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。     

复发性翼状胬肉的综合治疗及临床观察

目的探讨复发性翼状胬肉的治疗方法。方法对65例(68眼)复发性翼状胬肉,先行平阳霉素注射后再行手术切除。术中加用丝裂霉素,再行角膜缘干细胞移植。术后滴用皮质类固醇和色甘酸钠。结果术后6月复诊观察,68眼中,1眼复发(1.47%),余67眼随诊2年未见复发,无并发症出现。结论综合治疗是复发性翼状胬肉有效的治疗方法。     

应用羊膜移植手术治疗复发性翼状胬肉

翼状胬肉是一种临床常见的外眼病 ,药物治疗及手术临床效果均不很理想。传统的翼状胬肉切除术 ,其复发率可高达 30～ 5 0 % 〔1〕。以往曾有用手术切除联合应用丝裂霉素等免疫抑制剂的方法进行治疗复发性胬肉 ,便因有许多副作用而无法广泛应用。现对 14例 14眼复发性翼状胬肉患者行常规翼状胬肉切除术并一期行保存羊膜移植术治疗 ,观察羊膜移植的临床疗效。临床资料 :本组 14例患者共 14只患眼。女 8例 ,男 6例。右眼 7例 ,左眼 7例。均为常规翼状胬肉切除术后复发者 ,其中 4例在本次手术前曾行 2次胬肉切除术。本组手术距上次手术时间为 6…     

羊膜移植治疗复发性翼状胬肉

复发性翼状胬肉 (下简称胬肉 )因其范围大 ,进展快 ,再次手术复发率更高 ,为临床上较为棘手的一种眼病。我科于 1998年以来采用羊膜移植治疗复发性翼状胬肉 ,经过临床观察 ,疗效满意 ,报告如下。临床资料 :本组 2 2例 2 4眼 ,年龄 46～ 75岁。发病时间 10～ 30年 ,平均 15 6年。 1次手术后复发 18眼 ,2次手术后复发 6眼 ,胬肉均位于鼻侧 ,长入角膜均在 4ｍｍ以上。手术方法 :(1)羊膜制备 :将剖腹产后获得的人类健康胎盘 ,在无菌操作下用含有 5 0ｍｇ/ｍｌ链霉素和 4ｍｇ/ｍｌ庆大霉素的平衡液清洗胎盘表面的血凝块 ,将羊膜从绒毛上钝性分离…     

自体角膜缘移植治疗复发性翼状胬肉

从1998年3月～2001年3月我科采用翼状胬肉切除术加自体角膜缘干细胞移植术治疗复发性翼状胬肉33例37眼。经随访观察疗效满意，现报告如下。     

90Sr敷贴治疗复发性翼状胬肉疗效分析

我院于 1999年 1月至 2 0 0 1年 6月用翼状胬肉根治术联合术后90 Sr敷贴治疗 18眼复发性翼状胬肉 ,并与同期施行的单纯根治术进行对照 ,报告如下。1　资料与方法1.1　临床资料　 2 8例 2 8眼复发性翼状胬肉。年龄 40～ 69岁 ,平均 5 4岁± 7 82岁。随机分为A、B两组。A组行根治术后联合放射性核素90 Sr敷贴治疗 ,B组单纯行翼状胬肉根治术。术后随访 18～ 2 6个月。1.2　复发性翼状胬肉切除方法　 1%丁卡因表面麻醉 ,2 %利多卡因 3ml眼球周围浸润麻醉。在翼状胬肉根治切除方法基础上扩大切除范围。用圆韧刀沿胬肉头部前 0 5mm处划开一浅…     

自体干细胞移植治疗复发性翼状胬肉疗效观察

翼状胬肉（以下简称胬肉）是眼科的常见病,常规手术后复发率高,作者对14例14眼复发性翼状胬肉,在彻底切除病变组织后行同眼颞上方角结膜瓣移植术,取得了较好的效果。     

手术切除联合羊膜移植治疗复发性翼状胬肉

翼状胬肉术后复发率较高。我们近年来采用显微手术切除联合羊膜移植治疗复发性翼状翼肉，取得了较好的疗效，现报告如下：     

羊膜移植治疗复发性翼状胬肉临床观察

目的：观察羊膜移植治疗复发性翼状胬肉的疗效。方法：共治疗复发性翼状胬肉60只眼。按常规方法切除胬肉组织,巩膜裸露区采用保存的人着膜移植。结果：随访1年,56只眼角膜透明,无新生血管及结膜样组织增生,巩膜区结膜覆盖良好,充血消失。手术成功率93%,4只眼翼状胬肉复发（7%）。结论：羊膜移植治疗复发性翼状胬肉有独特疗效,治疗愈率高,复发率低,是目前较为理想的手术方法。     

Cyclooxygenase-2 expression in primary and recurrent pterygium

Background: Pterygia are common, benign, fibrovascular, and infiltrative processes of the corneo-conjunctival junction of unknown pathogenesis. Cyclooxygenase-2 (COX-2) mediates the rate-limiting step in arachidonic acid metabolism. Extensive evidence indicates that the COX-2 prostanoid pathway is involved in inflammation. The aim of the study was to document the immunohistochemical expression of COX-2 in primary and recurrent pterygia. Materials and Methods: In this study, 21 primary pterygia and 12 recurrent pterygia from subjects undergoing pterygium surgery and six normal corneal-scleral tissue specimens were studied immunohistochemically for COX-2 expression. Results: COX-2 was expressed in primary pterygia and recurrent pterygia specimens. There was a statistically significant difference in COX-2 expressions in fibroblasts between primary and recurrent pterygium cases ( P = 0.001). There were statistically significant differences in COX-2 expressions in surface epithelium ( P = 0.028) and stromal inflammatory cells ( P =0.000) between control tissues and primary pterygia tissues. We also detected statistically significant differences in COX-2 expressions in surface epithelium ( P =0.000), stromal fibroblasts P =0.000 (stromal fibroblasts and inflammatory cells), vessels ( P = 0.027) and inflammatory cells ( P =0.001) between control tissues and recurrent pterygia tissues. Conclusions: This is the first study to document the expression of COX-2 in primary and recurrent pterygia. In our opinion after excision of pterygia, fibroblastic proliferation continues and this contributes to recurrence.     

Comparative evaluation of lymphatic vessels in primary versus recurrent pterygium

Purpose

To compare lymphangiogenesis in primary versus recurrent pterygium.

Methods

Tissues from 88 excised primary and 34 recurrent pterygia were evaluated, and tissues from 7 nasal epibulbar conjunctivae segments were used as controls. The lymph-vascular area (LVA), lymph-microvascular density (LMD), and lymph-vascular luminal diameter (LVL) were examined and compared between the primary and recurrent pterygia. In addition, the expression of VEGF-A and VEGF-C in the primary and recurrent pterygia were determined by ELISA and real-time PCR. The relationships between the mRNA level and LVA, LMD, and LVL were clarified.

Results

Although there was no significant difference in quantification of LVL between primary and recurrent pterygia, the quantification of LVA and LMD in recurrent pterygia dramatically increased in comparison with primary pterygia (both P-values <0.01). Compared with primary pterygia, the VEGF-A and VEGF-C mRNA levels were up-regulated significantly in recurrent pterygia (both P-values <0.05). There was a significant relationship between VEGF-C mRNA and LVA, LMD, and LVL, while VEGF-A mRNA was only closely correlated with LMD in recurrent pterygia.

Conclusions

Lymphangiogenesis develops in recurrent pterygium, for which transient up-regulation of VEGF-C might be responsible.     

Relationship between angiogenesis and lymphangiogenesis in recurrent pterygium

AIM: To examine the relationship between angiogenesis and lymphangigenesis in recurrent pterygia. METHODS: Tissues from 34 excised recurrent pterygia (including 12 Grade 1, 10 Grade 2, and 12 Grade 3) were involved in the study and tissues from 7 nasal epibulbar conjunctivae segments were used as controls. Sections from each pterygium were immunostained with CD₃₁ and LYVE-1 monoclonal antibodies to evaluate lymphatic microvessel density (LMVD) and blood microvessel density (BMVD), and the relationship between LMVD and BMVD in the pterygium was examined. RESULTS: There was a large number of CD₃₁⁽⁺⁾LYVE-1^(-) blood vessels but only a few CD₃₁⁽⁺⁾LYVE-1⁽⁺⁾ lymphatic vessels in grades 1 and 2 pterygium. However, lymphatic vessels were dramatically increased in grade 3 pterygium. LMVD correlated closely with BMVD in all pterygia, including grades 1, 2 and 3 peterygium patients (all P values <0.01). Although both the density of blood and lymphatic vessels increased in recurrent pterygia, lymphatic vessels developed much faster than blood vessels, especially in grade 3 pterygia. CONCLUSION: There is a significant but not parallel relationship between angiogenesis and lymphangiogenesis in recurrent pterygium. The outgrowth of blood and lymphatic vessels provide evidence that immunological mechanism may play a role in the development and recurrence of pterygium.     

复发性与原发性翼状胬肉广泛切除联合羊膜移植治疗观察

目的:评估广泛性翼状胬肉切除联合羊膜移植术治疗复发性与原发性翼状胬肉的疗效。方法:回顾性分析作者手术治疗的复发性翼状胬肉患者38例40眼(A组)及原发性翼状胬肉195例231眼(分为B组156例185眼和C组39例46眼),追踪观察1～6a。结果:行广泛性翼状胬肉切除联合羊膜移植术后A组复发6眼,复发率为15%,B组复发11眼,复发率为6%。C组行单纯广泛性翼状胬肉切除术后复发10眼,复发率22%。A组与B组(P<0.05),B组与C组(P<0.01)间复发率的差异具有统计学意义。结论:广泛性翼状胬肉切除联合羊膜移植术治疗复发性与原发性胬肉安全有效,能降低术后复发率,但对原发性胬肉的效果更好。     

复发性翼状胬肉切除联合自体角膜缘上皮移植的疗效分析

目的:探讨翼状胬肉切除联合自体角膜缘上皮移植治疗复发性翼状胬肉的疗效。方法:对129例(135眼)复发性翼状胬肉在显微镜下行胬肉切除联合自体角膜缘上皮移植术。结果:术后观察10mo,复发2眼,复发率1%。结论:显微镜下行胬肉切除联合自体角膜缘上皮移植术治疗复发性翼状胬肉复发率低,疗效确切。     

采用生物羊膜移植治疗复发翼状胬肉临床观察

目的：观察生物羊膜移植对治疗复发翼状胬肉疗效的影响。
　　方法：采用生物羊膜移植术治疗56例68眼复发翼状胬肉,手术在显微镜下完成。观察术后反应,植片生长及翼状胬肉的复发情况。
　　结果：术后随访17（5．17±1．22）mo,角膜创面上皮愈合时间为4．61±1．23d,羊膜移植手术均一次成功,无1例出现植片排斥,无角巩膜溃汤,无睑球粘连和眼球运动受限。结论：生物羊膜阻断新生血管形成,可快速促进创面上皮愈合,术后无复发和眼部感染,是安全有效的手术方法。     

大范围切除联合新鲜羊膜移植治疗复发性翼状胬肉

目的:观察大范围切除联合新鲜羊膜移植术在治疗复发性翼状胬肉的临床疗效。方法:对复发性翼状胬肉47例50眼在显微镜下行大范围翼状胬肉切除联合新鲜羊膜移植术,观察术后胬肉复发及眼表修复情况。结果:术后随访观察6～36mo,4眼复发,46眼治愈,复发率为8%。结论:大范围翼状胬肉切除联合新鲜羊膜移植治疗复发性翼状胬肉能够有效降低胬肉的复发,且羊膜取材方便,手术操作简单,有利于基层医院开展。     

自体角膜缘干细胞移植治疗复发性翼状胬肉

目的观察自体角膜缘干细胞移植术治疗复发性翼状胬肉的临床效果。方法对复发性翼状胬肉27例(30眼)在手术显微镜下行胬肉切除加自体角膜缘干细胞移植术,术后随访6月以上,观察其效果。结果30眼中治愈29眼,治愈率为96.67%;1眼胬肉复发,复发率3.33%。结论角膜缘干细胞移植术能明显减少胬肉手术的复发率。     

原发性与复发性翼状胬肉的临床指标及实验室指标差异

翼状胬肉是一种临床常见的人眼表结膜疾病,目前主要归因于慢性紫外线暴露。以往研究主要集中于翼状胬肉的临床特点、外科治疗和发病机制,而对原发性翼状胬肉和复发性翼状胬肉的区别归纳较少。本文总结了关于原发性和复发性胬肉的差异性研究的最新发现,对原发性和复发性翼状胬肉的临床表现、组织病理学、实验室研究差异进行一综述。