翼状胬肉撕离联合带角膜缘结膜瓣转位术疗效观察

目的探讨翼状胬肉头部撕离方式切除联合自体带角膜缘结膜瓣转位术治疗翼状胬肉的临床效果。方法在手术显微镜下采取用有齿镊逆行撕离胬肉头部后用上方带角膜缘结膜瓣转位方式治疗翼状胬肉58例(61眼),术后随访3月~1年。结果随访期内有3眼复发(4.96%)。未发现睑球粘连。结论翼状胬肉逆行撕离联合上方带角膜缘结膜瓣转位术有利于重建角膜缘干细胞功能,可较大幅度地降低胬肉术后复发率。     

逆行撕离联合原位自体结膜瓣旋转移植治疗翼状胬肉64例

目的:观察逆行撕离联合原位自体结膜瓣旋转转位移植治疗翼状胬肉的临床效果。方法:显微镜下逆行撕离切除翼状胬肉,原胬肉体部球结膜取5mm×2mm长条形结膜瓣,原位旋转360°后与角膜缘结膜及鼻侧球结膜紧密缝合。术后随访3～18mo。结果:所有病例移植片成活良好,64例病例中仅4例复发。结论:逆行撕离联合原位自体结膜瓣转位移植术,减少局部炎症刺激,改变了角膜缘移位,促进角膜缘干细胞微环境的修复并使角膜缘干细胞向角膜上皮细胞分化,是目前治疗翼状胬肉有效的方法之一。     

自体角膜缘干细胞移植与结膜瓣转位治疗翼状胬肉的对比研究

目的 探讨自体角膜缘干细胞移植与结膜瓣转位治疗翼状胬肉的疗效.方法 将126例(214眼)翼状胬肉患者随机分为2组:角膜缘干细胞移植组58例92眼,结膜瓣转位组68例122眼,分别在手术显微镜下行胬肉切除联合自体角膜缘干细胞移植术和胬肉切除联合结膜瓣转位术,术后随访1 a,观察并比较2组复发率和并发症情况.结果 术后1 a,自体角膜缘干细胞移植组4眼复发,复发率为4.35%,结膜瓣转位组23眼复发,复发率为18.85%,2组术后复发率比较差异有显著统计学意义(P=0.002<0.01).角膜缘干细胞组无一眼发生睑球粘连,而结膜瓣转位组有9眼出现睑球粘连.结论 自体角膜缘干细胞移植是治疗翼状胬肉的一种有效方法 .     

翼状胬肉逆行切除联合带蒂结膜瓣移植术的疗效观察

目的观察翼状胬肉逆行切除联合带蒂结膜瓣移植术治疗翼状胬肉的临床效果。方法对28例（28只眼）翼状胬肉行逆行切除联合带蒂结膜瓣移植术，术后随访6—15个月。结果28只眼中27只眼治愈，1只眼复发，复发率3．6％。结论翼状胬肉逆行切除联合带蒂结膜瓣移植术取材容易，操作简便，疗效佳，复发率低。     

角膜缘干细胞移植联合封闭筋膜囊间隙预防翼状胬肉术后复发

目的：：探讨翼状胬肉切除联合带自体角膜缘干细胞结膜瓣移植术辅以封闭球结膜与Tenon囊间隙的手术方式治疗翼状胬肉的临床疗效。方法：对110例128眼实施翼状胬肉切除联合带自体角膜缘干细胞结膜瓣移植术,辅以术中封闭球结膜与Tenon囊之间间隙,观察术后角膜上皮修复及翼状胬肉复发等情况。结果：随访观察术后12,24 mo 胬肉的复发率分别为2.3％,3.9％,角膜上皮恢复时间为2~3d,无其他并发症发生。结论：翼状胬肉切除联合带自体角膜缘干细胞结膜瓣移植术辅以封闭球结膜与Tenon囊间隙治疗翼状胬肉疗效可靠,该手术取材方便、术后恢复快、炎症反应轻、复发率低、泪阜形态及位置恢复正常,是治疗翼状胬肉比较理想的术式。     

逆行切除带蒂角膜缘干细胞移植治疗翼状胬肉

目的探讨逆行性翼状胬肉切除联合带结膜蒂角膜缘干细胞移植治疗翼状胬肉的临床效果。方法 115例（120眼）翼状胬肉经逆行性翼状胬肉切除联合带结膜蒂角膜缘干细胞移植术进行疗效观察。结果术后观察6～36个月,复发率2.50%,无明显并发症。结论逆行性翼状胬肉切除联合带结膜蒂角膜缘干细胞移植治疗翼状胬肉疗效良好。     

翼状胬肉切除联合带角膜缘上皮的自体结膜瓣移植术152例疗效观察

目的 探讨翼状胬肉切除联合带角膜缘上皮的自体结膜瓣移植术的疗效。方法 对152例(182只眼)翼状胬肉患者行翼状胬肉切除后联合带角膜缘上皮的自体结膜瓣移植术。术后随访观察6～12个月。结果 术后复发10只眼，复发率5．49％，其中3只眼为复发性翼状胬肉。结论翼状胬肉切除联合带角膜缘上皮的自体结膜瓣移植术方法简单、疗效可靠。     

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。     

自体角膜缘干细胞移植术与传统术式治疗翼状胬肉的对比研究

目的:观察于显微镜下自体角膜缘干细胞移植术治疗翼状胬肉的疗效.方法:在眼科手术显微镜下切除翼状胬肉后,采用角膜缘干细胞移植术治疗翼状胬肉46例53眼,与之前的单纯翼状胬肉切除术39例46眼对照组进行对比分析.结果:术后随访6～12mo未出现1例复发,全部患者球结膜无明显的纤维血管增生及角膜浸润.疗效与对照组相比有极其显著差异(P<0.01).结论:翼状胬肉切除联合自体带结膜瓣的角膜缘干细胞移植术,术后视力提高,复发率低,是治疗翼状胬肉的有效方法.     

自体角膜缘干细胞移植术治疗复发性翼状胬肉疗效观察

目的:观察自体角膜缘干细胞移植术治疗复发性翼状胬肉疗效。方法:把66例81眼复发性翼状胬肉患者随机分为两组,治疗组:34例44眼行翼状胬肉切除联合自体角膜缘干细胞移植术;对照组:32例37眼行翼状胬肉切除联合带蒂结膜瓣转移术。胬肉复发的定义:血管纤维组织重新侵入角膜。结果:术后随访12~24mo。治疗组治愈率98%,复发率2%;对照组治愈率84%,复发率16%。两组复发率有统计学意义(χ2=4.62,P<0.05),两组均无明显并发症。结论:自体角膜缘干细胞移植术治疗复发性翼状胬肉疗效高,复发率低于带蒂结膜瓣转移术。     

Combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C in the treatment of primary pterygium

PURPOSE: To introduce a new technique of conjunctival reconstruction after primary pterygium excision, and to evaluate the efficacy of combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C application in preventing recurrence of primary pterygium. METHODS: In a prospective, non-comparative case series, 43 eyes of 41 consecutive patients with primary pterygium were studied. In all patient eyes, after excision of pterygia, 0.02% mitomycin C was applied topically for 2 min over the exposed scleral surface and "symmetrical conjunctival flap transposition" was performed to reconstruct the conjunctival defect. The main outcome measures were pterygium recurrence or any complications related with surgery or mitomycin C. RESULTS: The mean age of the patients was 47.5 +/- 12.4 years (range 30-70 years). Among the 38 patients who were not lost to follow up, three patient eyes (7.5%) had grade 1, 24 eyes (60.0%) had grade 2 and 13 eyes (32.5%) had grade 3 pterygium. The mean follow up was 12.2 +/- 5.7 months (range 7-28 months). No recurrence or sight-threatening complications were encountered in any patient eye throughout the follow-up period. CONCLUSION: Combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C application may be an effective surgical alternative in preventing recurrence of primary pterygium. Although the procedure seems to be free from severe complications, surgeons and patients should be well aware of the risk of late radiomimetic complications of mitomycin C. Comparative, randomized trials with more number of patients and longer follow up are required to further establish the safety and efficacy of this treatment strategy.     

不同术式治疗翼状胬肉的疗效观察

目的:寻求一种治疗翼状胬肉的理想手术方式。方法:对121眼采用单纯胬肉切除加巩膜暴露术(49眼)、带蒂结膜瓣转位术(43眼)及加丝裂霉素C的辅助疗法(29眼)3种显微手术方法治疗。随访2mo~4a,比较其复发率。结果:胬肉切除加丝裂霉素C辅助疗法术后无1例复发,单纯胬肉切除加巩膜暴露术复发率为12.3%,带蒂结膜转位术复发率为9.3%,3种手术方法均有部分病例周边角膜云翳。结论:胬肉切除加丝裂霉素C辅助治疗是一种相对理想的手术方法。     

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。     

Pterygium surgery by double-sliding flaps procedure: Comparison between primary and recurrent pterygia

Purpose:This study aimed to evaluate the surgical outcomes of pterygial excision for primary and recurrent pterygia by a single method of pterygia excision combined with two conjunctival flaps.Methods:This retrospective study divided 193 cases of pterygium into the primary (140 cases) and recurrent (53 cases) pterygium groups. Following double-sliding conjunctival transposition flap operation and surgical excision of the pterygium, the success and recurrence rates of pterygial surgery were assessed based on visual acuity and corneal and total astigmatism during follow-up at least 6 months.Results:Both primary and recurrent pterygium groups showed significant improvements in visual acuity and astigmatism (corneal and total) between before and after this procedure. Total astigmatism and success rate of primary pterygium were significantly better than those for recurrent pterygium. Two cases (1.4%) of primary pterygium and four cases (7.5%) of recurrent pterygium developed recurrence, corresponding to a rate of 3.1% (6/193 cases). The success rates significantly make a difference between primary and recurrent groups but did not differ significantly between the first recurrent and over twice recurrent pterygium. However, visual acuity, cornea, and total astigmatism improved significantly after surgery in first recurrent group but not in over twice recurrent group.Conclusion:The double-sliding conjunctival flaps surgery appeared to be a useful method, with a better success rate and lower pterygial recurrence in pterygium surgery. Especially, when pterygium is larger or recurrent type, this technique can be easily covered the bare sclera, as compared to any transposition conjunctival flap operation.     

带蒂结膜瓣转移联合丝裂霉素C治疗复发性翼状胬肉的临床研究

目的:探讨带蒂结膜瓣转移联合应用丝裂霉素C治疗复发性翼状胬肉的临床疗效。方法:对26例(26眼)复发性翼状胬肉患者,采用翼状胬肉切除、术中加用丝裂霉素C并行带蒂结膜瓣转移、术后低浓度丝裂霉素C点眼进行治疗并随访观察。结果:所有患者均接受了6~12mo随访,有1例患者复发,复发率为4%。没有并发症发生。结论:对复发性翼状胬肉,翼状胬肉切除术中加用带蒂结膜瓣转移联合应用丝裂霉素C,是一种有效的治疗方法。     

优化翼状胬肉切除术联合角膜缘干细胞移植术的临床研究

目的:研究优化的翼状胬肉切除术联合角膜缘干细胞移植术的临床疗效方法:选择59例59眼初发的翼状胬肉患者,随机分为实验组(优化的翼状胬肉切除术+角膜缘干细胞移植术组)32例32眼和对照组(翼状胬肉切除术+角膜缘干细胞移植术组)27例27眼,分别采用相应的手术方式治疗,比较术后角膜上皮愈合时间、结膜瓣愈合时间、手术操作时间、复发率、术后患者舒适度等并做统计分析。结果:实验组和对照组的术后角膜上皮愈合时间分别为2.16±0.37,2.87±0.31d;手术操作时间分别为30.03±1.98,36.63±2.42min;结膜瓣愈合时间分别为8.06±0.75,10.02±1.01d;术后患者不适感评分分别为0.91±0.69,1.63±0.74。差异均有统计学意义(P<0.01),两组均未见复发病例。结论:采用优化的翼状胬肉切除术联合角膜缘干细胞移植术,术后角膜上皮、结膜瓣愈合时间缩短和手术操作时间明显缩短,术后患者舒适度高。     

原发性翼状胬肉手术时机临床观察

目的探讨原发性翼状胬肉临床手术治疗的时机对术后胬肉复发及眼表重建的影响。方法原发性翼状胬肉203例（256眼），采用胬肉逆行镊撕法切除联合带蒂球结膜瓣移植法手术。术后随访3个月～2a。结果静止期翼状胬肉98例（117眼），术后胬肉复发2例（2眼），2l例（24眼）伴眼十症状，均未遗留角膜斑翳。进行期翼状胬肉105例（139眼）术后胬肉复发9例（9眼），62例（86眼）伴眼干症状，89例（94眼）角膜留有不同程度瘢痕性浑浊。结论翼状胬肉静止期与进行期手术治疗相比较，前者术后复发率少、眼表重建快及眼表症状轻，翼状胬肉静止期可行手术切除治疗。     

羊膜和桥状结膜瓣移植治疗翼状胬肉

目的研究翼状胬肉切除加羊膜和桥状结膜瓣移植治疗翼状胬肉的疗效。方法31例翼状胬肉患者两眼分别行翼状胬肉切除加羊膜和桥状结膜瓣移植和单纯翼状胬肉切除加羊膜移植，比较二者治疗后翼状胬肉复发率。结果随访1．5a。前者翼状胬肉复发率为3.22％，后者复发率为16．12％。二者相比有显著性差异（P〈0．01）。结论翼状胬肉切除加羊膜和桥状结膜瓣移植治疗翼状胬肉远期复发率低，值得推广。     

翼状胬肉扩大切除联合自体角膜缘干细胞移植术的临床疗效观察

目的:探讨翼状胬肉扩大切除联合自体带结膜瓣的角膜缘干细胞移植术的手术方法及其临床疗效。方法:选择达到或超过瞳孔缘的35例36眼翼状胬肉患者,其中有4眼为复发性,其余均为原发性,于显微镜下做扩大的翼状胬肉切除,包括变性的球筋膜,联合自体带结膜瓣的角膜缘干细胞移植术,术后随访6～24.4mo,中位数为14.6mo,观察术眼手术前后视力变化及术后复发情况。结果:术前视力为指数/眼前～0.6,中位数为0.25,术后1mo视力为指数/眼前～1.2,中位数为0.7(秩和检验u=5.325,P<0.01)。无1例术后复发,复发率为0。结论:翼状胬肉扩大切除联合自体带结膜瓣的角膜缘干细胞移植术,术后复发率低,视力提高显著,是治疗翼状胬肉的有效方法,其术后的长期疗效仍需进一步观察。     

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.