纤维蛋白胶在翼状胬肉切除联合自体角膜缘干细胞移植术中的应用研究

目的探讨纤维蛋白胶固定球结膜移植片的效果和安全性。方法采用前瞻性随机对照的方法。对40例原发忡鼻侧翼状胬肉行翼状胬肉切除联合自体角膜缘干细胞移植术,术中分别采用纤维蛋白胶（20例,20眼）和10-0尼龙缝线（20例,20眼）同定球结膜移植片,术后随访6个月。．结果两组手术移植的球结膜瓣均成功固定于巩膜表面,并全部成活。纤维蛋门胶组患者平均手术时间（20．5±3．6）rain,104）尼龙缝线组平均手术时问（42．8±4．5）min（P〈0．01）。术后纤维蛋白胶组患者疼痛、异物感、畏光、流泪症状比缝线组轻并消失较快（P〈0．01）。随访期间两组均无复发。结论翼状胬肉切除后使用纤维蛋白胶牯贴同定自体球结膜瓣是一种安全、有效的方法。     

翼状胬肉细胞之间的相互作用

目的探讨翼状胬肉中血管内皮细胞和成纤维细胞之间的相互作用。方法收集翼状胬肉标本,采用血管内皮细胞和成纤维细胞单独培养、条件培养和共同培养的方法构建培养体系,采用ELISA和RT—PCR法检测3种体系培养上清液和细胞中血管内皮细胞生长因子（VEGF）、碱性成纤维细胞生长因子（bFGF）蛋白及mRNA含量的变化。结果单独培养、条件培养和共同培养各组培养上清液中VEGF和bFGF的质量浓度增加,差异均有统计学意义（P〈0．05）;细胞单独培养、条件培养和共同培养三者相比,VEGF和bFGF的mRNA表达升高,差异均有统计学意义（P〈0．05）。结论内皮细胞和成纤维细胞有相互上调作用,2种细胞在翼状胬肉的发生发展过程中相互促进。     

改良纤维蛋白粘合剂在眼表翼状胬肉手术中的应用

目的:观察表皮生长因子(epidermal growth factor,EGF)与纤维蛋白封闭剂复合物代替常规的缝线,在眼表胬肉手术中的使用情况。方法:对60例78眼翼状胬肉患者,根据胬肉生长侵犯角膜缘的范围分成两组,A组为侵犯范围<1/2者,共28例34眼,B组为侵犯范围≥1/2者,共32例44眼,随机将以上两组每组分成两小组,即A1,A2,B1,B2组。A1,B1组使用常规缝线10-0可吸收尼龙线缝合,A2,B2组为采用表皮生长因子的改良生物粘合剂纤维蛋白粘合剂粘贴法,A组手术采用胬肉切除联合结膜瓣移植术,B组手术采用单纯切除胬肉。术后对四组的手术时间、疼痛感觉、复发率、眼表上皮愈合时间、并发症等指标进行比较分析。结果:手术时间:A1组与A2组以及B1与B2组间比较具有显著差异性(P<0.05)。疼痛评估:采用改良生物粘合剂粘贴法组患者较常规缝线组疼痛减少有显著差异性(P<0.05);术后4,6d观察角膜上皮愈合情况,粘贴法组患者较常规缝线组上皮愈合面积大,有显著差异性(P<0.05);术后6mo复发率比较采用改良生物粘合剂粘贴法组患者较常规缝线组复发率减少,但统计学无显著差异性(P>0.05)。结论:在翼状胬肉手术中,采用改良纤维蛋白封闭剂复合物代替常规的缝线,可减轻患者疼痛,减轻炎症反应,缩短手术时间,避免手术后缝线松解拆线的麻烦,提高手术质量,加快术后角膜上皮愈合,降低复发率。     

纤维蛋白胶运用于翼状胬肉手术的临床观察

目的:观察纤维蛋白胶运用于翼状胬肉切除联合自体结膜移植术的临床效果。方法:选取60例60眼原发性鼻侧翼状胬肉患者随机分为试验组(纤维蛋白胶组)和对照组(缝线组)各30例30眼。行翼状胬肉切除联合自体结膜移植术,试验组采用纤维蛋白胶粘合固定植片,对照组采用10-0尼龙线缝合固定植片。术后随访6mo,观察手术时间、术后疼痛、异物感、并发症以及复发。结果:试验组手术时间(24.5±6.5min)较对照组(35.2±5.4min)短,两组差异有统计学意义(P<0.05)。术后患者疼痛和异物感试验组较对照组减轻(P<0.05)。两组均未发生术后严重并发症,试验组结膜下出血发生率低于控制组(P<0.05),6mo时纤维蛋白胶组1例(3%)复发,缝线组3例(10%)复发。结论:纤维蛋白胶运用于翼状胬肉手术固定结膜植片能减轻患者术后不适,减少手术时间及术后并发症,是一种安全有效的方法。     

人纤维蛋白胶在翼状胬肉切除联合新鲜羊膜移植术中的应用

目的：观察翼状胬切除联合新鲜羊膜移植术中应用人纤维蛋白胶的临床效果。

方法：采用前瞻性对照病例研究,观察2018-03/10在我院接受翼状胬肉切除联合新鲜羊膜移植术的原发性翼状胬肉患者153例153眼(双眼患者只选择胬肉较大眼手术)。将患者随机分为试验组和对照组,试验组(人纤维蛋白胶组)78例78眼,对照组(缝线组)75例75眼。在切除胬肉组织后,试验组用人纤维蛋白胶固定羊膜植片,对照组用10-0尼龙缝线间断缝合固定羊膜植片,10d后拆线。记录患者具体手术时间,比较各组患者术后2h,1、3、5及10d(拆线前)的疼痛情况,并观察术后1a时复发率情况。

结果：试验组手术时间(14.5±3.6min)短于对照组手术时间(18.3±4.2min)(P<0.05); 两组患者术后2h,1、3、5及10d(拆线前)疼痛水平评分组间、时间、时间及组间有差异(F=39.939、419.026、28.410,均P<0.01)。各时间点试验组患者疼痛水平评分均低于对照组(P<0.05); 各组内不同时间点的疼痛评分差异显著(P<0.01)。术后1a时两组患者复发率相近(P>0.05)。

结论：在翼状胬肉切除联合新鲜羊膜移植术中使用人纤维蛋白胶,可以缩短手术时间,减轻术后疼痛,但不能明显降低胬肉术后的复发率。     

纤维蛋白胶与无缝无胶自体球结膜瓣固定术治疗翼状胬肉的疗效比较

目的：比较两种大小纤维蛋白胶与无缝无胶自体球结膜瓣固定术在原发性翼状胬肉手术中的患者舒适度、移植物稳定性、移植物炎症、复发等术后并发症。

方法：本研究对2014-12/2016-08共80例翼状胬肉患者(80眼)进行前瞻性介入对比研究。研究组随机抽取并分为两组,组1接受纤维蛋白胶疗法,组2采用无缝合无胶结膜自体移植固定术。每组再将等量的受试者随机平均分为两组(组1：组A+组B,组2：组C+组D)。组A(自体移植物的大小与裸眼巩膜相同)和组B(比裸巩膜大1 mm)实施纤维蛋白胶疗法; 组C(自体移植物的大小与裸眼巩膜相同)和组D(比裸巩膜大1 mm)采用无缝线无胶结膜自体移植固定术。每一位患者都接受翼状胬肉切除术,并根据组别使用不同大小的自体球结膜瓣。

结果：组1平均年龄为43.525,组2平均年龄为42.2。男性20例,女性60例。37例患者右眼有翼状胬肉。四组间平均手术时长相似。在术后随访期间,除结膜下出血(纤维蛋白胶组在术后1wk内明显增多)外, 4组间患者的舒适度、移植物回缩、移植物炎症和移植物水肿等术后参数均相似(P<0.0001)。组2仅3例患者出现4级移植物回缩/移位。术后1wk,组A和组D各出现1例移植囊肿患者。随访6mo后,组D中2例患者复发。

结论：两种方法均安全有效,术后不适及并发症少。与纤维蛋白胶疗法相比,无缝无胶疗法更加经济且效果相当。由于该手术成本低,且具有纤维蛋白胶疗法的所有优点,无缝无胶法可被认为是治疗患者非常有效的方法。     

纤维蛋白胶在翼状胬肉手术中应用的研究进展

翼状胬肉是一种最常见的眼表疾病之一,覆盖角膜进而影响视力和美观。临床治疗以胬肉切除联合自体结膜移植手术为主,术中结膜缝合既费时又容易引起眼部刺激、眼红等并发症。为了预防这些并发症,学者们尝试使用纤维蛋白胶替代缝线显示了独特优势。本文就纤维蛋白胶在翼状胬肉手术中应用的优缺点和研究进展做一综述,为临床应用提供依据。     

纤维蛋白胶联合绷带型角膜接触镜在复发性翼状胬肉手术中应用

目的探讨纤维蛋白胶联合绷带型角膜接触镜应用于复发性翼状胬肉手术的临床效果。方法对2013～2015年期间我院复发性翼状胬肉60例（63只眼）行翼状胬肉切除联合带自体角膜缘干细胞的结膜移植术,随机分为试验组（ A）应用纤维蛋白胶联合绷带型角膜接触镜、对照组（ B）应用缝线法联合绷带型角膜接触镜,观察手术时间、术后眼部症状、愈合、复发率、不良反应,评价其临床疗效。结果2组间比较手术时间、术后眼部症状、愈合、复发率及不良反应A组均优于B组。结论对于复发性翼状胬肉,应用纤维蛋白胶联合绷带型角膜接触镜手术时间、术后症状、愈合、复发率、不良反应更优,具有广泛的临床实用价值。     

纤维蛋白胶和缝线固定两种方法在翼状胬肉手术中的比较

目的:在翼状胬肉切除联合自体角膜缘移植手术中,比较运用纤维蛋白胶和缝线固定两种方法的手术安全性和有效性。方法:采用前瞻性的研究。随机选取58例因鼻侧初发性翼状胬肉而进行手术的58只患眼。翼状胬肉切除后取位于颞上侧角膜缘处的自体结膜移植片以覆盖巩膜创口。58例眼分为两组,每组29例。翼状胬肉切除后,组1用纤维蛋白胶(Beriplast P)固定结膜,而组2采用8-0缝线固定结膜。术后观察患者≥6mo,对术后患者的不适感(疼痛、刺痛感、流泪)和显微镜下的检查(充血、水肿)进行评分,采用Mann-Whitney U法对两组间的差异进行统计学分析。结果:组1中有1例患者出现球结膜下出血,组2中有7例由于肉芽肿反应,于术后15d移除缝线。组1中患者的不适症状和显微镜下所见显著性优于组2。组1中有1例患者术后胬肉复发,组2中有2例复发。组1与组2比较,平均手术费用较高但手术时间明显缩短,且差异具有统计学意义(P<0.05)。结论:翼状胬肉切除后,运用纤维蛋白胶固定植片能显著地减少患者术后的疼痛,并有效地缩短手术时间。     

翼状胬肉切除联合自体球结膜移植术中使用纤维蛋白胶和缝线有效性的随机对照试验的Meta分析

背景目前国外已将医用纤维蛋白胶用于翼状胬肉切除联合自体球结膜移植术植片的固定,其临床效果和安全性评价的临床随机对照试验（RCT）和回顾性研究已有报道,但单个研究的样本量较少。目的采用荟萃分析的方法对翼状胬肉切除联合自体球结膜移植术中使用纤维蛋白胶和缝线的有效性和安全性进行评价,为临床提供高等级的研究证据。方法按照拟定的检索策略,计算机检索MEDLINE（2000年1月至2010年10月）、Embase（2000年1月至2010年10月）、Cochrane协作网“CENTRAL”数据库（2010年4期）、中国生物医学文献数据库（2000年1月至2010年10月）、中国期刊全文数据库（2000年1月至2010年10月）,并采用手工检索等方法收集会议文献及检索检出文献的参考文献,最大限度地收集与翼状胬肉切除联合自体球结膜移植术中使用纤维蛋白胶和缝线相关的临床RCT文献,采用Jadad量表评分对纳入的文献进行质量评价,采用RevMan5．0软件进行异质性检验和合并效应量的统计学分析,用Meta分析对纤维蛋白胶和缝线用于翼状胬肉切除联合自体球结膜移植术植片固定的有效性进行评价,其评价指标为手术时间、复发率、术后并发症。结果按照纳入标准和排除标准共纳入与翼状胬肉切除联合自体球结膜移植术中使用纤维蛋白胶和缝线相关的RCT文献6篇,发表于2004--2010年,研究文献来自中国、新西兰、瑞典、以色列、土耳其、马来西亚等国家,发表文种均为英文。纳入文献的Jadad评分为4～5分,总样本量377例401眼。Meta分析结果表明,与缝线固定法相比,纤维蛋白胶用于翼状胬肉切除联合自体球结膜移植术植片的固定可缩短手术时间[MD=14．23,95％CI（-16．18～-12．29）,P=0．00]并降低复发率[RR=0．49,95％CI（0．26～0．95）,P=0．03]。在植片裂开或丢失率方面,两种固定方法的差异无统计学意义[RR=3．41,95％CI（0．85～13．68）,P=0．08]。结论在翼状胬肉切除联合自体球结膜移植术中,使用纤维蛋白胶黏合植片代替缝线缝合植片疗效好,操作简单。由于本系统评价纳入研究病例数较少,上述结论有待更多设计严谨的大样本RCT加以验证。     

纤维蛋白黏合胶预防去势雄兔干眼症的实验研究

目的 研究纤维蛋白黏合胶黏合泪道对雄兔去势所致干眼症的缓解作用.方法 选择新西兰白兔36只(36眼,均为右眼),剪除第三眼睑后,3g·L-1氧氟沙星滴眼液滴眼1周,随后继续适应性喂养1周,取24只雄兔制作去势雄兔干眼症模型,随机分为A、B两组(各12眼):对照组(A组)泪道注射生理盐水,实验组(B组)泪道内注射纤维蛋白黏合胶.剩余12只(12眼,C组)雄兔切开阴囊,不切除睾丸,眼部不予处理,作为假手术组.分别于注射前和注射后2周、4周及8周行Schirmer Ⅰ试验(Schirmer Ⅰ test,SⅠT)、角膜荧光素(fluorescein,FL)染色、泪液蛋白测定,并于注射后2周、4周对B组泪道黏膜进行K16免疫荧光染色及Western Blot检查.结果 C组注射前及注射后各时间段各项检测差异均无统计学意义(均为P＞0.05).注射后2周、4周及8周,A、B两组SⅠT、FL染色评分、泪液总蛋白含量、乳铁蛋白、溶菌酶及淀粉酶活性较注射前均有不同程度下降,其差异均有统计学意义(均为P＜0.05),但注射后2周及4周B组S ⅠT、FL染色评分下降程度较轻,与A组下降程度相比差异均有统计学意义(均为P＜0.05).而B组泪液总蛋白量、乳铁蛋白、溶菌酶及淀粉酶活性则在注射后4周出现下降减缓,与A组相比差异均有统计学意义(均为P ＜0.05).免疫荧光染色和Western Blot结果显示B组下睑泪道黏膜K16阴性表达.结论 使用纤维蛋白黏合胶黏合泪道可较快而明显地改善干眼的症状和维持泪液蛋白成分,从而延缓去势雄兔干眼症的进展.     

翼状胬肉切除联合结膜自体移植术中纤维蛋白胶应用的Meta分析

目的 探讨纤维蛋白胶(FG)在翼状胬肉切除联合结膜自体移植术中的临床疗效.方法 应用循证医学的研究方法检索美国国立医学图书馆、荷兰医学文摘、循证医学数据库、中国知网、万方数据库、中国期刊全文数据库及维普中文科技期刊数据库并辅以手工检索,遵循Cochrane Handbook 5.0质量评价原则评价纳入研究的质量,采用RevMan5.0软件进行统计学处理.结果 纳入7项随机对照实验,共366只眼.Meta分析结果显示:与缝线组相比,FG组在术后复发方面,差异有统计学意义[RR=0.28,95%CI(0.10,0.76),P=0.01];在术后并发症方面,两组比较差异无统计学意义[RR=2.53,95%CI(0.47,13.51),P=0.28].结论在翼状胬肉切除联合结膜自体移植术中,应用FG封闭伤口可降低术后复发.(中华眼科杂志,2011,47:550-554)

Abstract：

Objective To evaluate the clinical efficacy of FG for attaching conjunctival autografts in pterygium surgery. Methods Search was conducted in Pubmed, Embase, Cochrane Library, CNKI, Wanfang database, CBM and VIP,and hand-search was also performed, the methodological quality were carried out according to evidence-based medicine (EBM). The qualities of the randomized controlled trials(RCT) were evaluated according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0. The Cochrane Collaboration's software RevMan 5.0 was used for Meta-analysis. Results Only 7 trials, involving 366 eyes, were included. Meta-analysis showed that significant differences were found between the FG and suture in recurrence [RR=0.34, 95%CI(0.15,0.80), P=0.01], but there is no difference in reducing the complications [RR=2.53,95%CI(0.47,13.51),P=0.28]. ConclusionFibrin glue-assisted conjunctival autograft in pterygium surgery reduces postoperative recurrence.     

Comparison of fibrin glue with sutures for pterygium excision surgery with conjunctival autografts

Purpose:  To compare pterygium excision conjunctival autograft surgery using Tisseel fibrin glue versus Vicryl sutures.
Method:  Prospective randomized clinical trial. Fifty patients were randomized into either sutured graft or glued graft groups. Twenty-five received standard conjunctival autograft sutured with Vicryl and 25 received surgery with the autograft placed with Tisseel fibrin glue. Outcome measures include surgical time, patient discomfort, pathology, complications and recurrence rates at 3, 6 and 12 months. Patients were followed up at days 1, 7, 14, 30, 90, 180 and 365.
Results:  The mean surgical time for the glue group was significantly shorter at 12 min compared with the suture group at 26 min ( P  < 0.001). Postoperative pain was significantly less at day 1 ( P  < 0.001) and day 2 ( P  < 0.05) but was not significantly different following these visits. Complications in the glue group included one patient with an absent graft at week 1 that required revision of the graft. At 3 months there were no recurrences in the glue group and two recurrences in the suture group. The 6- and 12-month recurrence rate was unchanged and not significantly different between the glue and suture groups (both 0/24 and 2/23, respectively).
Conclusion:  Both glued and sutured conjunctival autografting procedures are safe and effective methods for pterygium surgery. The glued autograft recurrence rate at 12 months was similar to that of sutured grafts. Conjunctival autograft with fibrin glue in pterygium surgery decreased surgical time and resulted in less postoperative pain in the first 48 hours but had a higher complication rate.     

Sandwich fibrin glue technique for attachment of conjunctival autograft during pterygium surgery

Objective

To report the results of a sandwich application of fibrin glue compared with the standard method of using fibrin glue for the attachment of the conjunctival autograft in pterygium surgery.

Participants

The study group consisted of 56 consecutive eyes with primary pterygium.

Methods

We performed a retrospective analysis comparing the standard method of using fibrin glue for the attachment of the conjunctival autograft during pterygium excision surgery versus the “sandwich technique.” In the “sandwich technique,” the thrombin component of the fibrin glue was applied after the graft was secured in position over a bed of fibrinogen.

Results

Graft dehiscence occurred in 3 eyes in the conventional group only. Recurrence occurred in 2 eyes in the conventional group and 1 eye in the sandwich group. None of the values reached statistical significance.

Conclusions

The sandwich technique simplifies conjunctival graft fixation during pterygium surgery with conjunctival autograft by allowing more time to properly position the autograft before fibrin clot formation.     

Comparison of fibrin glue and sutures for conjunctival wound closure in strabismus surgery

Purpose

To evaluate and compare the efficacy and tolerance of fibrin glue and sutures for closing conjunctival wounds in strabismus surgery.

Methods

In a prospective trial, we performed strabismus surgery using limbal incisions. Conjunctival wounds were closed with fibrin glue in 20 eyes of 20 patients (fibrin group) and 8-0 polyglactin suture in 20 eyes of 20 patients (suture group). Postoperative pain, tearing, and inflammation were compared at 1 day, 1 week, 3 weeks, and 6 weeks after surgery. Conjunctival incision healing was also investigated.

Results

One day and one week post-operatively, pain and tearing scores were lower in the fibrin group (p = 0.000, respectively). Mean surgery time was significantly shorter in the fibrin (48 ± 5 minutes) than the suture group (63 ± 7 minutes) (p = 0.000). Inflammation was significantly more severe in the suture group until 3 weeks postoperative (p = 0.000, respectively), but conjunctival healing did not differ between the groups. Hyperemia appeared more prominent in the fibrin group 3 and 6 weeks after surgery (p = 0.087 and 0.000, respectively). Two eyes in the fibrin group showed conjunctival gaps of more than 2 mm, which closed spontaneously by three weeks after surgery. No allergic reactions or infections developed.

Conclusions

Fibrin glue proved to be as effective as sutures in closing conjunctival wounds. It provides more comfortable early postoperative courses and might be considered as an alternative to sutures in strabismus surgery.     

Comparison of fibrin glue and suture technique in pterygium surgery performed with limbal autograft

AIM: To compare the efficiency and safety of fibrin glue to suture technique in pterygium surgery performed with limbal autograft. METHODS: A prospective randomised clinical trial was carried out in 58 eyes of 58 patients operated for primary nasal pterygium. Autologous conjunctival graft taken from the superotemporal limbus was used to cover the sclera after pterygium excision. In 29 eyes, the transplant was attached to the sclera with a fibrin tissue adhesive (Beriplast P) and in 29 eyes with 8-0 Virgin silk sutures. The Mann-Whitney U test was used for statistical analysis. Postoperative patient discomfort (pain, stinging, watering) and biomicroscopic findings (hyperemia, edema) were graded. Patients were followed up at least for six months. RESULTS: Subconjunctival hemorrhage occured under the graft in one patient in group 1. In seven cases of group 2, sutures were removed at the 15th day because of granulomatous tissue reaction. Patient symptoms were significantly less and biomicroscopic findings were better in group 1. Pterygium recurrence was seen in one case of group 1, and 2 cases of group 2. Average surgery cost was higher (P<0.05) and surgery time was shorter (P<0.05) in fibrin group. CONCLUSION: Using fibrin glue for graft fixation in pterygium surgery causes significantly less postoperative pain and shortens surgery time significantly.     

纤维蛋白胶在翼状胬肉切除联合自体角膜缘干细胞移植术中的临床效果

目的:探讨应用纤维蛋白胶在胬肉切除联合自体角膜缘干细胞移植术中的效果。方法:对48例60眼行胬肉切除联合自体角膜缘干细胞移植手术治疗的初发性翼状胬肉患者,随机分为试验组(纤维蛋白胶组)22例30眼和对照组(缝线组)26例30眼。实验组及对照组给予常规20g/L利多卡因浸润麻醉后进行胬肉切除联合自体角膜缘干细胞移植术;试验组采用黏合剂将植片与植床进行粘贴(黏合剂为凝血酶溶液及含有因子Ⅷ和抑肽酶的纤维蛋白溶液),对照组采用10-0缝线缝合植片与植床。术后随访6mo,主要观察手术时间,植床与植片的匹配程度及术中与术后患者的疼痛评分。结果:试验组手术时间相对较短,差异有统计学意义(P<0.01),试验组植床与植片匹配度与对照组无明显差异(P<0.05),术后1wk内患者生活质量试验组优于对照组。结论:纤维蛋白胶黏合剂完全能满足胬肉切除联合自体角膜缘干细胞移植术的要求,且能清晰地切除病变组织并使植床与植片很好匹配,缩短了手术时间,减少了患者的痛苦。