5-Fu结膜下注射后在眼组织中的分布

目的 观察5-Fu在小梁切除术和正常眼结膜下注射后在眼组织中的分布。方法 18只兔随机分为两组，一组在12点处行小粱切除术，另一组不行手术作为对照，分别在3点处结膜下每日注射5-Fu 5mg 1次，共5次，于末次注射后第1、3、10d处死动物，取12点处结膜、全角膜、全品状体、视乳头周围视网膜组织，并抽取房水0．2ml，采用氟离子选择电极法测氟。结果 随时间推移，5-Fu在角膜中质量分数逐渐下降，而在视网膜中质量分数逐渐上升并有蓄积性；在房水和品状体中的质量分数较低且恒定；在结膜中质量分数先升高后降低。结论 结膜下注射5-Fu后，其分布与眼组织中细胞的数量和代谢旺盛程度相关。青光眼术后应用5-Fu，其在视网膜组织中的蓄积可能具有潜在的毒性。     

Postoperative subconjunctival corticosteroid injection to prevent pterygium recurrence

PURPOSE: To report the outcome of postoperative subconjunctival injection of triamcinolone in eyes that underwent pterygium surgery and were at risk for recurrence. METHODS: Twelve eyes of 11 patients with primary (7 eyes) or recurrent (5 eyes) pterygia underwent excision and conjunctival autografting (4 eyes, 33.3%), amniotic membrane grafting (6 eyes, 50%), or both (2 eyes, 16.6%). All of these eyes had signs that were considered to be risk factors for recurrence (conjunctival inflammation, hemorrhage, granuloma, and fibrovascular proliferation); accordingly, they also underwent subconjunctival injection of triamcinolone. RESULTS: Among the 11 patients, there were 8 (72.7%) men and 3 (27.3%) women; the mean age was 41 years (range, 20-56 years). In 5 (41.7%) eyes, the pterygium was graded as T2 (intermediate) and in 7 (58.3%) eyes was graded as T3 (fleshy). The time between surgery and the first injection ranged from 2 to 5 weeks (mean, 3.4 weeks), and 1-3 injections were necessary (mean, 1.7) to achieve the desired effect. After injection, 1 (8.3%) eye developed inflammation, and 2 (16.7%) eyes from another patient developed intraocular hypertension that was controlled with a topical beta-blocker. The follow-up after the last injection ranged from 8 to 36 months (mean, 14.5 months); only 1 recurrence (grade 3) occurred during this period. CONCLUSIONS: The postoperative use of subconjunctival triamcinolone seems to benefit patients at increased risk of pterygium recurrence. It is relatively safe and is accompanied by few complications, but controlled and prospective studies are necessary to confirm its efficacy.     

5-氟尿嘧啶治疗早期复发性翼状胬肉的临床研究

目的:观察5-氟尿嘧啶(5-FU)治疗早期复发性翼状胬肉的临床疗效。方法:早期复发性翼状胬肉患者48例采用结膜下注射5-FU,观察结膜角膜眼压及前房反应,定期随访观察。结果:随访6～24mo,48例复发病例中,痊愈加显效30例,有效12例,6例无效。2例结膜囊缩窄,6例继续进展再次手术。12例角膜上皮点状脱落,停药48h愈合。结论:5-FU结膜下注射是治疗早期复发性翼状胬肉的一种安全、简便、有效的方法。     

平阳霉素结膜下注射治疗复发性翼状胬肉疗效观察

目的 探讨平阳霉素结膜下注射治疗早期复发性翼状胬肉的疗效.方法 治疗组应用国产注射用盐酸平阳霉素进行结膜下沣射,每周1次,连续3周治疗23例(25只眼)早期复发性翼状胬肉;另2l例(22只眼)早期复发性翼状胬肉给予0.1%氟甲松龙眼液点眼2周,作为对照组.分别于治疗后1d、1周、1个月、3个月、6个月、1年进行随诊观察翼状胬肉的消退及进展情况.结果 治疗组随访6～12个月,21只眼复发性翼状胬肉消退,好转4只眼,治疗后均无明显并发症.对照组22只眼中,10只在6个月后进行了二次胬肉切除联合角膜缘干细胞移植术或羊膜移植术.结论 应用国产注射用盐酸平阳霉素进行结膜下注射操作简便、对组织损伤小、经济实用、患者痛苦小,是治疗早期复发性翼状胬肉的一种有效方法.     

Efficacy of preoperative injection versus intraoperative application of mitomycin in recurrent pterygium surgery

Purpose:

To determine the efficacy of preoperative subconjunctival injection of mitomycin C a day before surgery in the management of recurrent pterygium.

Materials and Methods:

Randomized comparative case series. Fifty eyes with recurrent pterygium were randomly divided into two groups; the mitomycin injection group (25 eyes) and the mitomycin application group (25 eyes). The mitomycin injection group underwent preoperative subconjunctival injection of mitomycin C in low dose (0.1 ml of 0.15 mg/ml) a day before bare sclera pterygium excision surgery. The mitomycin application group underwent bare sclera pterygium excision with topical application of mitomycin C (same concentration).

Results:

At one year of follow-up, 24 of 25 eyes (96%) in the mitomycin injection group and 23 of 25 (92%) eyes in the mitomycin application group were free of recurrence. The difference was statistically insignificant. As regards postoperative complications, delayed epithelization (more than two weeks) occurred in two eyes (8%) in the mitomycin injection group and in one eye (4%) in the mitomycin application group. Scleral thinning was reported in one eye (4%) in the mitomycin application group which resolved within three weeks after surgery, no other serious postoperative complications were reported.

Conclusion:

Preoperative subconjunctival injection of mitomycin C in low dose (0.1 ml of 0.15 mg/ml) a day before pterygium surgery is a simple and effective modality for management of recurrent pterygium. It has the advantage of low recurrence and complications’ rate.     

针拨联合5-氟尿嘧啶结膜下注射治疗功能不良滤过泡的临床观察

目的观察针拨联合5-氟尿嘧啶(5-FU)注射对青光眼小梁切除术后早中期功能不良滤过泡的处理效果和影响因素.方法对34例(40只眼)青光眼患者术后2～8周内滤过功能不良滤过泡行针拨联合5-FU 结膜下注射,其中14只眼经过重复针拨联合5-FU注射,针拨后随访3个月.结果 40只眼术后退败滤过泡和早期失败滤过泡类型低平限局肥厚充血型23只眼、包囊型13只眼、袋状下垂充血型4只眼.针拨后滤过泡外观形态轻度膨隆弥散型26只眼、多腔或薄壁型9只眼、限局肥厚型或无滤过泡5只眼.针拨前患者的眼压为 (23.6±2.1) mm Hg(1 mm Hg＝0.133 kPa),针拨后即刻为(13.7±5.4) mm Hg,随访结束时,具有功能滤过泡眼的眼压为(16.3±2.9) mm Hg;与针拨前比较两者差异有统计学意义(P<0.01).失败滤过泡眼经多次用药,眼压控制在(19.6±2.6) mm Hg.针拨后滤过泡3个月的生存率为(87.51±5.23)%(生存率±标准误).Logistic回归分析显示,青光眼类型、内眼手术史及患者年龄对针拨效果无影响,手术后间隔时间较长者针拨效果较差(P=0.046),但中效水平时间t=5.9(周).针拨术中结膜下出血6只眼,术后未见任何并发症.结论针拨联合5-FU注射对小梁切除术后退败滤过泡和早期失败滤过泡是一有效、安全及简便的处理方法,具有危险因素的滤过泡多需重复针拨和5-FU注射,手术后间隔时间长者效果差,6周时成功的可能性接近50%.     

针刺分离联合结膜下注射5-氟尿嘧啶治疗小梁切除术后功能不良滤过泡

目的：：探究针刺分离联合结膜下注射5-氟尿嘧啶治疗小梁切除术后功能不良滤过泡的临床效果。方法：选取行小梁切除术后1~4 wk来院复诊的青光眼患者26例30眼,对功能不良的滤过泡进行针刺分离联合膜下注射5-氟尿嘧啶进行治疗。观察滤过泡形态、眼压和并发症,随访3 mo。结果：针刺分离后滤过泡形态有24眼表现为功能性滤过泡。针刺分离前患者眼压为26.4±2.8mmHg,分离后眼压为14.1±1.1mmHg,两者差异有统计学意义(P<0.05)。治疗后治愈率70%(21眼),有效率17%(5眼),总有效率87%。常见并发症包括结膜下出血、角膜上皮点状剥脱和前房积血。结论：针刺分离联合结膜下注射5-氟尿嘧啶对小梁切除术后功能不良滤过泡有着良好效果,值得在临床治疗中推广应用。     

Fungal endophthalmitis complicating subconjunctival injection of triamcinolone acetonide in anterior scleritis

Fungal endophthalmitis following subconjunctival triamacinolone acetonide in anterior scleritis is a rare complication. Two patients with aneterior scleritis, who received subconjunctival injection of triamcinolone developed fungal endophthalamitis. Both patients were positive by smear and polymerase chain reaction for 28S ribosmal RNA gene for fungus. Colletotrichum dematium was identified in one patient. Both patients responded well to pars plana vitrectomy and antifungal therapy.     

曲安奈德球结膜下注射治疗前部非坏死性巩膜炎的疗效观察

目的：观察曲安奈德球结膜下注射治疗前部非坏死性巩膜炎的临床疗效。方法回顾性病例系列。前部巩膜炎患者12例（14只眼）,弥漫性2例,结节性10例。曲安奈德4～8 mg巩膜病灶处结膜下注射,小于二象限做1点注射,大于二象限做2点注射。观察治疗方法的有效性及局部和全身的不良反应。结果注射后病变轻者1周显效,重者2周显效,一次注射后均治愈。结论曲安奈德结膜下注射治疗前部非坏死性巩膜炎简单安全有效。     

Halting pterygium recurrence by postoperative 5-fluorouracil

PURPOSE: To investigate the efficacy of postoperative 5-fluorouracil (5-FU) in halting recurrence of pterygium. METHODS: Early recurrence of pterygium was detected in six eyes of six patients aged 40 to 66 years that, over a 3-year period, had undergone pterygium excision in our institution, using the "bare sclera" technique. Each of the hyperemic fibrovascular tissues was found to override the cornea by 1.5 mm or less in length. Five of these eyes had undergone a primary excision and one, a second operation (with intraoperative mitomycin C). Upon diagnosis, each eye was treated with two to four injections of 5-FU, administered into the dome of the fibrovascular tissue. The dose of 5-FU per injection was 1 to 3 mg (mean, 2.1 +/- 0.8 mg). Of all 126 eyes that underwent pterygium surgery during that 3-year period, pterygium recurred in nine additional eyes but was found to be 2 mm or more in length in each. These eyes were not treated by 5-FU. RESULTS: In five of the six treated eyes, the pterygium became clinically atrophic and the recurrence process was stopped. No renewal of the recurrence process was detected after 12 months or more of follow-up. No major complications were related to the use of 5-FU. CONCLUSION: This pilot study suggests that when early recurrence of pterygium is already evident, 5-FU treatment into the dome of the fibrovascular tissue may be beneficial in halting its progression, by rendering it atrophic. A prospective, randomized, controlled study is required to confirm the efficacy of this approach.     

5-Fluorouracil in primary,impending recurrent and recurrent pterygium: Systematic review of the efficacy and safety of a surgical adjuvant and intralesional antimetabolite

Pterygium is an ultraviolet-related disease characterized by an aberrant, wing-shaped and active wound-healing process. There is nothing quite as disheartening for the surgeon or patient as the recurrence of pterygium, and various adjuvants have been studied to ameliorate this. This systematic review provides a comprehensive summary of the efficacy and safety of 5-Fluorouracil (5-FU) as an antimetabolite agent for pterygium management. An appraisal of electronic searches of six databases identified 34 clinical studies reporting recurrence outcomes of 5-FU use in primary, impending recurrent and recurrent pterygia. In vitro and in vivo studies of 5-FU showed dose- and duration-dependent cytostatic and cytotoxic effects in human cells. 5-FU is relatively inexpensive, available, and easy to administer, making it attractive for resource-limited scenarios. However, the published evidence demonstrates a recurrence rate of 11.4–60% with the bare scleral technique, 3.5–35.8% with conjunctival rotational flaps, 3.7–9.6% with conjunctival autografts for intraoperative topical 5-FU, and 14–35.8% for preoperative and intraoperative injections. This suboptimal efficacy brings the role of 5-FU as an adjuvant for pterygium surgery into question and the authors do not recommend its use. In contrast, postoperative intralesional injections of 5-FU to arrest progression in impending recurrent pterygium and true recurrent pterygia were more promising, with success rates of 87.2–100% and 75–100%, respectively. Furthermore, 5-FU as a treatment modality, without surgery, effectively arrested progression in 81.3–96% of primary and recurrent pterygia. Other treatments such as topical and intralesional corticosteroids, cyclosporine and anti-VEGF agents are discussed. Complications of 5-FU increase with higher doses and range from transient and reversible to severe and sight-threatening. For pterygium, 5-FU has a predilection for causing scleral thinning, corneal toxicity, and graft-related complications. Additional study with extended follow-up is needed to elucidate the optimal dose, frequency, duration, and long-term safety of 5-FU injections. If 5-FU is used in the management of pterygium, it should be with caution, in selected patients and with vigilant long-term monitoring.     

Hypotonous maculopathy after trabeculectomy with subconjunctival 5-fluorouracil.

Long-term success in trabeculectomy has been enhanced in recent years by postoperative subconjunctival 5-fluorouracil injections and intraoperative mitomycin C applications. During 1990 and 1991, after trabeculectomy with a small scleral flap (2 x 3 mm) augmented by antimetabolite therapy, hypotonous maculopathy developed in eight eyes of six patients. The maculopathy was characterized by loss in visual acuity, retinal striae, and choroidal folds without evidence of vascular leakage. The average loss in visual acuity was four Snellen lines. Visual acuity did not return to preoperative levels even when the hypotony could be reversed. Reversing the hypotony with various strategies aimed at stimulating subconjunctival scarring has been relatively ineffective. During that same period, an additional seven eyes in six patients had prolonged hypotony but without development of maculopathy. Features common to patients who developed maculopathy included age (mean age, 46 years; range, 32 to 60 years) and myopia (mean, -7.5 diopters; range, -0.75 to -11.75 diopters). The patients with hypotony but no maculopathy were older (mean age, 73 years; range, 63 to 82 years) and were closer to emmetropia (mean, -1.11 diopters; range, +1.50 to -9.00 diopters). The means of the ages and refractive errors were statistically significantly different in the two groups (P = .007 and .04, respectively). Trabeculectomy with adjunctive antifibrosis therapy should be used with caution in young myopic patients.     

曲安奈德治疗复发性翼状胬肉24例疗效观察

目的 探讨曲安奈德治疗早期复发性翼状胬肉的疗效.方法 复发性翼状胬肉20例(24只眼)体部注射曲安奈德0.1ml,注射后随诊6个月,观察胬肉消褪与进展情况.结果 24只眼中16只眼复发性胬肉消退,好转6只眼.治疗后未发现明显并发症.结论 曲安奈德翼状胬肉体部注射对复发性翼状胬肉有明显治疗效果.     

A prospective evaluation of subconjunctival injection of triamcinolone acetonide for resistant anterior scleritis

PURPOSE: Prospective evaluation of the efficacy and safety of subconjunctival triamcinolone injections for resistant, nonnecrotizing, anterior scleritis. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Twelve eyes of 10 consecutive patients seen in the Doheny Eye Institute between August 1999 and December 2000 with diffuse, nonnecrotizing anterior scleritis that was resistant to systemic antiinflammatory therapy. Eyes with a history of steroid response were excluded. INTERVENTION: Subconjunctival injection of triamcinolone acetonide to the areas of maximal inflammation. MAIN OUTCOME MEASURES: Scleritis activity, adverse treatment effects, and number of systemic medications required at the end of the follow-up period. RESULTS: Within 1 to 14 days after injection, complete resolution of signs and symptoms was achieved in 11 eyes and partial resolution in 1 eye. Two patients had one recurrence each, 2.5 and 11 months after injection. Six of 10 patients were able to discontinue all systemic therapy (prednisone +/- immunosuppressive drugs); the remaining 4 needed continued oral therapy for systemic indications. Transient ocular hypertension and subconjunctival hemorrhage occurred in one eye each. Median follow-up period was 15 months. No eye developed necrotizing scleritis. CONCLUSIONS: Subconjunctival injection of triamcinolone acetonide is a safe and effective treatment for resistant, nonnecrotizing anterior scleritis. It provides rapid effect, is well tolerated, and may spare patients the significant complications and side effects of systemic corticosteroid and immunosuppressive therapy.     

Subconjunctival bevacizumab injection for corneal neovascularization in recurrent pterygium

PURPOSE: We report on the use of subconjunctival bevacizumab on corneal vessel density in recurrent pterygia. METHODS: The charts of 5 patients with recurrent pterygium, who received subconjunctival injections of bevacizumab (2.5 mg/0.1 ml) were retrospectively reviewed. Ophthalmic evaluation included Snellen visual acuity (VA), tonometry and complete examination before the injection and at 1 week and 1 and 3 months thereafter. Digital photographs of the eyes were analyzed by image analysis software to determine the area of cornea covered by new vessels as a percentage of the total corneal area. RESULTS: No ocular or systemic adverse events were observed. No change in visual acuity was noted in any patient following the injection. The mean change in corneal vascularization after one bevacizumab injection was 0.03%+/-0.45, while after two injections the change was 0.025%+/-0.19 (both not statistically different than zero, t-test). CONCLUSIONS: Short-term results suggest that subconjunctival bevacizumab is well tolerated but does not cause regression of corneal vessels in recurrent pterygium.     

结膜下注射曲安奈德治疗葡萄膜炎继发黄斑水肿的效果

目的：评价经结膜下注射曲安奈德治疗葡萄膜炎继发黄斑水肿患者的临床效果。
　　方法：选取本院2014-10/2015-10收治的葡萄膜炎继发黄斑水肿患者68例82眼,并其按随机数字表法分为对照组和试验组,每组34例41眼患者。对照组患者采用经球内注射曲安奈德,试验组患者采用经结膜下注射曲安奈德。对比两组患者治疗后临床效果,黄斑中心凹视网膜厚度( CMT)变化,不良反应发生的情况。
　　结果：两组患者治疗前黄斑中心凹视网膜厚度及最佳矫正视力比较无统计学意义(P>0.05);但试验组治疗后黄斑中心凹视网膜厚度(214.26±65.54μl)明显低于对照组(256.47±84.52μl);试验组治疗后最佳矫正视力(4.8±1.3)明显优于对照组的(4.0±1.4),差异具有统计学意义(P<0.05);试验组患者治疗后的总有效率(98%)明显高于对照组的(83%),差异具有统计学意义(P<0.05);试验组患者治疗后不良反应的总发生率(37%)明显低于对照组的(59%),差异具有统计学有意义(P<0.05)。
　　结论：葡萄膜炎继发黄斑水肿患者采用结膜下注射曲安奈德可以有效地改善患者视力及减轻黄斑水肿的情况,减少眼压升高、结膜出血等并发症发生。