Amniotic membrane transplantation with conjunctival autograft for recurrent pterygium

OBJECTIVE: To study the effect of amniotic membrane transplantation (AMT) combined with either limbal autograft transplantation (LAT) or conjunctival autograft transplantation (CAT) in recurrent pterygium. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Twenty-seven eyes of 27 patients with recurrent pterygium. The mean number of prior surgeries was 3.1 (range, 1-10). Fifteen eyes each had restriction of ocular movement and symblepharon before surgery. INTERVENTION: Patients were treated by AMT with either LAT (n = 15) or CAT (n = 12). MAIN OUTCOME MEASURES: Recurrence of pterygium, improvement in ocular movement, and symblepharon formation. RESULTS: Twenty-three (85.2%) of 27 eyes showed no recurrence with a mean observation period of 67.0 weeks. Fourteen eyes (93.3%) each showed improvement in ocular movement restriction and symblepharon after AMT. In four eyes that developed recurrence, three had LAT and one had CAT combined with AMT, suggesting that there was no difference in surgical outcome between LAT and CAT. CONCLUSIONS: AMT with CAT is a safe and effective method for recurrent pterygium, especially that associated with ocular movement restriction and symblepharon. Considering the potential adverse effects associated with limbal excision, AMT plus CAT may be preferred over AMT plus LAT.     

Transplantation of conjunctival limbal autograft and amniotic membrane vs mitomycin C and amniotic membrane in treatment of recurrent pterygium

AIM: To compare the efficacy and complications of conjunctival limbal autograft (CLAU) and amniotic membrane transplantation (AMT) vsintraoperative mitomycin C (MMC) and AMT for treatment of recurrent pterygium.METHODS: Forty eyes of 40 patients with recurrent pterygium underwent CLAU and AMT (20 eyes) or intraoperative MMC (0.02%, 3 min) and AMT (20 eyes). Three eyes (15%) had symblepharon before surgery in each group. Recurrence was compared in each group by using chi(2) test.RESULTS: No major postoperative complications occurred during 6-19 months of follow-up. In CLAU/AMT group, no pterygium recurrence was observed. Recurrence occurred in four eyes (20%) in MMC/AMT group after 3 and 4 months (P-value=0.035, chi(2) test). No recurrence of pterygium or symblepharon was seen in six eyes with recurrent pterygium and symblepharon (three eyes in each group).CONCLUSION:CLAU with AMT seems to be more effective than intraoperative MMC with AMT for treatment of recurrent pterygium.     

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.     

丝裂霉素C局部贴敷辅助自体角膜缘结膜移植术治疗翼状胬肉

目的探讨术中局部使用丝裂霉素c贴敷能否进一步提高自体角膜缘结膜移植术治疗原发及复发翼状胬肉的效果。方法将2005年至2009年在天津医科大学总医院眼科门诊确诊为翼状胬肉的114例患者（134眼）按随机数字表法分为A、B2组。A组59例70眼（原发63眼,复发7眼）,采用翼状胬肉切除联合自体角膜缘结膜移植术,并于术中局部使用0．02％丝裂霉素C：B组55例64眼（原发57眼,复发7眼）,采用同样手术方法,但术中不使用丝裂霉素C。比较2组术后角膜上皮生长情况、翼状胬肉复发率、视力及术后并发症。患者平均随访时间（23．3＋8．6）个月（12～65个月）。数据采用独立样本t检验和卡方检验。结果A组病例角膜上皮生长时间平均为（4．0±0．8）d,略长于B组的（3．4±0．6）d（t=3．71,P〈0．05）。2组翼状胬肉复发率均为3％（X2=0．008,19〉0．05）。A组术后视力不变或提高者为74％,B组为65％（X。=1．301,P〉0．05）。术后并发症主要包括角膜上皮延迟愈合,角膜缘结膜植片松脱,角膜缘小凹形成,结膜上皮下囊肿等。A组并发症发生率为6％,B组为5％（X。=0．071,P〉0．05）。结论术中局部应用丝裂霉素C对于自体角膜缘结膜移植术治疗原发及复发翼状胬肉的辅助作用有限．而且可能引起角膜上皮延迟愈合等并发症。     

复发性翼状胬肉33眼手术疗效观察

目的:观察复发性翼状胬肉不同手术方法的术后再复发率及并发症。方法:我院2006-11/2009-02对31例33眼复发性翼状胬肉患者(伴有睑球粘连,眼球运动不同程度受限者12眼)施行翼状胬肉切除、丝裂霉素创面贴敷、自体结膜(带蒂或游离)移植或羊膜移植手术,手术方式:彻底切除净胬肉组织,裸露巩膜创面以0.2g/L丝裂霉素C溶液浸湿的棉片贴敷3min后,用生理盐水冲洗干净。巩膜创面覆盖方法:上或(和)下方结膜转位移植26眼,颞上方结膜游离移植2眼,羊膜移植5眼。结果:随访9mo～3a,胬肉未复发28眼;轻度复发(鼻侧球结膜及结膜下组织充血增厚,但未长入角膜缘或长入角膜缘内≤2mm)5眼,复发率15%,其中结膜转位移植4眼,羊膜移植1眼;睑球粘连轻度复发3眼;术后并发结膜肉芽肿1眼,眼部干痛、有时红卡等不适症状5眼,无1例发生角膜、巩膜溶解。结论:翼状胬肉切除联合自体结膜移植或羊膜移植及丝裂霉素创面贴敷的手术方式能明显降低复发性翼状胬肉的术后再复发率。     

Inferior limbal-conjunctival autograft transplantation for recurrent pterygium

PURPOSE: To study the safety and efficacy of inferior limbal-conjunctival autograft (LCAT) transplantation in the surgical management of recurrent pterygium. METHODS: Prospective non-comparative case series. Inferior limbal-conjunctival autografting was performed on 11 patients (11 eyes) with recurrent pterygium. Pterygium recurrence was considered a surgical failure. RESULTS: Recurrence of pterygium was noted in two (18.2%) eyes, after a mean follow up of 16.2 +/- 0.9 months (range: 10-19 months). Neither recurrence required further surgical treatment. Nonprogressive pseudopterygium formation was noted at the donor site in five (45.5%) eyes. CONCLUSION: Inferior LCAT appears to be a safe and effective option in the management of recurrent pterygium. In patients with suspected or proven glaucoma, this may be the procedure of choice, if mitomycin C is contraindicated.     

生物羊膜联合带自体角膜缘干细胞的结膜瓣移植治疗伴睑球粘连的复发性翼状胬肉

目的:观察生物羊膜联合带自体角膜缘干细胞的结膜瓣移植治疗伴睑球粘连的复发性翼状胬肉的临床效果。方法:将68例76眼伴睑球粘连的复发性翼状胬肉患者按年龄、性别、翼状胬肉大小、睑球粘连程度分为A,B两组,A组30例34眼为翼状胬肉切除加生物羊膜移植组,B组38例42眼为翼状胬肉切除加生物羊膜联合带自体角膜缘干细胞的结膜瓣移植组。术后随访6～24mo。观察角膜透明程度,新生血管的有无,胬肉复发及睑球粘连复发情况。结果:A组有不同程度角膜云翳21眼(62%),其中9眼(26%)伴新生血管,4眼(12%)胬肉复发,1例睑球粘连复发。B组有不同程度角膜云翳9眼(21%),其中3眼(7%)伴新生血管,2眼(5%)胬肉复发,无睑球粘连复发患者。两组比较有角膜云翳及新生血管的发生率有显著性差异,复发率无显著性差异。结论:生物羊膜联合带自体角膜缘干细胞的结膜瓣移植治疗伴睑球粘连的复发性翼状胬肉是一种较理想的治疗方法。     

Combined mitomycin C application and free flap conjunctival autograft in pterygium surgery

PURPOSE: To evaluate the long-term postoperative outcome and complication rate of combined intraoperative low-dose mitomycin C application and free conjunctival autograft for the treatment of pterygium. METHODS: In a prospective, consecutive, noncomparative case series, a series of 46 consecutive patients (50 eyes) with primary pterygium (43 eyes) or recurrent pterygium (7 eyes) were studied. The patients' ages ranged from 23.0 to 80.0 years (mean, 53.4 years). All patients underwent pterygium excision combined with intraoperative low-dose mitomycin C application (0.02% for 2 minutes) and free conjunctival autograft. The mean follow-up period was 29.2 months (range 12 to 41 months). The main outcome measures were recurrence of pterygium and postoperative complications. RESULTS: Pterygium recurred to a small extent (0.5 mm) in one eye (2%) of a patient with recurrent pterygium. There were no intraoperative complications. Subconjunctival graft hematoma appeared soon after surgery and resolved spontaneously in five eyes (10%). One eye developed transient high intraocular pressure without optic nerve or visual field defect, and one eye developed mild symblepharon. There were no sight-threatening complications or serious side effects. CONCLUSIONS: By applying a single low dose of mitomycin C combined with free conjunctival autograft during pterygium excision, the recurrence rate of pterygium can be markedly reduced.     

角膜缘干细胞移植治疗复发性翼状胬肉的疗效观察

目的:观察自体角膜缘干细胞移植治疗复发性翼状胬肉的临床疗效。方法:在显微镜下采用胬肉切除联合自体角膜缘干细胞移植治疗复发性翼状胬肉48例65眼。结果:术后随访6～24mo,59眼痊愈,6眼复发,复发率为9%。结论:翼状胬肉切除联合自体角膜缘干细胞移植操作简单,复发率低,是治疗复发性翼状胬肉较为满意的手术方法。     

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.     

羊膜移植联合带结膜瓣自体角膜缘移植及丝裂霉素C治疗多次复发性翼状胬肉

目的：探讨羊膜移植(AMT)联合带结膜瓣的自体角膜缘移植及术中应用丝裂霉素c(MMc)治疗多次复发性翼状胬肉的疗效。方法：选择多次复发性翼状胬肉20例，进行复发翼状胬肉局部切除，放置丝裂霉素c后取患眼或对侧健眼带结膜瓣的自体角膜缘进行移植，其余缺损部分应用羊膜进行修补。结果：其中19例翼状胬肉未见复发，20例羊膜无排斥反应发生，睑球粘连患者恢复眼球运动功能，复视消失，部分患者视力提高。结论：羊膜移植联合带结膜瓣的自体角膜缘移植及术中应用丝裂霉素c治疗多次复发性翼状胬肉效果良好。     

三种不同术式治疗复发性翼状胬肉的疗效观察

目的:评价羊膜移植、自体角膜缘干细胞移植、羊膜移植联合自体角膜缘干细胞移植3种不同术式治疗复发性翼状胬肉的效果。方法:将127例127眼复发性翼状胬肉患者随机分为A,B,C三组,采用不同手术方式。其中A组45例45眼行羊膜移植术;B组40例40眼行自体角膜缘干细胞移植术;C组42例42眼行羊膜移植联合自体角膜缘干细胞移植术。术后随访12～24mo,分析对比3种不同术式的手术复发率。结果:A组10眼复发,复发率为22.2%;B组9眼复发,复发率为22.5%;C组3眼复发,复发率为7.1%。A组与B组比较差异无统计学意义,C组与A,B组比较有显著性差异(P<0.05)。结论:羊膜移植联合自体角膜缘干细胞移植术治疗复发性翼状胬肉术后复发率最低,是治疗复发性翼状胬肉较为理想的手术方式,值得临床推广应用。     

Limbal versus conjunctival autograft transplantation for advanced and recurrent pterygium

PURPOSE: To compare the safety and efficacy of limbal versus conjunctival autograft transplantation for treating advanced and recurrent pterygia. DESIGN: Randomized, prospective clinical trial. PARTICIPANTS: Seventy-nine patients with advanced primary or recurrent pterygia treated by conjunctival (n = 36) or limbal-conjunctival (n = 43) autograft transplantation. INTERVENTION: Twenty four eyes with primary and 12 eyes with recurrent pterygia underwent free conjunctival autograft transplantation (group A), and 28 eyes with primary and 15 eyes with recurrent pterygia underwent limbal-conjunctival autograft transplantation (group B). MAIN OUTCOME MEASURES: Recurrence of pterygium and complications. RESULTS: With a 3-year minimum of follow-up, 2 cases of primary (8.3%) and 4 cases of recurrent (33.3%) pterygia in group A showed recurrence. No patients in group B developed recurrence. CONCLUSIONS: In this study both techniques were effective in cases of advanced primary pterygia with no statistically significant difference. Limbal transplantation appeared more effective than free conjunctival transplantation for treatment of recurrent pterygia (P < 0.05).     

Amniotic membrane transplantation for reconstruction of the conjunctival fornices

PURPOSE: To describe the clinical outcome of amniotic membrane transplantation (AMT) for fornix reconstruction in a variety of ocular surface disorders. DESIGN: Noncomparative interventional case series. PARTICIPANTS: Seventeen eyes in 15 patients with symblepharon. Four eyes had ocular-cicatricial pemphigoid, two eyes had symblepharon after pterygium excision, four eyes had chemical or mechanical trauma, two eyes had strabismus surgery, two eyes (one patient) had Stevens-Johnson syndrome, one eye had toxic epidermal necrolysis, and two eyes (one patient) had chronic allergic conjunctivitis. INTERVENTION: The subconjunctival scar tissue was dissected from the episclera, and the freed conjunctival flap was recessed to the fornix. A layer of amniotic membrane (AM) was applied to cover the exposed episclera. The fornical edge of the membrane was anchored with sutures passing through the full thickness of the lid. MAIN OUTCOME MEASURES: A deep conjunctival fornix, lack of motility restriction. RESULTS: The mean follow-up period was 37 +/- 24 months (range, 9-84 months). Complete fornix reconstruction was demonstrated in 12 of 17 eyes (70.6%), whereas 2 eyes had a partial success, and 3 eyes (3 patients) had recurrence of symblepharon with restricted motility. In eyes that demonstrated partial success or failure, the underlying etiology was either an autoimmune disorder or a recurrent pterygium. The most successful outcome was observed in eyes with symblepharon associated with trauma. CONCLUSIONS: AMT is an effective method of fornix reconstruction for the repair of symblepharon in a variety of ocular surface disorders. Future modifications, including an epithelial cellular component on the AM (conjunctival autograft or ex vivo expanded epithelial stem cells) may improve the outcome of this surgical procedure.     

自体角膜缘干细胞移植联合羊膜移植术治疗复发性翼状胬肉的临床研究

目的:了解自体角膜缘上皮干细胞移植联合羊膜移植术治疗复发性翼状胬肉的临床疗效。方法:82例(91眼)复发性翼状胬肉,随机分成3组,角膜缘上皮干细胞联合纯甘油保存羊膜移植组(联合组)31例(34眼);羊膜移植组(羊膜组)26例(30眼);角膜缘上皮干细胞移植组(干细胞组)25例(27眼)。进行定期随访观察疗效评价。结果:82例患者(91眼)术后随访时间4~31(平均15.30±8.31)mo。联合组31例(34眼),术后随访时间平均(15·43±8.31)mo,无1例复发;单纯羊膜组26例(30眼),术后随访时间平均(14.80±8.86)mo,有4眼复发,复发率为13%;单纯干细胞移植组25例(27眼),术后随访时间平均(15.58±8.06)mo,有3眼复发,复发率为11%。联合组与羊膜组及干细胞组的复发率(P<0.05)有显著性差异,而羊膜组与干细胞组的复发率无显著性差异。全部病例均无感染、排斥、复视和眼球运动障碍等并发症。结论:角膜缘上皮干细胞移植联合羊膜移植术是治疗复发性翼状胬肉最有效手术方法。特别对翼状胬肉多次复发患者或伴有睑球粘连患者应作为首选的治疗方法。     

角膜缘自体结膜移植和羊膜移植治疗原发性翼状胬肉的疗效

目的：观察角膜缘自体结膜移植和羊膜移植治疗原发性翼状胬肉的临床效果。

方法：选取2013-01/2015-12深圳人民医院收治的翼状胬肉患者96例96眼,依据手术方式分为两组,其中LCAT组46例46眼,行翼状胬肉切除联合角膜缘自体结膜移植术; AMT组50例50眼,行翼状胬肉切除联合羊膜移植术。比较两组患者手术用时,术后随访12mo,比较两组角膜上皮修复所需时间、术后并发症以及复发情况。

结果：LCAT组和AMT组手术用时分别为33.83±1.65、23.60±1.51min,LCAT组高于AMT组,差异有统计学意义(t=-31.683,P<0.001)。LCAT组和AMT组术后角膜上皮修复所需时间分别为4.04±0.95、4.67±1.18d,LCAT组低于AMT组,差异有统计学意义(t=-2.922,P=0.004); LCAT组复发1例1眼,复发率2%,AMT组复发3例3眼,复发率6%,两组复发率比较,差异无统计学意义(P=0.618)。LCAT组术后2wk术区发生结膜肉芽肿1例1眼,AMT组术后未见严重并发症。

结论：角膜缘自体结膜移植术和羊膜移植术治疗原发性翼状胬肉术后恢复快,并发症少,复发率低,是安全有效的手术方式。     

5-FU联合自体角膜缘干细胞移植治疗复发性翼状胬肉

目的:观察5-氟尿嘧啶(5-FU)联合自体角膜缘干细胞移植治疗复发性翼状胬肉的临床疗效。方法:在手术显微镜下采用复发性翼状胬肉切除联合自体角膜缘干细胞移植及5-FU治疗复发性翼状胬肉74例74眼。结果:术后随访12～24mo,74例74眼复发性翼状胬肉患者治愈70例70眼,复发4例4眼,治愈率为94.6%,复发率为5.4%。结论:复发性翼状胬肉切除联合自体角膜缘干细胞移植及5-FU是一种治疗复发性翼状胬肉安全有效、复发率低的手术方法。     

自体角膜缘干细胞移植联合MMC治疗翼状胬肉疗效观察

目的:观察自体角膜缘干细胞移植联合丝裂霉素治疗翼状胬肉治疗的疗效。方法:翼状胬肉手术258例272眼(初发性胬肉229眼,复发性胬肉43眼)在显微镜下作自体角膜缘干细胞移植手术,术中常规联合应用丝裂霉素。结果:术后所有病例随访12～24mo,14眼初发性胬肉术后复发,3眼复发性胬肉术后复发,复发率6.3%。结论:自体角膜缘干细胞移植联合应用丝裂霉素可有效降低翼状胬肉术后的复发率。     

羊膜移植与结膜移植治疗翼状胬肉的比较

目的:比较翼状胬肉切除联合羊膜移植或游离自体结膜移植对原发性胬肉的治疗效果。方法:对65例74眼行翼状胬肉切除联合羊膜移植术,对61例69眼行翼状胬肉切除联合游离自体结膜移植术,观察两组病例术后疗效。结果:术后随访12～20mo,随访期内,羊膜移植组5例复发,复发率6.7%,结膜移植组8例复发,复发率11.6%。结论:两种方式均能显著降低胬肉术后复发率,但羊膜移植更为理想。     

综合治疗复发性翼状胬肉疗效观察

目的:探讨综合治疗复发性翼状胬肉的疗效。方法:患者80例105眼均施行翼状胬肉切除联合平阳霉素注射及羊膜移植,术中用丝裂霉素,术后贝复舒眼液点眼的综合治疗。结果:随访6～18mo,胬肉复发2眼,复发率1.9%;术后并发眼部干、红、异物感等不适症状4眼,无1例发生角膜、巩膜溶解。结论:综合治疗能明显降低复发性翼状胬肉的术后再复发率。