AS-OCT在翼状胬肉切除联合自体结膜移植加戴绷带镜术后的结膜植片厚度测量中的应用

目的应用前段光学相干断层成像(anterior segment optical coherence tomography,AS-OCT)对翼状胬肉切除联合自体结膜移植加戴绷带镜术后患者球结膜植片厚度进行研究,同时研究绷带镜对翼状胬肉患者术后角膜上皮愈合率、疼痛评分的影响。方法回顾性分析2016年1月至2018年1月在我院眼科就诊的52例单眼初发翼状胬肉患者资料。行翼状胬肉切除联合自体球结膜移植加戴绷带镜26例为试验组,行相同手术方式但不加戴绷带镜26例为对照组,应用AS-OCT测量两组患者术后1 d、1周、2周及2个月鼻侧结膜植片距离巩膜突1 mm、2 mm及3 mm的厚度并进行比较,同时比较两组患者角膜上皮愈合率、疼痛评分。结果术后1 d,两组患者各部位结膜植片厚度比较,差异均无统计学意义(均为P>0.05);术后1周、2周、2个月,试验组各部位结膜植片厚度均较对照组薄,差异均有统计学意义(均为P<0.05)。术后1 d、1周,两组患者三处部位平均结膜植片厚度比较,差异均无统计学意义(均为P>0.05);术后2周、2个月,试验组患者三处部位平均结膜植片厚度均较对照组...     

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。     

Spectral domain anterior segment optical coherence tomography assessment of pterygium and pinguecula

Purpose: To study the morphological patterns of pterygia and pingueculae using high‐resolution anterior segment spectral domain optical coherence tomography (SD‐OCT). Methods: Prospective cross‐sectional study of 25 eyes presented with pterygia and pingueculae was conducted, and the eyes were examined by anterior segment SD‐OCT. Results: We examined 25 eyes, including 13 eyes with primary pterygia, six eyes with recurrent pterygia, one case with a pseudopterygium and five eyes with pingueculae. Primary pterygia revealed elevation of the corneal epithelium by a wedge‐shaped mass of tissue separating the corneal epithelium from the underlying Bowman’s membrane, which became wavy and interrupted. We found satellite masses of pterygium tissue advanced under the epithelium beyond the clinically seen pterygium margins. In recurrent pterygia, we detected that the central tip of the pterygium was more advanced and creeping beneath the basal corneal epithelium than the primary pterygium. In pseudopterygium, the SD‐OCT images showed that the overgrowing membrane was not really attached to the underlying cornea. In cases of pingueculae, SD‐OCT revealed a wedge‐shaped mass that was nearly similar in pattern to that of the pterygia but stopped at the limbal region. Immediately after removal of pterygia, we noticed many remnants of the pterygia masses over the corneal stroma in spite of the clinically clear appearance of cornea. Conclusions: SD‐OCT provided us with high‐resolution images of the pterygium and the pinguecula and showed clearly the anatomical relationship between the corneal tissues and these lesions. The use of this new modality of imaging may help to decrease the current recurrence rates after pterygium excision through using the anterior segment SD‐OCT in the evaluation of these lesions.     

前段光学相干断层成像测量翼状胬肉术后结膜植片厚度的临床研究

目的 应用前段光学相干断层扫描仪（Visante OCT）对翼状胬肉切除术后球结膜植片在不同时间内进行测量,对比观察球结膜植片厚度在翼状胬肉术后短期内的改变.方法 回顾性分析翼状胬肉切除联合球结膜移植术13例（13眼）,应用Visante OCT测量术后1周、1个月及3个月球结膜植片距离巩膜突1 mm、2 mm及3 mm的厚度;对照组对术眼相同位置的正常颞侧球结膜厚度进行测量.结果 术后1周,结膜植片的平均厚度最大为（456±169） μm,至术后1个月植片厚度逐渐减小至（303±64） μm,差异有统计学意义（t=3.055,P=0.002）;术后3个月植片厚度继续减小为（289±117） μm,但与术后1个月相比差异并无统计学意义（t=0.695,P=0.89）.设定位置相对应的颞侧球结膜厚度术后1周、1个月及3个月厚度别为（58±16） μm、（61±14） μm、（61±19） μm,差异无统计学意义;术后不同时间段内结膜植片厚度均明显大于正常结膜厚度.结论 通过Visante OCT的测量,翼状胬肉切除术后1周,结膜植片明显增厚;至术后3个月表现出厚度逐渐减小的趋势.Visante OCT可准确地对翼状胬肉术后结膜厚度做出较为准确的评估.     

羊膜移植与自体角膜缘联合结膜移植治疗复发性翼状胬肉比较

目的 观察羊膜移植术与自体角膜缘联合结膜移植术治疗复发性翼状胬肉的临床疗效.方法 40例（46眼）复发性翼状胬肉随机分成A、B 2组.A组20例（22眼）行羊膜移植术;B组20例（24眼）行自体角膜缘联合结膜移植术.结果 A组19眼术后效果良好,3眼术后不同程度复发,复发率13.64%;B组23眼术后效果良好,1眼术后5月复发,复发率4.17%.结论 自体角膜缘联合结膜移植术较单纯羊膜移植术治疗复发性翼状胬肉较有效.     

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.     

Efficacy of second donor conjunctival graft from the same site for pterygium - A retrospective analysis

Purpose:To know the efficacy of the second donor conjunctival graft from the same site as that of the previous donor area in pterygium treatment.Methods:Case record of patients were retrospectively analysed and those patients who had undergone pterygium excision previously, either for nasal or temporal pterygium excision and came with complaints of pterygium growth in opposite side of the bulbar conjunctiva in the same eye were included in the study. The patients with double head pterygium previously treated only over one side were also included. Total of 23 such patients were included in the study. The patients were followed up on post-operative day 1, 2 weeks, 6 weeks, 6 months and 1 year. The outcome measures like recurrence, graft edema, graft retraction, graft loss and other complications were noted in each follow up.Results:Among the 23 patients included in the study 9 were male and 14 were female patients with a mean age of 44±7.2 years (range 24-57 years). On an average follow up period of 15±8.5 months, only 1 patient among 23 patients had recurrence (4.43%). Other complications noted were graft retraction in 4 eyes (17.4%), sub conjunctival hemorrhage in 8 eyes (34.8%) and graft edema in 11 eyes (47.8%). Only one patient presented with granuloma (4.34%).Conclusion:The second conjunctival graft from the same site is safe and effective with encouraging results in indicated cases.     

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.     

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.

Mitomycin C and conjunctival autograft for recurrent pterygium

Purpose To observe the efficiency of intraoperative low-dose Mitomycin-C combined with conjunctival autograft in the treatment of recurrent pterygium. Methods Fifteen eyes with recurrent pterygium were included in this study. The mean age of the patients was 51.6 ± 11.4 (9 men, 6 women). All patients underwent excision of the pterygium tissue and subconjunctival fibrous tissue with a no cautery approach. 0.2 mg/ml Mitomycin-C (0.02%) was applied for 3 min. Conjunctival autograft was obtained from the superotemporal bulbar conjunctiva of the same eye. Eyes were followed for a mean period of 21.0 ± 9.1 months. Results Recurrence was seen in two eyes (13.3%) during the follow-up period. The only complication seen was graft edema (two eyes; 13.3%) which healed after pressure patching. Graft necrosis, scleral melting or failure of revascularization was not noted. Conclusion Intraoperative application of 0.2 mg/ml Mitomycin-C combined with conjunctival autograft reduces recurrence in recurrent pterygium cases, with minimal complications.     

自体角膜缘联合羊膜移植术与联合结膜移植术治疗复发性翼状胬肉比较

目的 比较自体角膜缘联合羊膜移植术和自体角膜缘联合结膜移植术治疗复发性翼状胬肉的疗效，探讨自体角膜缘联合羊膜移植术能否代替自体角膜缘联合结膜移植术治疗复发性翼状胬肉。方法 36例42眼复发性翼状胬肉患者随机分成A、B2组，A组18例22眼行自体角膜缘联合羊膜移植术；B组18例20眼行自体角膜缘联合结膜移植术。结果 A组20眼术后效果满意，2眼术后5个月复发，复发率9．09％；B组19眼术后效果满意，1眼术后3个月复发，复发率5．00％．2组术后复发率在统计学上无显著差异。结论 自体角膜缘联合羊膜移植术可代替自体角膜缘联合结膜移植术治疗复发性翼状胬肉。     

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。     

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.     

Comparison of inferior conjunctival autografting and conjunctival tissue grafting from pterygium itself in the cases of filtering blebs and glaucoma suspects-A retrospective analysis

Purpose:This study aims at comparing the effectiveness of inferior conjunctival autografting (CAG) and conjunctival tissue grafting from pterygium itself (CTG) in the cases of filtering blebs/glaucoma suspects.Methods:One hundered and five eyes of 97 patients who underwent pterygium excision with conjunctival autografting (CAG) in the period from 2010 to 2016 were included. Fifty one eyes had filtering blebs and 54 were glaucoma suspects. Fifty two eyes of 49 patients (Group 1) had undergone pterygium excision with inferior conjunctival autograft (CAG) and 53 eyes of 48 patients (Group 2) had undergone pterygium excision with conjunctival tissue graft (CTG) from the pterygium itself. The minimum follow up period was 6 months.Results:Both groups had 2 eyes with recurrence, which was not statistically significant. Among other complications, graft retraction was seen with a higher incidence in Group 2, which was statistically significant.Conclusion:In situations where sparing of the superior conjunctiva is mandatory, both the techniques of inferior conjunctival autografting and conjunctival tissue graft from the pterygium itself are excellent alternate options with comparable outcomes and no additional risk of significant complications.     

Sutureless and glue-free limbal-conjunctival autograft in primary and recurrent pterygium: A pilot study

Purpose:To evaluate and analyze the outcomes of sutureless and glue-free limbal-conjunctival autografting in cases of primary as well as recurrent pterygium.Methods:This prospective interventional study was carried out between February 2019 and February 2020 at a tertiary care hospital in North India. A total of 70 patients with pterygium underwent sutureless and glue-free limbal-conjunctival autograft. The patients were divided into two groups: group 1 patients with primary pterygium (n = 45), group 2 patients with recurrent pterygium (n = 25). The patients were followed up till 12 months postoperatively.Results:The mean age of the patients in group 1 and group 2 was 37.04 ± 8.69 years and 32.52 ± 6.49 years, respectively (P = 0.04). Postoperatively, no recurrence was recorded in group 1. Recurrence was noticed in two patients (8%) of group 2. The BCVA changed from 78.73 ± 9.86 letters to 80.15 ± 7.29 letters (P = 0.45) and from 79.6 ± 6.44 letters to 79.8 ± 5.86 letters (P = 0.45) in group 1 and group 2, respectively. Graft edema was found in seven (15.55%) cases of group 1 and four (16%) cases of group 2. Graft retraction was found in two (4.44%) cases of group 1 and three (12%) cases of group 2.Conclusion:Sutureless and a glue-free limbal-conjunctival autograft is a safe and effective treatment option for primary as well as recurrent pterygium.     

羊膜移植与结膜瓣转移治疗复发性翼状胬肉的疗效比较

目的:回顾性分析对比羊膜移植与结膜瓣转移治疗复发性翼状胬肉的临床疗效。方法:选用46例53眼复发性翼状胬肉患者随机分成羊膜移植术组和结膜瓣转移组治疗,手术后随访12～18mo。结果:羊膜移植组26眼治愈,2眼术后不同程度复发,复发率7%;结膜瓣转移组17眼治愈,8眼术后不同程度复发,复发率32%;两组疗效比较差异有统计学意义(P<0.05)。结论:在治疗条件基本相同的情况下,羊膜移植术与结膜瓣转移术都能有效的治疗复发性翼状胬肉,降低复发率,羊膜移植术更具优越性。     

自体结膜瓣移植术和角膜缘干细胞移植术对原发性翼状胬肉术后泪膜的影响

目的：比较自体结膜瓣移植术(CAT)和角膜缘干细胞移植术(LCAT)对原发性翼状胬肉患者术后泪膜的影响。

方法：前瞻性研究。收集2018-09/2019-05在新疆军区总医院北京路医疗区眼科诊断为原发性翼状胬肉患者共150例150眼,依次纳入本研究,奇数者行CAT,偶数者行LCAT,术前,术后1、3、6mo,1a完成泪膜破裂时间(TBUT)、SchirmerⅠ试验(SⅠt)和眼表疾病指数(OSDI),结果进行统计学分析。

结果：患者129例129眼完成术后1a随访,CAT组64例64眼,复发4眼(6.2%); LCAT组65例65眼,复发3眼(4.6%),两组复发率无差异(P=0.718)。CAT组和LCAT组TBUT、SⅠt和OSDI评分术前和术后1、3、6mo,1a均有差异(P<0.05),术后1mo和术后3、6mo,1a均有差异(P<0.05),术后3、6mo和术后1a均无差异(P>0.05)。CAT组和LCAT组不同时间点TBUT、SⅠt和OSDI评分均无差异(P>0.05)。

结论：CAT和LCAT均能有效治疗原发性翼状胬肉,术后复发率低且相近,两种手术方式改善原发性翼状胬肉术后泪膜功能的程度相近。