Meta-analysis on the recurrence rates after bare sclera resection with and without mitomycin C use and conjunctival autograft placement in surgery for primary pterygium

BACKGROUND/AIMS—Bare sclera resection with and without use of mitomycin C and conjunctival autograft placement are three surgical techniques currently in use for the treatment of primary pterygium. The purpose of this study was to determine through a meta-analysis the risk for postoperative pterygium recurrence comparing the three surgical treatment modalities.
METHODS—A search through Medline for randomised controlled clinical trials comparing at least two of the three surgical techniques in the treatment of primary pterygium, along with a hand search of all references in relevant papers, was conducted. All eligible clinical trials were graded for quality utilising the Detsky score; those studies with a score of 0.5 or greater were included. The main outcome measurements were the pooled odds ratios and 95% confidence intervals for the risk of pterygium recurrence. These were calculated utilising the Mantel-Haenszel method.
RESULTS—Five eligible studies with an adequate quality score were retrieved, three comparing bare sclera resection with and without mitomycin C use, one comparing bare sclera resection with conjunctival autograft placement, and one comparing both. The pooled odds ratio for pterygium recurrence in patients who had only bare sclera resection was 6.1 (95% confidence intervals, 1.8 to 18.8) compared with the patients who had conjunctival autograft placement and 25.4 (9.0 to 66.7) compared with the patients who received mitomycin C.
CONCLUSIONS—The odds for pterygium recurrence following surgical treatment of primary pterygium are close to six and 25 times higher if no conjunctival autograft placement is performed or if no intra/postoperative mitomycin C is used, respectively. Surgeons and clinical triallists should not be encouraged in the use of bare sclera resection as a surgical technique for primary pterygium.

Keywords: meta-analysis; bare sclera resection; pterygium; mitomycin C     

两种手术方式对翼状胬肉的疗效

目的观察单纯性巩膜暴露术与自体角膜缘结膜瓣移植术对翼状胬肉的疗效。方法将73例(73眼)单侧原发性翼状胬肉患者分为A、B 2组。A组进行单纯性巩膜暴露术,B组进行自体角膜缘结膜瓣移植术。比较2组术前翼状胬肉突入角膜缘长度,术后角结膜上皮愈合时间及术后3个月复发率。结果术前2组翼状胬肉突入角膜缘长度差异无统计学意义(P>0.05)。术后B组比A组角结膜上皮愈合时间短,差异有统计学意义(P<0.01)。A组术后3个月复发率比B组高,差异有统计学意义(P<0.01)。结论自体角膜缘结膜瓣移植术治疗翼状胬肉比单纯性巩膜暴露术更有效。     

Effect of pterygium surgery on corneal topography: a prospective study

OBJECTIVE: To evaluate the effect of pterygium surgery on the corneal topography and visual acuity and to correlate the results with patients' features. METHODS: A prospective, nonrandomized, self-controlled trial. Computerized videokeratography was performed in 54 patients (55 eyes) with primary pterygium before and after pterygium excision using bare sclera technique combined with intraoperative mitomycin C. The following topographic parameters were noted: corneal astigmatism at the central 3 mm; total mean refractive power of the whole cornea; surface regularity index (SRI); and surface asymmetry index (SAI). Best corrected visual acuity of the operated eyes was also examined. Differences between pre- and postoperative values were evaluated statistically with paired two-tailed t test and two-tailed Pearson correlation. RESULTS: The respective values (mean +/- SD) before and after treatment of the study parameters were as follows: simulated keratometric astigmatism at 3 mm, 3.12 +/- 2.43 and 2.51 +/- 2.50 (P = 0.05); mean SRI, 0.99 +/- 0.65 and 0.90 +/- 0.65 (NS); mean SAI, 1.37 +/- 1.69 and 1.23 +/- 1.49 (NS). Best corrected visual acuity was 20/40 preoperatively and 20/25 postoperatively (P < 0.01). Both pre- and postoperative astigmatism correlated with pterygium size. CONCLUSIONS: Pterygium surgery significantly reduces refractive astigmatism and improves SRI, SAI, and best corrected visual acuity.     

Management of primary pterygia using free conjunctival and limbal-conjunctival autografts without antimetabolites

PURPOSE: To report the incidence of recurrence after primary pterygium surgery using either a free conjunctival or limbal-conjunctival autograft without antimetabolites. METHODS: One hundred eleven eyes of 90 patients underwent pterygium resection; a free conjunctival autograft was used in 88 surgeries and a free limbal-conjunctival autograft in 24; the latter technique was reserved for dark-skinned patients, under age 30, and with a history of recurrent pterygium in the contralateral eye. RESULTS: Mean age was 42.5 years (range, 23-75), and 50% of the patients were male. Mean follow-up was 9 months (range, 3-12). There were 2 recurrences (1.8%), both observed in the third postoperative month. CONCLUSIONS: With a good surgical technique, the incidence of recurrence after primary pterygium surgery is very low, making the use of antimetabolites unnecessary.     

A comparative study of recurrent pterygium surgery: limbal conjunctival autograft transplantation versus mitomycin C with conjunctival flap

OBJECTIVE: To compare the recurrence rate following treatment of recurrent pterygia using one of two techniques-limbal conjunctival autograft transplantation versus low-dose intraoperative mitomycin C (0.2 mg/ml) combined with conjunctival flap closure. DESIGN: Randomized clinical trial. PARTICIPANTS: Eighty-one patients with recurrent pterygia treated by limbal conjunctival autograft transplantation (n= 41) or mitomycin C combined with conjunctival flap (n= 40) participated. INTERVENTION: Limbal conjunctival autograft transplantation or low-dose intraoperative mitomycin C application with conjunctival flap technique was performed on recurrent pterygium cases. MAIN OUTCOME MEASURES: Recurrence of pterygium and postoperative complications. RESULTS: During mean follow-up periods of 16+/-1.9 and 15.5+/-1.5 months, six recurrences (14.6%) in the limbal conjunctival autograft transplantation group and five recurrences (12.5%) in the mitomycin C group were observed (P=0.77). The difference between the mean ages of recurrent (26.4+/-8.0 years) and nonrecurrent (35.8+/-11.9 years) cases for all patients was statistically significant (P=0.014). Technically, limbal conjunctival autograft transplantation seemed to be more difficult. The most frequent complication in limbal conjunctival autograft transplantation was graft edema, whereas that in the mitomycin C group was superficial keratitis. CONCLUSION: Both techniques showed similar recurrence rates in the treatment of recurrent pterygia. Although technically easier to perform, further follow-up is necessary to determine the long-term safety of low-dose intraoperative mitomycin C with conjunctival flap closure. The surgeon's familiarity with either procedure should determine the method of choice.     

Low-dose intraoperative mitomycin C as chemoadjuvant for pterygium surgery

PURPOSE: To evaluate the efficacy and safety of low-dose intraoperative mitomycin C (MMC) during bare sclera procedure and to compare the rates of pterygium recurrence between recurrent pterygium patients treated with adjuvant MMC and those reconstructed with a conjunctival autograft. METHODS: We studied the recurrence of pterygium, 12-month pterygium-free survival rates, final appearance, and postoperative complications in 96 eyes of 92 patients who received either intraoperative 0.02% MMC for 30 seconds or conjunctival autografting after pterygium excision. Patients were divided into three groups: group 1 included 38 eyes with primary pterygium undergone intraoperative MMC; group 2, 26 eyes with recurrent pterygium treated with intraoperative MMC; and group 3, 32 eyes with recurrent pterygium treated with pterygium excision and conjunctival autografting. RESULTS: Pterygium recurred in 3 (7.9%) of 38 eyes in group 1, 5 (19.2%) of 26 eyes in group 2, and 2 (6.3%) of 32 eyes in group 3. Despite the higher recurrence rate in group 2 compared with that of group 3, the difference between the two was not statistically significant (p = 0.22). The cumulative probabilities of success were 91.6+/-4.6%, 80.8+/-7.7%, and 92.3+/-5.4% at 12 months for groups 1, 2, and 3, respectively. Final appearance of the pterygium excision area was satisfactory in nearly two-thirds of the MMC-treated patients, 71.1% and 65.4% for groups I and 2, compared to 75.1% of patients who had undergone conjunctival autografting. No patients experienced severe complications during a mean postoperative follow-up of 27.3+/-4.1 months, 29.9+/-3.9 months, and 40.9+/-19.1 months for groups 1, 2, and 3, respectively. CONCLUSIONS: A single intraoperative application of 0.02% MMC for 30 seconds after pterygium excision is associated with minimal complication and effectively reduces the recurrence rates after excision of primary or recurrent pterygium. In comparison with conjunctival autografting, low-dose application of MMC after bare sclera procedure is less efficacious in preventing recurrence of pterygium, but simpler and produces a similar proportion of patients with satisfactory final appearance.     

Acute scleral thinning after pterygium excision with intraoperative mitomycin C: a case report of scleral dellen after bare sclera technique and review of the literature

PURPOSE: To describe a patient with scleral dellen after pterygium excision with intraoperative mitomycin C. METHODS: Case report and MEDLINE review of the medical literature on scleral dellen after bare sclera technique. RESULTS: A 48-year-old man had a left nasal pterygium excised by the bare sclera technique with intraoperative mitomycin C. Eight days after surgery, the patient noticed a small black spot in the bare sclera area with mild irritation. Slit-lamp examination revealed a focal area of extreme thinning, centered on the nonepithelialized bare sclera, surrounded by edematous conjunctiva. The ciliary body was visible through the thin and dry scleral lesion. After topical lubricant therapy, the scleral lesion appeared normal thickness and white in color 3 days later. Therapy was continued until the sclera epithelialized. CONCLUSIONS: Scleral dellen is an early postoperative complication of bare sclera technique owing to delayed conjunctival wound closure. Hydration of the thinned sclera will rapidly thicken it. However, medical therapy should be continued until the surrounding conjunctiva has flattened and the sclera has epithelialized. Surgical wound closure is an alternative management and may be the way to prevent scleral dellen formation after bare sclera technique. All patients after bare sclera surgery should be followed up until the conjunctival wound has healed. If delayed healing is found, frequent artificial tears, patching, or surgical intervention is necessary.     

Outcome of pterygium surgery: analysis over 14 years

AIM: To report the outcome of pterygium surgery performed at a tertiary eye care centre in South India. METHODS: Retrospective analysis of medical records of 920 patients (989 eyes) with primary and recurrent pterygia operated between January 1988 and December 2001. The demographic variables, surgical technique (bare sclera, primary closure, amniotic membrane transplantation (AMT), conjunctival autograft (CAG), conjunctival-limbal autograft (CLAG), or surgical adjuvants), recurrences and postoperative complications were analysed. RESULTS: A total of 496 (53.9%) were male and 69 (7.5%) had bilateral pterygia. Bare sclera technique was performed in 267 (27.0%) eyes, primary conjunctival closure in 32 (3.2%), AMG in 123 (12.4%), CAG in 429 (43.4%), and CLAG in 70 (7.1%). Adjuvant mitomycin C was used in 44 (4.4%) cases. The mean duration of follow-up was 8.9+/-17.0 and 5.9+/-8.8 months for unilateral primary and recurrent pterygia, respectively. The overall recurrence rate was 178 (18.0%). Following primary and recurrent unilateral pterygium excision respectively, recurrences were noted in 46 (19.4%) and 1 (33.3%) eyes after bare sclera technique, five (16.7%) and 0 after primary closure, 28 (26.7%) and 0 with AMG, 42 (12.2%) and five (31.3%) with CAG, and nine (17.3%) and two (40%) with CLAG. Recurrences were significantly more in males with primary (23.3 vs 10.7%, P<0.0001) and recurrent (26.7 vs 0%, P=0.034) pterygia, and in those below 40 years (25.2 vs 14.8%, P=0.003). CONCLUSION: CAG appears to be an effective modality for primary and recurrent pterygia. Males and patients below 40 years face greater risk of recurrence. Bare sclera technique has an unacceptably high recurrence. Prospective studies comparing CAG, CLAG, and AMG for primary and recurrent pterygia are needed.     

Intraoperative mitomycin C versus autologous conjunctival autograft in surgery of primary pterygium with four‐year follow‐up

Purpose: To compare the 4‐year outcome of primary pterygium excision using intraoperative mitomycin C (MMC) with suturing a free conjunctival autograft (CA). Methods: A total of 115 eyes with nasal primary pterygium of 115 patients were included in the study. After randomization into two groups, the eyes were operated on by a single surgeon (GK). After excision of the pterygium, 56 eyes received 0.04% MMC intraoperatively on the bare sclera for 3 min and 59 eyes received a free CA sutured using 7‐0 Vicryl. Postoperative follow‐up was 4 years. Main outcome measures were recurrences, re‐operations, surgery time, complications, visual acuity and astigmatism. Statistical evaluation was performed with the chi‐squared test. Results: The recurrence rate was 38% in the MMC group and 15% in the CA group (p < 0.05). The re‐operation rate of the recurrences was 53% in the MMC group and 29% in the CA group. Average surgery time was 13 minutes (range: 6–22 min) in the MMC group and 26 min (range: 18–32 min) in the CA group (p < 0.01). There was no significant change in best‐corrected visual acuity and astigmatism. One major complication occurred in each group. The most frequently observed complication was delayed epithelial healing (40%) and mild scleral thinning (20%) in the MMC group and suture‐related inflammation in the CA group (10%). Conclusion: Pterygium surgery including free autologous conjunctival grafting is associated with fewer recurrences, re‐operations and complications than using the bare sclera technique together with single‐dose intraoperative MMC.     

Intraoperative daunorubicin versus conjunctival autograft in primary pterygium surgery

PURPOSE: To evaluate the safety and efficacy of intraoperative daunorubicin during a bare sclera procedure in primary pterygium surgery and to compare with conjunctival autograft. METHODS: The data for 84 patients who underwent pterygium surgery at Safdarjung Hospital and Guru Nanak Eye Center were analyzed retrospectively. The patients were divided into two groups: group A, those who underwent bare sclera excision along with conjunctival autograft, and group B, those who underwent bare sclera excision with intraoperative daunorubicin (0.02%) for 3 minutes. We evaluated pterygium recurrence and postoperative complications for both groups. Recurrence of pterygium was defined as growth of 2 mm of fibrovascular tissue over the corneoscleral limbus into the clear cornea in the area of previous pterygium excision. RESULTS: Follow-up ranged from 18 to 37 months (mean, 27). Recurrence rates of 8.33% (three of 36) and 7.14% (three of 42) were found in groups A and B, respectively. When compared statistically, the difference was not significant. All the recurrences occurred in patients younger than 30 years of age. Pyogenic granuloma, graft edema, loose graft, and dellen formation were seen, respectively, in 5.5% (two of 36), 2.77% (one of 36), 2.77% (one of 36), and 2.77% (one of 36) patients in group A. Nine of 42 (21.42%) patients in group B had chemosis of the conjunctiva and two of 42 (4.76%) had delayed epithelization. CONCLUSION: We conclude that intraoperative daunorubicin (0.02%) and conjunctival autograft are both equally effective adjuncts to pterygium surgery.     

角膜缘上皮移植联合丝裂霉素C治疗翼状胬肉

目的 探讨自体角膜缘上皮移值联合丝裂霉素C在降低翼状胬肉术后复发率方面的作用。方法常规方法切除翼状胬肉后，先用丝裂霉素C棉片贴敷，然后自体角膜缘上皮移植，覆盖巩膜暴露区。结果术后观察6～22月，手术42眼，有2眼复发，复发率为4．8％。并发症有异物感、流泪4眼(9．5％)，结膜创口愈合延迟2眼(4．8％)，浅层点状角膜炎1眼(2．4％)，干眼症2眼(4．8％)。结论自体角膜缘上皮移植联合丝裂霉素C能有效地降低翼状胬肉术后复发率，手术方法简单、安全、并发症少。     

Conjunctival autografting combined with low-dose mitomycin C for prevention of primary pterygium recurrence

PURPOSE: To compare the clinical outcome of pterygium surgery combining intraoperative mitomycin C (MMC) with a free conjunctival autograft, with three other methods of pterygium surgery, including intraoperative MMC alone, conjunctival autograft alone, and bare sclera without adjunctive treatment. DESIGN: Interventional, randomized and in part nonrandomized, prospective, comparative study. METHODS: setting: A university medical center department of ophthalmology. STUDY POPULATION: One hundred and twenty patients underwent pterygium excision surgery. These patients were divided into four treatment groups. INTERVENTION: In group 1 (30 patients), MMC, 0.2 mg/ml, was applied for three minutes. In group 2 (30 patients), conjunctival autografting was performed. Group 3 (30 patients) received sodium chloride 0.9% only, and group 4 (30 patients) underwent conjunctival autografting combined with one minute application of MMC, 0.2 mg/ml. MAIN OUTCOME MEASURE: Recurrence rates and complications. RESULTS: Pterygium recurred in two patients (6.6%) in group 1, in four patients (13.3%) in group 2, in 14 patients (46.6%) in group 3, and in none of the patients in group 4. chi(2) analysis revealed a significantly lower recurrence rate in group 4 compared with group 2 (P = .038) and with group 3 (P < .0001). Epithelialization of the wounds was complete within 14 days of surgery. No complications were demonstrated in any of the study groups except for one case of minor melting of the flap in group 4. CONCLUSIONS: This study indicates that pterygium excision with a free conjunctival autograft combined with intraoperative low-dose MMC is a safe and effective technique in pterygium surgery.     

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。     

Long-term results after bare sclera pterygium resection with excimer smoothing and local application of mitomycin C

PURPOSE: To evaluate the long-term results and complications after bare sclera pterygium excision with local application of mitomycin C and consecutive smoothing of the wound area with an excimer laser (PTK). METHODS: This was an observational case series of 133 eyes of 101 patients who underwent pterygium surgery using the bare sclera technique. Thirty-one of these treated eyes (23%) were recurrences with a mean of 3 previous operations. After pterygium surgery, phototherapeutic keratectomy with an ArF:excimer laser was performed in the area of the excision. Additionally, all patients were treated with mitomycin C 0.02% twice daily for 4 days. Median follow-up was 53 months (minimum, 36). RESULTS: In the group with primary pterygia, 3 recurrences occurred after 6, 12, and 28 months (recurrence rate, 2.9%). In the group with previous pterygium operations, 2 recurrences (recurrence rate, 6.4%) were recorded. Uncorrected visual acuity of all treated patients improved from 0.61 preoperatively to 0.79 postoperatively (P < 0.0001), best corrected visual acuity increased from 0.82 to 0.91 (P = 0.0001) [LogMAR]. Mean astigmatism was significantly reduced from 1.54 D preoperatively to 0.61 D postoperatively (P < 0.0001). In 7 eyes, discrete granulomas developed postoperatively (5.3%); in 3 cases (2.3%), dellen formation occurred that persisted for a maximum of 4 months. No further complications were recorded during the follow-up. CONCLUSIONS: Pterygium excision using the bare sclera technique, phototherapeutic keratectomy, and local application of mitomycin C 0.02% eyedrops is a safe method with good functional results and a low recurrence rate.     

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.     

Pterygium surgery: conjunctival autograft using a fibrin adhesive

PURPOSE: To evaluate the efficiency and safety of using a fibrin adhesive (Tissucol Duo, Baxter AG, Vienna, Austria) to avoid the need for sutures during conjunctival autograft surgery for primary pterygium. METHODS: Twenty patients (20 eyes) with primary nasal pterygium were subjected to conjunctival autograft surgery. The free conjunctival graft placed over the bare sclera was fixed to the surrounding conjunctiva and cornea using the fibrin glue. An occlusive patch was applied. The outcome of surgery and any possible complications were periodically assessed. RESULTS: Mean patient age was 54.9 years (28-75 years). The mean follow-up time was 26.05 +/- 3.15 (SD) weeks. The time of surgery was 15 to 20 minutes. During the postoperative course, none of the patients felt pain, and only 5/20 (25%) had the mild sensation of the presence of a foreign body. In 18/20 (90%) patients, the conjunctival autograft was observed to be correctly positioned and fixed in all the follow-up exams. No sutures were used during or after surgery. There were no cases of regrowth of the pterygium. CONCLUSION: Our findings demonstrate the safety and efficiency of Tissucol Duo as a conjunctival adhesive for pterygium autograft surgery as treatment of primary pterygium. Because of its fast and easy application, this product considerably reduces the time of surgery. Its use also avoids complications derived from sutures and diminishes the sensation of a foreign body in the eye following surgery.     

Current concepts and techniques in pterygium treatment

PURPOSE OF REVIEW: Pterygium is a common ocular disorder in many parts of the world. At present, there is a wide variety of surgical methods but very few clinical guidelines on the optimal treatment of primary or recurrent pterygium. The purpose of this review is to summarize the more recent and relevant studies on pterygium treatment. RECENT FINDINGS: The primary aim is to excise the pterygium and prevent its recurrence. As bare sclera excision is associated with a high recurrence rate, pterygium excision is often combined with conjunctival autograft, mitomycin C, beta-irradiation or other adjunctive therapies to reduce recurrence rates. There is currently, however, no consensus regarding the ideal treatment for the disease. Comparability between studies is also hampered by the various definitions of pterygium recurrence. SUMMARY: This article reviews the current concepts and techniques used for the treatment of pterygium. Conjunctival autografting and mitomycin C application are the most commonly used methods for preventing recurrences. The use of mitomycin C and beta-irradiation should be used judiciously because of the potential long-term risk of sight-threatening complications. Additional clinical trials should be performed to evaluate the relative efficacies and long-term safety of the various treatment modalities.     

Pterygium treatment using 5-FU as adjuvant treatment compared to conjunctiva autograft

BACKGROUND: The use of conjunctiva autograft, adjunct antimetabolite therapy has been shown to be effective in preventing pterygium recurrence. OBJECTIVE: To compare 5 fluorouracil (5-FU) to conjunctival autograft in the treatment of large, fleshy pterygium. METHODS: A randomised controlled prospective study of outcome of pterygium treatment using 5-FU as adjuvant treatment compared to conjunctiva autograft. Thirty-five eyes with large pterygium treated with bare sclera conjunctival excision plus 5-FU were compared with 33 eyes treated with excision and conjunctival autograft alone. RESULTS: Post-operative pterygium recurrence was observed in four (11.4%) eyes treated with 5-FU and 4 (12.1%) eyes treated with conjunctiva autograft (P>0.05). The post-operative complications included, granuloma formation 11.4% for 5-FU and 3.0% for autograft and conjunctival discharge 5.7% for 5-FU group only. CONCLUSION: 5-FU is marginally superior to conjunctival autograft in the prevention of pterygium recurrence but neither gives a more desirable single digit recurrence rate. Randomised studies combining both conjunctival autograft and 5-FU in pterygium treatment is advocated to further explore their effect.     

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。     

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。