减少翼状胬肉复发的三种术式疗效比较

目的 比较丝裂霉素C应用加带蒂结膜瓣转移术;羊膜移植术、自体带结膜瓣的角膜缘干细胞移植术治疗初发翼状胬肉的临床疗效,寻求一种理想的手术方法.方法 将95例(110眼)患者随机分为三组,分别采用丝裂霉素C应用加带蒂结膜瓣转移术(MMC组,34眼)、羊膜移植术(AMT组,37眼)和自体带结膜瓣的角膜缘干细胞移植术(ALCT组,39眼),术后随访一年,比较创面修复时间及复发率.结果 ALCT组1眼复发,复发率为2.56%,AMT组3眼复发,复发率为8.11%,两组比较差异无统计学意义(P＞0.05),MMC组9眼复发,复发率为26.47%,与其它两组比较差异有统计学意义(P＜0.05).角膜创面上皮平均修复时间ALCT组为(4.73±1.15)d,AMT组(6.36±1.35)d,MMC组为(8.56±1.15)d,三组比较差异有统计学意义(P＜0.05).结论 自体带结膜瓣的角膜缘干细胞移植术治疗初发性翼状胬肉术后复发率低,角膜创面修复快,是一种理想的手术方法.     

不同术式治疗原发性翼状胬肉的临床效果分析

目的:比较分析羊膜移植术、自体角膜缘干细胞移植术及术中应用0.2g/L丝裂霉素C治疗原发性翼状胬肉的临床效果。方法:回顾性分析我院232例曾行原发性翼状胬肉手术的患者,其中82例行羊膜移植术治疗,90例行自体角膜缘干细胞移植术治疗,60例在术中应用0.2g/L丝裂霉素C治疗,比较三种术式术后复发率及并发症。结果:自体角膜缘干细胞移植术和术中应用0.2g/L丝裂霉素C治疗原发性翼状胬肉的复发率低于羊膜移植术(P<0.05);而自体角膜缘干细胞移植术和术中应用0.2g/L丝裂霉素C之间复发率无差异(P>0.05)。角膜上皮缺损,流泪和畏光在0.2g/L丝裂霉素组发生比例较其他两组高(P<0.05),在自体角膜缘干细胞移植组和羊膜移植组两组间差异无统计学意义(P>0.05)。结膜充血及结膜下出血在三组间无统计学差异(P>0.05)。结论:与其他两种术式相比,自体角膜缘干细胞移植术治疗原发性翼状胬肉,有着复发率低、并发症少的优点。     

两种术式联合丝裂霉素C治疗翼状胬肉

目的探讨结膜瓣转移术或羊膜移植术联合丝裂霉素C治疗翼状胬肉的疗效。方法采用双盲法将翼状胬肉患者分成A、B两组。两组患者翼状胬肉切除后,术中一次性应用丝裂霉素C(0.2 mg/mL),A组36例采用结膜瓣转移术,B组32例采用羊膜移植术。观察患者术后症状、角膜上皮愈合及复发率。结果随访6月,A组复发率为2.70%,B组复发率为6.13%(2χ=0.484,P>0.05)。结论结膜瓣转移术或羊膜移植术联合丝裂霉素C治疗翼状胬肉均能有效防止术后胬肉复发。     

两种术式治疗翼状胬肉疗效观察

目的 比较胬肉切除联合自体结膜瓣移植术和胬肉切除联合角膜缘干细胞移植术治疗翼状胬肉的效果.方法 对2008年1月至2012年4月在我院采用两种术式治疗的134例患者的病案资料进行回顾性分析.结果 胬肉切除联合自体结膜瓣移植术治愈率为89.9％,胬肉切除联合角膜缘干细胞移植术治愈率为94％,两种治疗方法比较有统计学意义（x2=4.7947,P＜0.05）.结论 胬肉切除联合角膜缘干细胞移植术的效果优于胬肉切除联合白体结膜瓣移植术.     

翼状胬肉三种不同术式的疗效分析

我院分别采用翼状胬肉切除联合自体结膜角膜缘上皮移植术、翼状胬肉切除联合保存人羊膜移植术及翼状胬肉切除巩膜暴露术3种术式对翼状胬肉进行治疗，现将不同术式的疗效分析结果报告如下。     

翼状胬肉不同术式预防复发的对比研究

目的采用翼状胬肉切除联合丝裂霉素及羊膜移植术和翼状胬肉切除联合丝裂霉素及自体角膜缘干细胞移植术,与以往传统的胬肉切除及暴露角膜缘巩膜术方法进行对比研究。方法将翼状胬肉随机分为3组,每组50例,A组:胬肉切除及暴露角膜缘巩膜术组50例(50眼);B组:翼状胬肉切除联合丝裂霉素及羊膜移植术组50例(50眼);C组:翼状胬肉切除联合丝裂霉素及自体角膜缘干细胞移植术组50例(50眼)。术后随访3~22月,对3种不同术式预防复发进行研究。结果A组复发10眼(20.00%),B组复发3眼(6.00%),C组复发2眼(4.00%)。B组和C组与A组对比差异有统计学意义(P<0.01),B组与C组对比差异无统计学意义(P>0.05)。结论翼状胬肉切除联合丝裂霉素及羊膜移植术和翼状胬肉切除联合丝裂霉素及自体角膜缘干细胞移植术都能有效预防翼状胬肉复发。     

不同手术方式治疗翼状胬肉的临床疗效分析

目的：探讨不同手术方式治疗翼状胬肉的临床效果。

方法：对我院2006-01/2010-12行不同手术方式治疗的164例206眼翼状胬肉患者的临床资料进行回顾性分析。A组(36例50眼)采用单纯切除术; B组(41例47眼)采用单纯切除联合丝裂霉素术; C组(42例52眼)采用胬肉切除联合丝裂霉素和羊膜移植术; D组(45例57眼)采用胬肉切除联合自体角膜缘干细胞移植术。记录每例手术时间,术后1wk; 3,6,12,24mo进行随访观察,观察结膜愈合及胬肉复发情况等。

结果：A组复发率最高,B组复发率有所降低,C、D 组复发率较A组及B组明显降低,C、D 组复发率无明显差异。手术时间方面,单纯切除组的手术时间明显短于其他组,羊膜移植及自体角膜缘干细胞移植组的手术时间较长。复发主要发生在术后1a内。

结论：丝裂霉素可以降低单纯胬肉切除术的复发率,角膜缘干细胞移植及羊膜移植术可以更有效的降低胬肉的复发率。     

不同术式治疗翼状胬肉的疗效观察

0引言原发性翼状胬肉是一种原因仍不很清楚的眼科常见病和多发病之一。传统的单纯胬肉切除,手术快捷,但术后复发率较高,一般为30%～50%,甚至高达69%[1]。近年来,随着角膜缘干细胞理论的提出和人们对羊膜功能认识的深入,手术方法得以不断改进,方法较多。我们对照观察分别采用单纯胬肉切除,羊膜移植,自体角膜缘干细胞移植3种不同术式治疗翼状胬肉的术后疗效,并报告如下。1对象和方法1.1对象所有患者63例63眼均系2006-12/2008-12在我院眼科治疗患者。其中,单纯胬肉切除组25例25眼,羊膜移植术组20例20眼,自体角膜缘干细胞移植术组18例18眼。年龄45～68(平均57.5)岁。1.2方     

翼状胬肉术中丝裂霉素C的应用

目的 丝裂霉素C能抑制翼状胬肉切除术后的复发,研究胬肉切除术中应用丝裂霉素C治疗翼状胬肉的有效性和安全性.方法 将原发性翼状胬肉患者随机分为三组,术中应用0.02%丝裂霉素C组、术后用0.02%丝裂霉素C组和胬肉切除加角膜缘干细胞移植术组,观察术后复发率和并发症情况.结果 共有132例153只眼纳入本研究,其中术中用丝裂霉素C组50只眼中3只眼复发(6.0%),术后用丝裂霉素C组51只眼中4只眼复发(7.5%),胬肉切除加角膜缘干细胞移植术组52只眼中3只眼复发(5.8%).三组间差别无统计学意义(P>0.05);随访期间三组患者均没有出现严重的并发症.结论 翼状胬肉切除术中应用丝裂霉素C是治疗翼状胬肉简易有效地方法,且较术后应用丝裂霉素C可能更为安全.     

羊膜与自体角膜缘结膜移植治疗翼状胬肉疗效对比

目的　评价羊膜移植与自体角膜缘结膜移植治疗翼状胬肉疗效并进行对比。方法　原发性翼状胬肉 48例 ( 4 8眼 ) ,随机分成A、B两组 ,每组 2 4例。A组采用羊膜移植术 ;B组采用自体角膜缘结膜移植术 ,观察翼状胬肉术后复发情况。结果　术后随访 3～ 6月 ,A组 2例复发 ( 8 3 % ) ,3例羊膜下有瘢痕形成 ;B组 1例复发 ( 4 2 % ) ,未见结膜植片下有瘢痕形成。2组复发率对比差异有显著性 (P <0 0 1)。结论　羊膜移植与自体角膜缘结膜移植均不失为防治翼状胬肉术后复发的治疗方法。但自体角膜缘结膜移植更优于羊膜移植。     

翼状胬肉的不同手术方法疗效分析

目的比较自体角膜缘干细胞移植联合丝裂霉素C,新鲜羊膜移植,及单纯性胬肉切除的临床疗效。方法将胬肉的病人83眼随机分A、B、C三组,A组26眼用单纯切除术,B组28眼用翼状胬肉切除联合新鲜羊膜移植手术,C组29眼行角膜缘干细胞移植联合丝裂霉素C应用,术后随访六月至一年,观其复发率。结果A组26眼中有8眼复发,复发率30．76％,B组28眼有5眼复发,复发17．85％,C组有2眼复发,复发率为6．89％。A组与C组比较复发率差异有统计学意义（χ2=4．32,P〈0．05）,B组与C组比较复发率差异有统计学意义（χ2=4．41,P〈0．05）。结论自体角膜缘干细胞移植联合丝裂霉素C明显有效的降低翼状胬肉术后的复发率,是比较理想的手术方法。     

翼状胬肉不同手术方法疗效分析

目的 比较自体角膜缘干细胞移植，新鲜羊膜移植及单纯性翼状胬肉切除对原发性翼状胬肉的临床疗效。方法 137例（167眼）翼状胬肉患者随机分为A、B、C组，A组48例行单纯性翼状胬肉切除术；B组53眼行翼状胬肉切除联合新鲜羊膜移植术；C组66眼行翼状胬肉切除联合自体角膜缘干细胞移植术。术后随访6月～60月，比较各组患者术后翼状胬肉复发情况。结果 A组48眼中16眼复发，复发率33．33％；B组53眼中8眼复发，为15．09％；C组66眼中3眼笔发，复发率为4．55％；A组与B组比较（X^2=4．47，P〈0．05）；B组与C组比较（X^2=3．90，P〈0．05）差异具有显著性。结论 自体角膜缘于细胞移植可有效地降低翼状胬肉术后的复发率，是目前较理想的手术方法。     

Comparison of conjunctival autograft and conjunctival transposition flap techniques in primary pterygium surgery

Purpose

To investigate and compare the efficacy of conjunctival autograft and conjunctival transpositional flap for the treatment of primary pterygium surgery.

翼状胬肉切除联合准分子激光治疗性角膜切削术与角膜缘干细胞移植术疗效对比观察

目的 对比观察两种治疗翼状胬肉的手术效果.方法 翼状胬肉患者123例124只眼,随机分为A组,(60只眼),行翼状胬肉切除联合准分子激光治疗性角膜切削术(PTK);B组,(64只眼),行翼状胬肉切除联合自体角膜缘干细胞移植术.比较其复发率、术后角膜修复情况、手术前后泪膜恢复及散光和矫正视力提高情况.结果 术后复发率两组差异无统计学意义,A组患者术后早期角膜修复情况、泪膜破裂时间的提高优于B组(P＜0.01).矫正视力的提高及散光减少在早期二者差异无统计学意义,晚期A组略高于B组(P＜0.05).结论 单纯胬肉切除联合准分子激光治疗性角膜切削术优于胬肉切除联合自体角膜缘干细胞移植术.

Abstract：

Objective To explore a safe and simple method ofpterygium surgery to reduce recurrence rate and side effect.Methods All 123 patients (124 eyes) were randomly divided into two groups:PTK surgery group (group A,60 eyes) and corneal limbal stem cells autograft transplantation surgery group (group B,64 eyes),then compared the recurrence rate,satisfaction rate,reparation of cornea,and tear function,astigmatism,beast corrected visual acuity (BCVA) before and after surgery.Results The recurrence rate of two groups was similar.There were statistically significant different of the reparation of cornea and tear function (BUT) after surgery in early days,P ＜0.001.No significant difference was found in eyesight raise and astigmatism decrease in early stage,but in later stage group A were raised compared group B,P ＜0.05.Conclusions Pterygium excision surgery with phototherapeutic keratectomy is a method which can achieve good effect and decrease surgery complication maximality.     

Safety profile and complications of autologous limbal conjunctival transplantation for primary pterygium

Purpose

Primary pterygium is a fibrovascular proliferation over the nasal cornea, probably resulting from the limbal stem cell deficiency. Intraoperative mitomycin-C application seems to associate with reduced recurrences, however produced ocular surface problems and vision threatening complications. The present clinical study investigated the safety profile of autologous limbal conjunctival transplantation in terms of recurrence rate, as the main outcome measure and complications as the secondary outcome.

Methods

The present study was randomised, interventional and prospective clinical study conducted from a tertiary Hospital. Pterygium excision was performed with limbal conjunctival autograft availed from the affected eye. Secondary pterygia resulting from inflammation, trauma and other diseases were excluded. Patients were followed up for 18 months for recurrence and other complications. Microsoft Office Excel 2007 was used for statistical analysis.

Results

A total of 71 eyes of sixty-eight patients with primary pterygia included between November 2007 and October 2010. The study recruited 35 (51%) males and 33 (49%) females with mean age of 36.9 with ±12.82 years standard deviation (mean, SD) ranging from 19 to 75 years. Age grouped by range intervals categorised into six groups. Pterygium was diagnosed in 32 (45%) right eyes and 39 (55%) left eyes. There were 65 (91.55%) nasal and 4 (5.63%) temporal pterygium and no case of double head pterygia found. Average horizontal extension of the pterygium measured was 1.67 mm (±4.23) from the apex to the corneal limbus. Graft oedema in 1 (0.71%) patient, graft bleed in 2 (1.42%) cases and 1 (0.72%) case of granuloma observed. No recurrences encountered during 18 months follow up.

Conclusions

Pterygium occurred predominantly in the younger population group 36.9 mm (±12.82) probably due to the increased outdoor activity with high exposure to sunlight and dusty atmosphere. Absence of recurrences was probably attributable to the smaller pterygium size of 1.67 mm (±4.23), use of the autologous limbal conjunctival graft and treatable intra and post operative complications successfully.     

Epithelial ingrowth following surgery of recurrent pterygium

Epithelial ingrowth is a rare but devastating condition of the eye, known to complicate incisional ocular procedures. We report a case of secondary glaucoma due to epithelial ingrowth following limbal conjunctival autograft in a case of recurrent pterygium. To prevent such devastating conditions from occurring dissection of recurrent pterygium demands special care to avoid anterior chamber penetration. Institution to which the work should be attributed: MR Bangoor Hospital.     

自體角膜緣幹細胞球結膜移植治療翼狀胬肉

目的探討自體角膜緣幹細胞球結膜移植治療翼狀胬肉的療效以及顯微手術技術的有關要點.方法應用自體角膜緣幹細胞球結膜移植治療翼狀胬肉38例52祗眼,其中静止期翼狀胬肉13例22祗眼,活動期25例30祗眼,包括復發性胬肉3例4祗眼,隨訪期最長18個月,最短6個月.結果經過平均11.80個月觀察,祗有1眼胬肉術後復發(占52祗眼的1.92%),其餘病例無復發,角膜上皮穩定、泪膜正常、供區角膜創面正常愈合.結論本術式是目前治療翼狀胬肉最爲安全有效的方法.     

自体角膜缘干细胞移植术治疗翼状胬肉

目的 评价自体角膜缘干细胞移植术治疗翼状胬肉的效果。方法 采用自体角膜缘干细胞移植术治疗初发性及复发性翼状胬肉76例87眼，术后随访6－68月，平均26月。结果 76例87眼，术后均无胬肉组织复发，被胬肉组织侵袭的角膜透明或遗留薄翳，无新生血管长入。结论 自体角膜缘干细胞移植术可为受损的角膜缘提供新的健康的干细胞，可有效防止翼状胬肉的复发，是治疗翼状胬肉的理想方法。     

Comparison between sutureless and glue free versus sutured limbal conjunctival autograft in primary pterygium surgery

Purpose

To compare and evaluate the safety and efficacy of two surgical techniques for the management of primary pterygium.

Design

Prospective randomized clinical trial using the CONSORT 2010 Statement (Consolidated Standards of Reporting Trials) for parallel group randomized trials.

Setting

Department of Ophthalmology, Al-Minya University, Faculty of Medicine, Egypt.

Methods

The study included 150 eyes of 150 patients with primary pterygium. The mean age was 49 ± 12 years (range 24–74 years). Simple excision under local anesthesia was performed followed by closure of the bare sclera by suture less and glue free conjunctival autograft in 50 eyes of 50 patients (group 1), versus the conventional method of a sutured conjunctival autograft in 100 eyes of 100 patients (group 2).

Results

The pterygium recurrence rate was 6% for group 1, 8% for group 2.Graft dehiscence occurred in 4 eyes out of 50 (8%) in group 1. Graft retraction occurred in 6 (12%) out of 50 eyes for group 1 versus 6 eyes (6%) in group 2. Pyogenic granuloma occurred in 3 (3%) eyes out of 100 in group 2. No other serious complications were noted. At the 3 week visit the overall patient satisfaction score was statistically significantly higher for group 1 (P < 0.002) compared to group 2. At 3 months postoperatively, the gain in uncorrected visual acuity (UCVA) ranged from 0.2 to 0.5 Log MAR in 10 eyes.

Conclusion

Sutureless and glue free conjunctival autograft technique is easy, safe, effective, prevents potential adverse reactions encountered with the use of foreign materials. This technique has an acceptable pterygium recurrence rate that is comparable to conventional sutured conjunctival autograft for primary pterygium.     

角膜缘干细胞移植与单纯球结膜瓣移植治疗翼状胬肉疗效比较

目的 比较自体角膜缘干细胞移植与单纯球结膜瓣移植治疗翼状胬肉的疗效.方法 对125例（133眼）患者随机行翼状胬肉切除联合自体角膜缘干细胞移植63例（67眼）或翼状胬肉切除联合单纯球结膜瓣移植62例（66眼）治疗翼状胬肉,随访8-12月,观察手术效果.结果 自体角膜缘干细胞移植组有4眼复发,复发率5.97％,单纯球结膜瓣移植组有5眼复发,复发率7.57％,两组相比较,差异无统计学意义（P＞0.05）.结论 自体角膜缘干细胞移植与单纯球结膜瓣移植均能有效的治疗翼状胬肉,复发率相差不明显,但自体角膜缘干细胞移植组患者术后相对角膜上皮修复时间短,恢复快,异物感轻.