结论酒精分离联合自体带蒂角膜缘结膜瓣转位移植治疗翼状胬肉术式简单、易操作,安全、可靠,手术损伤小、术后反应轻、恢复快、复发率低,无严重并发症,是值得临床推广的有效方法。     

角膜缘干细胞联合羊膜移植治疗翼状胬肉疗效观察

目的:观察自体角膜缘干细胞移植与羊膜移植术治疗翼状胬肉的临床疗效。方法:将126例142眼翼状胬肉患者随机分成A,B组,A组64例72眼行翼状胬肉切除联合角膜缘干细胞移植术;B组62例70眼行翼状胬肉切除联合羊膜移植术,术后1wk;1mo及3mo,观察比较移植片生长、角膜创面修复、角膜新生血管及胬肉复发率。术后随访24mo。结果:A、B两组角结膜上皮愈合时间分别为(2.6±0.4)d和(3.2±0.7)d,两组比较差异有显著性差异(P<0.05);A组2例2眼翼状胬肉复发,治愈率为97.1%,复发率2.9%;B组9例12眼翼状胬肉复发,治愈率为81.8%,复发率18.2%;两组比较差异有统计学意义(P=0.003)。结论:自体角膜缘干细胞移植与羊膜移植术均可有效防止翼状胬肉的复发,具有方便、创伤小,修复快,术后患者自觉症状轻,复发率低等优点。     

带角膜缘的自体结膜瓣移植术治疗翼状胬肉的疗效

目的:观察用带角膜缘的自体结膜瓣移植术治疗翼状胬肉的临床效果。方法:翼状胬肉50例56眼,采取显微手术取同侧眼上方带角膜缘的游离结膜瓣进行移植。行翼状胬肉切除联合带角膜缘的自体结膜瓣进行移植,缝合时注意移植片移植床上角膜缘各自准确对位吻合,术后对角膜上皮化及植片生长情况随访观察。结果:术后随访6～12mo,角膜上皮平整光滑,泪膜正常,供区角结膜创面正常愈合,术后角膜透明或仅遗留少许云翳,无新生血管长入,无1例复发。结论:用带角膜缘的自体结膜瓣移植术治疗翼状胬肉,有利于重建角膜缘功能,是一种治疗翼状胬肉安全有效的手术方法。     

翼状胬肉两种手术方法的临床效果比较

目的 对比两种手术方法治疗翼状胬肉的临床效果.方法 翼状胬肉46例（51只眼）随机分成两组,每组均为23例.第1组,翼状胬肉切除加自体角膜缘干细胞移植 第2组,翼状胬肉切除加带蒂结膜瓣转移术中联合应用丝裂霉素C.观察术后角膜上皮修复、角膜缘新生血管及翼状胬肉复发情况.结果 术后随诊6～36月,第1组中有1只眼复发（4.35%）,第2组有2只眼复发（8.70%）.结论 翼状胬肉切除加自体角膜缘干细胞移植及翼状胬肉切除加带蒂结膜瓣转移术中联合应用丝裂霉素C均能有效阻止胬肉复发.但前者在手术安全性、舒适性、术后并发症等方面更具优势.     

自体带结膜瓣角膜缘干细胞移植联合羊膜移植治疗复发性翼状胬肉

目的:降低翼状胬肉术后复发率,减少术后并发症。方法:采用自体带结膜瓣的角膜缘干细胞移植联合羊膜移植治疗26例(26眼)复发性翼状胬肉患者。结果:在26眼中显效25眼,复发1眼,有效率为96%。结论:采用自体带结膜瓣角膜缘干细胞移植联合羊膜移植,可有效维持角膜上皮与结膜上皮之间的屏障途径,阻止结膜上皮长入和新生血管形成,并使结膜下成纤维增殖抑制,睑球粘连松解,从而降低翼状胬肉术后复发率,减少术后并发症。     

自体角膜缘干细胞移植治疗角膜缘功能衰竭症

目的　探讨自体角膜缘干细胞移植在角膜缘功能衰竭症治疗中的作用。方法　将 83例 90眼初发性翼状胬肉、外伤性角膜缘板层缺损及角膜缘碱烧伤患者随机分为A、B组。A组为自体角膜缘干细胞移植组 (干细胞治疗组 ) 4 2例 4 5眼 ,其中 30眼翼状胬肉行翼状胬肉切除联合自体角膜缘干细胞移植术 ,外伤性角膜板层损伤 10眼、角膜缘碱烧伤 5眼行自体角膜缘干细胞移植术 ;B组为传统单纯翼状胬肉切除 ,外伤性角膜缘板层损伤、碱烧伤行结膜瓣移植术 (对照组 ) ,4 1例 4 5眼 ,其中翼状胬肉 30眼行单纯翼状胬肉切除 ,外伤性角膜缘板层缺损 11眼、碱烧伤 4眼行结膜瓣移植术 ,术后观察角膜上皮修复时间、角膜缘新生血管、角膜透明度、泪膜破裂恢复时间以及胬肉复发率 ,术后随诊 6～ 2 4月。结果　A组术后角膜上皮修复时间 2～ 4d、BUT(6 .7± 0 .8)d ,无角膜缘新生血管生长 ,术后翼状胬肉复发率为 0 ,角膜透明 ;B组术后角膜上皮修复时间 5～ 7d ,BUT(7.9± 0 .5 )d ,角膜缘有 3～ 8支新血管生长 ,角膜有不同程度的云翳 ,翼状胬肉复发率 13.33% ,A、B 2组各项指标比较有统计学差异。结论　自体角膜缘干细胞移植治疗角膜缘功能衰竭症是一种简单、安全、有效的手术方法。     

翼状胬肉上结膜反向移植联合羊膜移植治疗复发胬肉

目的：观察胬肉上结膜反向移植联合羊膜移植治疗复发性翼状胬肉的疗效。

方法：回顾性系列病例研究。回顾2009-01/2012-01本院确诊的复发性翼状胬肉26例26眼,均为经历一次手术,手术方法为翼状胬肉切除联合自体角膜缘干细胞移植术,复发1a以上病例。本次研究中,切除胬肉组织时,将其上结膜充分游离后切下保存,羊膜覆盖胬肉切除后裸露巩膜面,再将保留的胬肉上的结膜植片反向覆盖羊膜上缝合。术后1,2wk; 1mo及3mo观察结膜植片愈合情况、羊膜溶解吸收时间、角膜创面修复时间、角膜新生血管及胬肉复发率。术后随访12mo。

结果：结膜植片愈合时间6.03±2.76d,羊膜溶解吸收时间14.26±3.64d,角膜创面修复时间5.42±1.58d。术后3mo,胬肉切除后裸露巩膜面新生结膜及结膜植片愈合良好,无明显胬肉术后并发症。术后1a,再度复发2例,复发率8%,治愈率92%。

结论：对于复发性翼状胬肉,因传统自体角膜缘干细胞移植已经创伤部分角膜缘及眼表结膜瘢痕,单纯结膜移植,或单纯羊膜移植,术后胬肉复发率偏高,本方法取胬肉上结膜反向移植,避免大面积创伤眼表,取材容易,而且良好控制术后翼状胬肉复发问题,不失为一种解决复发性翼状胬肉的良好选择。     

康宁克通A与丝裂霉素在单纯翼状胬肉切除术后应用观察

目的:比较单纯翼状胬肉手术与应用康宁克通A与20g/L丝裂霉素于单纯翼状胬肉切除术后的疗效观察。方法:将72例80眼随机分两组,每组均为36例。A组,单纯翼状胬肉手术;B组,单纯翼状胬肉手术中注射康宁克通A与20g/L丝裂霉素(1:1)约0.2mL于泪阜处球结膜下。观察术后角膜上皮修复,角膜缘新生血管及翼状胬复发情况。结果:术后随诊6～36mo,A组中有14眼复发,B组有1眼复发。结论:单纯翼状胬肉手术较应用康宁克通A与20g/L丝裂霉素于单纯翼状胬肉手术有明显的对比,后者的复发率明显低于前者。有效阻止胬肉的复发,方法简要,并发症少,值得临床推广。     

酒精浸泡剥离法在翼状胬肉手术中的疗效观察

目的：观察酒精浸泡剥离法在翼状胬肉手术中的疗效和临床意义。

方法：原发翼状胬肉48眼,局部麻醉下将一个环形金属圈置于胬肉头部,其中填充200mL/L酒精,40～60s后,用生理盐水充分冲洗。自胬肉头部缘开始用特制上皮刮匙剥离并清除变性组织,用带角膜缘的自体结膜瓣进行移植。

结果：术后48眼,随访1wk～1a,手术效果良好,角膜创面光滑,组织结构完整、瘢痕少且散光明显减小。

结论：酒精浸泡剥离法治疗翼状胬肉是一种安全、有效的方法。     

原发性翼状胬肉两种治疗方法的疗效观察

目的:探讨原发性翼状胬肉两种治疗方法的疗效观察。方法:A组25例采用翼状胬肉切除联合丝裂霉素术治疗,B组10例采用自体球结膜+角膜缘干细胞移植术治疗。根据角膜创面恢复、结膜伤口愈合、胬肉有无复发进行观察。结果:A组患者术后角膜上皮第3～7d恢复,结膜充血10～15d消退,3例复发;B组患者术后角膜上皮第2d恢复,结膜充血7～10d消退,1例复发。结论:翼状胬肉切除术联合丝裂霉素和自体球结膜+角膜缘干细胞移植术都能降低胬肉复发率,二者相比较,自体球结膜+角膜缘干细胞移植术优于翼状胬肉切除联合丝裂霉素。     

Flow cytometry measurements of DNA content in primary and recurrent pterygia

PURPOSE: To evaluate DNA content and cellular proliferation rates in primary and recurrent pterygia. METHODS: Matched pterygium and superior conjunctiva tissue were obtained in 36 eyes of 36 patients undergoing pterygium excision with conjunctival autografting (24 primary pterygia, 12 recurrent pterygia). Epithelial and fibrovascular layers were separated for analysis. Matched superior conjunctiva obtained at the time of surgery were used as controls. Samples were prepared according to Thompson's method, and flow cytometry was performed with a Becton-Dickinson FACScan. Analysis of histograms and calculations of cell percentages in cell cycle phases were carried out using CellFit software (version 2.0). Mean proliferation indices (MPIs) were compared using the Wilcoxon matched-pair signed-rank test. RESULTS: The MPI of pterygium fibrovascular tissue (13.4) was significantly higher than the MPI of pterygium epithelium (3.1; P = 0.0001). The MPI of pterygium fibrovascular tissue was also significantly higher than that of superior conjunctival fibrovascular tissue (6.0; P = 0.0001). There was no difference in MPI values between pterygium epithelium and superior conjunctival epithelium (3.55; P = 0.12). The MPI of fibrovascular tissue from recurrent pterygium (73.75) was significantly higher than the MPI of fibrovascular tissue from primary pterygium (7.3; P = 0.003). CONCLUSIONS: The finding of high levels of cellular proliferation in the subepithelial fibrovascular layer of pterygium confirms that pterygium is a disorder of excessive cellular proliferation and that the fibrovascular layer is the site of cellular proliferation. Markedly raised levels of cellular proliferation in recurrent pterygium tissue suggest a clinical correlation between fibrovascular tissue upregulation and pterygium recurrence after surgery.     

The relation between expression of basic fibroblast growth factor and mast cells in pterygium

OBJECTIVE: To examine the expression and distribution of basic fibroblast growth factor (bFGF) and mast cells in pterygium, and evaluate its effects in the pterygium formation and progression. METHOD: The expression of bFGF and mast cell tryptase in 17 primary pterygia, 6 recurrent pterygia and 6 normal conjunctival specimens were studied. The mast cell count and bFGF expression situation were observed. RESULTS: The bFGF was specifically localized in the epithelium, blood vessels and a subset of connective tissue cells. The bFGF expression was increased in the recurrent pterygium. The numbers of infiltrating mast cells (five 400 x sights) were (45.47 +/- 5.50) cells and (48.83 +/- 3.19) cells in the primary and recurrent pterygium respectively. In the comparisons between the cells in the pterygium (primary and recurrent) and (4.24 +/- 2.36) cells in the normal connective tissue, there were significant differences (F = 200.3128; q = 26.6762, 23.7341; P < 0.05). The shape and distribution of all the tryptase-positive cells (mast cells) in the pterygium tissues were similar to that of the cells with bFGF expression in the connective tissue. And the majority of bFGF-positive cells (87.54 +/- 3.60)% were similar to that of mast cells in the connective tissue. CONCLUSIONS: All infiltrating mast cells in pterygium have bFGF-positive expression. The bFGF expression is increased in the epithelium, blood vessels and infiltrating mast cells of the pterygium, and may contribute to the formation and progression of a pterygium.     

Preventing conjunctival autograft inversion in pterygium surgery

BACKGROUND: Surgeon-dependent variables influencing pterygium surgical outcome using the conjunctival autograft technique include conjunctival retraction as a consequence of subepithelial contracting fibrous tissue, and autograft inversion causing necrosis and sloughing of the graft. METHOD: A simple and useful technique of pterygium excision is described, which helps to ensure the correct surface and linear orientations of the conjunctival autograft, and also defines the end point of adequate excision of the subepithelial connective tissue. CONCLUSION: This simple technique of defining the anterior surface and the centrifugal orientation with the letter "G" marked on the graft prevents reverse orientation of the graft.     

翼状胬肉手术中行200mL/L酒精预处理的临床疗效观察

目的:观察酒精预处理在翼状胬肉手术中的疗效和临床意义。方法:翼状胬肉300眼,随机分为两组;对照组:142眼,局部麻醉后自胬肉头部外0.5mm开始剥离并清除变性组织,再行角膜缘干细胞移植术。试验组:158眼,局部麻醉后将一个LASEK术中用来盛酒精的金属环置于胬肉头部以隔离治疗区,将数滴200mL/L酒精滴入环内,保留40~60s,然后用大量的生理盐水冲去酒精。其后手术过程同对照组。结果:随访1mo~3a。试验组术后角膜创面光滑,组织结构完整,视觉质量提高。试验组术后角膜上皮愈合快,泪膜破裂时间延长,角膜散光平均值和总高阶像差明显降低,与对照组比较,差异有统计学意义。试验组复发率明显低于对照组,差异有统计学意义。两组并发症发生率无明显差异。结论:酒精预处理法在翼状胬肉手术治疗中是一种安全、有效的方法。     

翼状胬肉组织中ATP结合盒转运蛋白B5的表达变化及意义

背景 角膜缘干细胞(LSCs)缺乏可引起多种眼表疾病,如翼状胬肉等.ATP结合盒转运蛋白B5(ABCB5)是新发现的特异性LSCs标志物,研究ABCB5在翼状胬肉组织中的表达变化对于翼状胬肉的防治具有重要的临床意义. 目的 研究ABCB5在翼状胬肉组织中的表达变化,探讨其在翼状胬肉发生和发展中的作用.方法 收集2015年1-11月在解放军474医院行原发性翼状胬肉切除术的手术标本37例,同期收集年龄匹配的行斜视矫正术和视网膜脱离复位术患者的正常结膜组织22例.采用免疫组织化学法检测ABCB5在翼状胬肉组织标本中的表达和定位,分别采用Western blot和实时荧光定量PCR法检测翼状胬肉标本中ABCB5蛋白及其mRNA的相对表达量,并与正常结膜标本进行比较. 结果 ABCB5蛋白表达于所有22例正常结膜复层扁平细胞的细胞质和细胞核中,以基底层细胞中表达更为明显,呈现明显极性.在37例翼状胬肉标本中,可见ABCB5阳性表达者34例,占91.89％,ABCB5表达阴性者3例,占8.11％.正常结膜组和翼状胬肉组ABCB5蛋白相对表达量分别为0.90±0.31和0.59±0.41,ABCB5 mRNA表达量分别为1.01±0.26和0.65±0.32,翼状胬肉组ABCB5蛋白和mRNA的相对表达量均明显低于正常结膜组,差异均有统计学意义(t=-0.266,P=0.011;t=-4.560,P=0.000). 结论 LSCs标志物ABCB5的表达下调提示LSCs的减少和缺失与翼状胬肉的发生和发展有关,提示ABCB5检测可能作为翼状胬肉发生和发展、术后复发及疗效评估的观察指标之一,也可能成为翼状胬肉的治疗靶点.     

Expression of vascular endothelial growth factor and inducible nitric oxide synthase in pterygia

PURPOSE: To evaluate the expression of vascular endothelial growth factor (VEGF) in pterygium and investigate the interrelationships between VEGF and nitric oxide (NO) in the development of pterygia. METHODS: Specimens of normal conjunctiva acquired incidentally to conjunctival transplantation during pterygium and strabismus surgery and the excised pterygium were used in this study. Cryopreserved tissue specimens consisting of normal conjunctiva and pterygium were used to study the expression of VEGF and inducible NO synthetase (iNOS), using immunohistochemistry. For confirmation of NOS activity, reduced nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase staining was done. Enzyme-linked immunosorbent assay (ELISA) for detection and quantification of VEGF was performed. RESULTS: Expression of VEGF and iNOS was strongly revealed mainly in the epithelium of the head portions of pterygial specimens, although not in the epithelium of conjunctival ones. Pterygial epithelium was stained with NADPH diaphorase, confirming NOS activity. ELISA showed a greater amount of VEGF in pterygium (11.7 +/- 2.1 pg/mg) compared with normal conjunctiva (4 +/- 0.47 pg/mg) ( p < 0.05). CONCLUSION: These data are the first to demonstrate that VEGF and NO may play an important role in the development of pterygium and to identify VEGF and NO in the epithelium of pterygium. We hypothesize that environmental stress, such as ultraviolet irradiation and local inflammation stimulate the elaboration of NO and VEGF, resulting in the conjunctival fibrovascular ingrowth characteristic of pterygium.     

绷带式角膜接触镜在翼状胬肉切除合并结膜移植术的应用

目的:探讨绷带式角膜接触镜应用于翼状胬肉切除合并结膜移植术的临床效果。方法:回顾性分析2012-06/2013-06行翼状胬肉切除合并结膜移植术101例114眼的临床资料,按术后处理方式分为A、B、C三组,A组30例38眼,配戴绷带式角膜接触镜,B组33例38眼,绷带加压包扎,C组38例38眼,遮盖普通眼垫,术后第1,3,5d观察。结果:选取114眼术后随诊均未发生角膜溃疡、肉芽肿、复发等并发症。三组间比较在各种眼部刺激症状程度方面A组比其他两组轻;术后角膜上皮修复时间上比较A、B组短于C组。结论:绷带式角膜接触镜能明显减轻翼状胬肉切除合并结膜移植术后患者各种眼部刺激症状,促进缺损区角膜上皮修复,与传统处理方式比较能明显提高患者术后的舒适度,易于推广,风险小,具有广泛的临床实用价值。     

Randomised controlled study of conjunctival autograft versus amniotic membrane graft in pterygium excision

AIM: To determine whether amniotic membrane can be used as an alternative to conjunctival autograft after pterygium excision. METHODS: 287 eyes with either primary or recurrent pterygium were included in this study. All eyes were randomised to undergo conjunctival autograft or amniotic membrane transplantation after pterygium excision by a single surgeon. 106 eyes in primary pterygium and 14 eyes in the recurrent group were treated with conjunctival autograft, and 148 eyes in primary pterygium and 19 eyes in the recurrent group were treated with amniotic membrane transplantation. Patients were followed up at 6 weeks and 6 months after operation. The main outcome measurement was recurrence rate after surgery. RESULTS: In the conjunctival group, the recurrence rate was 12.3%, 21.4% and 13.1% for primary, recurrent and all pterygia, respectively. In the amniotic membrane group, the recurrence rate was 25.0%, 52.6% and 28.1% for primary, recurrent and all pterygia, respectively. The recurrence rate for all pterygia in the amniotic membrane group was significantly higher than that in the conjunctival group (p = 0.003). CONCLUSIONS: Amniotic membrane graft had a higher recurrence rate than conjunctival autograft. However, it is an alternative choice, especially for advanced cases with bilateral heads or patients who might need glaucoma surgery later.