冀状胬肉中增殖细胞核抗原的免疫组化研究

目的 观察冀状胬内的增殖善及用药后的变化。方法 将５４例冀状胬肉术前患者随机分为３组：Ⅰ组１８例为未用药组，Ⅱ组１６主前局部应用氟美松，Ⅲ组２０例术前局部应用高三尖杉酯碱加氟美松。采用免疫组化方法对手术切除的冀状胬肉标本进行增殖细胞核抗原（ｐｒｏｌｉｆｅｒａｔｉｎｇ ｃｅｌｌ ｎｕｃｌｅａｒ ａｎｔｉｎｅｎ，ＰＣＮＡ）检测。结果 未用药组（Ⅰ组）ＰＣＮＡ阳性率为（１１．５３±３．６２）％，氟美松组     

高三尖杉酯碱预防翼状胬肉术后复发

目的探讨局部注射高三尖杉酯碱减少翼状胬肉术后复发的效果。方法６３例翼状胬肉患者随机分为３组：Ａ组２９例２９眼,术前局部注射高三尖杉酯碱;Ｂ组１６例１６眼术前局部注射地塞米松;Ｃ组１８例１８眼术前不用药。术后观察其眼部反应、复发率及行增殖细胞核抗原（ＰＣＮＡ）免疫组化染色检查。结果术后平均随访１９．１ｍｏ,复发率分别为：Ａ组和Ｂ组分别为３．４０％和６．２５％（Ｐ＞０．５０）,Ｃ组２７．７７％（Ｐ＜０．０５,与Ａ组相比较）。病理结果显示,Ａ组ＰＣＮＡ阳性率（６．０１±３．８５）％,Ｂ组（１０．２８±４．１８）％,Ｃ组（１１．５３±３．６２）％．Ａ组与Ｂ组、Ｃ组比较均有显著性差异（Ｐ＜０．０５）。结论术前翼状胬肉局部注射高三尖杉酯碱可以减少翼状胬肉术后复发。     

局部应用地塞米松对翼状胬肉组织中趋化因子受体CCR3表达的影响及意义

目的　探讨术前局部应用地塞米松对趋化因子受体ＣＣＲ３在翼状胬肉中表达的影响和意义。方法　选取３０例翼状胬肉患者,分为用药组和对照组,术前２周分别局部滴用３ｇ?Ｌ－１妥布霉素地塞米松眼液或３ｇ?Ｌ－１妥布霉素眼液,取手术切除的翼状胬肉组织;ＲＴ-ＰＣＲ及Ｗｅｓｔｅｒｎｂｌｏｔ法检测趋化因子受体ＣＣＲ３ｍＲＮＡ水平及蛋白水平的表达,进一步采用免疫组织化学法检测其蛋白水平的表达。结果　翼状胬肉组织中ＣＣＲ３在ｍＲ-ＮＡ和蛋白水平均存在表达,但用药组ＣＣＲ３ｍＲＮＡ表达明显低于对照组,差异有统计学意义（ｔ＝－５７１３,Ｐ＝０．０１３）,用药组ＣＣＲ３的蛋白表达也明显低于对照组（ｔ＝－３．９１５,Ｐ＝０００１）。免疫组织化学染色显示ＣＣＲ３表达主要分布在结膜上皮细胞及部分血管内皮细胞上。结论　趋化因子受体ＣＣＲ３可能参与翼状胬肉的发生发展。地塞米松引起的ＣＣＲ３表达改变是影响翼状胬肉预后、减少术后复发的可能机制之一。     

高三尖杉酯碱用于青光眼滤过术的临床随机对照研究

目的研究高三尖杉酯碱（ｈｏｍｏｈａｒｉｎｇｔｏｎｉｎｅ）在青光眼滤过术中的抗增殖作用。方法采用随机对照的临床验证方法,施行同一标准的小梁切除术,将７８例（８８只眼）难治性青光眼分为用药组４２例（４６只眼）和对照组３６例（４２只眼）。用药组术中应用高三尖杉酯碱０４ｍｇ,术后再分次结膜下注射高三尖杉酯碱０６２±０２０ｍｇ（范围０５３～０７５ｍｇ）;对照组未用高三尖杉酯碱。术后随访观察１８～４８个月（平均３６个月）。采用寿命表分析法统计。结果手术成功率：用药组为８４５％,对照组为５０９％（Ｐ＜０．０５）。功能性滤过泡的累计百分率：用药组为８４２％,对照组为５２９％（Ｐ＜０．０５）。并发症：用药组的角膜上皮缺损和结膜伤口渗漏发生率分别为２３９％和６５％,对照组为７１％和２４％（Ｐ＜０．０５）。用药组的角膜内皮细胞数在用药前后差异无显著性（Ｐ＞０．０５）。结论高三尖杉酯碱是安全有效的抗增殖药物,可明显提高青光眼滤过术的成功率,至少可在术后３年内将眼压维持在正常水平。     

争光霉素＿3和氟美松混合液治疗翼状胬肉

争光霉素＿３和氟美松混合液治疗翼状胬肉山东省德州市中西医结合医院眼科（２５３０１０）李树星，王泉极，徐勤国山东省德州市中医院眼科（２５３０１０）李真，李强翼状胬肉是眼科多发病，在农村发病率为２．７２％（１）。多年来，本病的治疗就是手术。但术后夏发率竟...     

锗132对体外培养翼状胬肉成纤维细胞的增殖抑制作用观察

观察锗１３２对体外培养翼状胬肉成纤维细胞的抗增殖作用,寻找辅助治疗翼状胬肉和预防翼状胬肉复发的新方法。方法将翼状胬肉成纤维细胞行体外原代和传代培养;观察不同浓度锗１３２及丝裂霉素Ｃ对成纤维细胞生长曲线的影响及培养的翼状胬肉成纤维细胞增殖抑制作用和毒性作用;采用免疫组织化学方法检测增殖细胞核抗原（ｐｒｏｌｉｆｅｒａｔｉｎｇ ｃｅｌｌ ｎｕｃｌｅａｒ ａｎｔｉｇｅｎ,ＰＣＮＡ）的表达,结果锗１３２可抑     

结膜下注射丝裂霉素C的抗瘢痕化效果和安全性研究

目的　研究结膜下注射丝裂霉素Ｃ（ｍｉｔｏｍｙｃｉｎＣ,ＭＭＣ）对兔眼瘢痕化模型的抗瘢痕化效果及对兔眼局部组织的毒副作用,探讨其作为青光眼滤过性手术后抗瘢痕形成辅助用药的可行性及有效性。方法　取１８只健康成年新西兰大白兔,随机分为３组,分别为Ａ组、Ｂ组和Ｃ组,每组１２眼,建立实验性瘢痕化模型。Ａ组术后３ｄ结膜下注射０．４ｇ?Ｌ－１的ＭＭＣ０．３ｍＬ,Ｂ组术中巩膜瓣下放置浸泡０．４ｇ?Ｌ－１ＭＭＣ的棉片５ｍｉｎ,Ｃ组术后３ｄ结膜下注射生理盐水（ｎｏｒｍａｌｓａｌｉｎｅ,ＮＳ）０．３ｍＬ。应用结膜印迹细胞学检查观察结膜损伤情况。分别于术后７ｄ、１４ｄ、２８ｄ分批处死实验兔,摘出眼球,应用免疫组织化学染色检查观察成纤维细胞增殖细胞核抗原（ｐｒｏｌｉｆｅｒａｔｉｏｎｃｅｌｌｎｕｃｌｅａｒａｎｔｉｇｅｎ,ＰＣＮＡ）的表达情况,应用光镜观察手术部位的病理改变。结果　术后３组均未出现结膜伤口渗漏,Ａ组、Ｂ组角膜上皮点状缺损于术后１周消失,Ｃ组无角膜上皮点状缺损。结膜印迹细胞学检查显示Ａ组和Ｂ组结膜印迹细胞分级均为２～３级,Ｃ组为２级。术后７ｄ、１４ｄ、２８ｄ光镜下,Ｃ组手术区球结膜下炎性细胞、纤维细胞、新生毛细血管增多,纤维组织增生较Ａ组和Ｂ组显著。免疫组织化学染色结果显示,术后７ｄ,Ａ组、Ｂ组、Ｃ组每高倍视野ＰＣＮＡ阳性细胞计数分别为（１２．８３±２．０８）个、（１４．３７±３．７６）个、（２８．１２±６．７４）个;术后１４ｄ,３组ＰＣＮＡ阳性细胞计数分别为（１３．８１±１．５３）个、（１６．２８±３．７８）个、（２５．６７±４．４５）个;术后２８ｄ,３组ＰＣＮＡ阳性细胞计数分别为（１１．９６±１．４５）个、（１３．０７±２．０４）个、（１７．６９±３．１１）个;相应时间点,Ａ组、Ｂ组ＰＣＮＡ阳性细胞计数均较Ｃ组少（均为Ｐ＝０．０００）,但Ａ组与Ｂ组间差异均无统计学意义（均为Ｐ＞０．０５）。结论　结膜下注射ＭＭＣ能有效抑制手术后术区的瘢痕化,与术中常规应用ＭＭＣ相比,其对结膜的损伤程度无明显差异,对其进一步研究有望为青光眼滤过手术后抗瘢痕化提供一种使用方便、安全、有效的局部用药方式。     

核心蛋白多糖抑制翼状胬肉成纤维细胞增生的实验研究

目的　观察核心蛋白多糖对体外培养人翼状胬肉成纤维细胞（ｈｕｍａｎｐｔｅｒｙｇｉｕｍｆｉｂｒｏｂｌａｓｔｓ,ＨＰＦ）增生和凋亡的影响,寻找辅助治疗和预防翼状胬肉切除术后复发的新方法。方法　采用组织块法体外培养ＨＰＦ,将处于对数生长期的细胞用于实验。将０．１ｍｇ?Ｌ－１、１．０ｍｇ?Ｌ－１、１０．０ｍｇ?Ｌ－１的Ｄｅｃｏｒｉｎ分别加入细胞培养基中培养２４ｈ、４８ｈ、７２ｈ。ＭＴＴ比色法分别测定不同浓度的Ｄｅｃｏｒｉｎ作用于ＨＰＦ不同时间后的细胞生长抑制率,流式细胞仪测定细胞周期时相变化,免疫组织化学法染色ＰＣ-ＮＡ检测细胞生长活性。结果　ＭＴＴ结果显示不同浓度组Ｄｅｃｏｒｉｎ作用ＨＰＦ２４ｈ细胞生长抑制率分别为（７．８１±１２６）％、（１９５２±２．１４）％、（４２．６９±１．６２）％,作用４８ｈ分别为（１０．１９±２．７４）％、（２２．２８±０．９７）％、（４５．７３±０．８２）％,作用７２ｈ分别为（２０．４９±１．３９）％、（２９．５０±２．４７）％、（５９．４１±１．７１）％。随着药物浓度的逐渐增高和作用时间的延长,细胞生长抑制率逐渐增加,差异均有统计学意义（均为Ｐ＜０．０５）。流式细胞仪检测各浓度Ｄｅｃｏｒｉｎ组ＨＰＦ中Ｇ０／Ｇ１期细胞比率均较空白对照组高,差异均有统计学意义（均为Ｐ＜０．０５）。当Ｄｅｃｏｒｉｎ浓度在０．１～１０．０ｍｇ?Ｌ－１范围内作用ＨＰＦ７２ｈ,均能够明显抑制细胞表达ＰＣＮＡ（均为Ｐ＜０．０５）。结论　Ｄｅｃｏｒｉｎ可以抑制ＨＰＦ的增生,诱导其凋亡,且呈明显的剂量和时间依赖性,有望成为防治翼状胬肉的药物之一。     

自体角膜缘与结膜移植治疗复发性翼状胬肉

目的比较自体角膜缘与结膜移植治疗复发性翼状胬肉的疗效。方法复发性翼状胬肉病人９４例（１１５眼）随机分为Ａ,Ｂ两组,Ａ组４７例（５６眼）,Ｂ组４７例（５９眼）。手术显微镜下切除胬肉后Ａ组行自体角膜缘移植术,Ｂ组行自体球结膜移植术。观察术后植片生长、角膜创面修复、角膜新生血管及胬肉复发率。结果术后植片成活时间３～５天（平均３．７５天）;术后角膜创面修复时间Ａ组较Ｂ组快（Ｐ＜０．０５）。角膜新生血管Ａ组较Ｂ组少。术后１２个月胬肉复发率Ａ组（３．８％）较Ｂ组（２５．９％）低（Ｐ＜０．０１）。结论治疗复发性翼状胬肉自体角膜缘移植较结膜移植疗效好。     

翼状胬肉手术后角膜曲率变化及对人工晶状体度数测算的影响

目的　探讨翼状胬肉手术后角膜曲率变化及对人工晶状体度数测算的影响。方法　收集2016年7月至2017年4月于广州医科大学附属第二医院行手术治疗的原发性鼻侧翼状胬肉患者,共32例42眼,设为胬肉组;对照组为胬肉组中单眼翼状胬肉患者的对侧眼,共22例22眼。术前测量胬肉组患者翼状胬肉长度、宽度和面积,同时计算对照组理论人工晶状体度数。在术前及术后1个月、3个月使用IOL Master测量胬肉组患者眼轴长度、前房深度、角膜曲率、理论人工晶状体度数等。结果　胬肉组术前角膜水平曲率为（43.32±1.69）D,术后1个月为（44.30±1.40）D,术后3个月为（44.32±1.43）D。术前角膜平均曲率（44.32±1.32）D,术后1个月为（44.78±1.40）D,术后3个月为（44.73±1.38）D,术后角膜水平曲率和角膜平均曲率均较术前升高（均为P<0.05）,但术后1个月与术后3个月差异均无统计学意义（均为P>0.05）。胬肉组患者术前术后眼轴长度、前房深度、角膜垂直曲率均无明显变化（均为P>0.05）。胬肉组患者术前理论人工晶状体度数为（21.46±1.57）D,术后1个月为（20.84±1.65）D,术后3个月为（20.86±1.64）D。术后理论人工晶状体度数较术前下降,差异均有统计学意义（均为 P<0.01）。根据ROC曲线计算得出,翼状胬肉长度2.15 mm、宽度4.20 mm、面积5.18 mm²为判断翼状胬肉及其手术对人工晶状体度数测算是否有较大影响的最佳诊断界值。结论　翼状胬肉术后角膜水平曲率和角膜平均曲率增加。角膜曲率的改变导致测算的人工晶状体度数下降。当翼状胬肉较大时会对人工晶状体度数测算产生有临床意义的影响。     

Efficacy of lidocaine 2% gel in pterygium surgery

PURPOSE: Anaesthesia during pterygium surgery is usually achieved with local injection of anaesthetic medications. The aim of this study was to determine whether lidocaine 2% gel is an effective topical anaesthetic agent for pterygium surgery. METHODS: We conducted a prospective, randomized clinical trial. Fifty-four consecutive patients who had primary pterygium underwent surgical excision of the lesion and conjunctival autograft. Patients were randomized into two groups. Group 1 received 1 ml of lidocaine 2% solution subconjunctivally and group 2 received lidocaine 2% gel topically. The primary outcome of interest was the pain experienced during anaesthetic administration and surgery. Following the dissection and excision of the pterygium, conjunctival autograft was transplanted in each of the patients. Immediately after the operation, pain and discomfort scores were determined using a 10-point linear visual analogue scale. RESULTS: The mean pain score during anaesthetic administration was 4.26 +/- 1.18 in the injection group and 0.92 +/- 0.56 in the gel group. The mean pain score during surgery was 3.96 +/- 0.95 in the injection group and 4.0 +/- 1.01 in the gel group. There was a statistically significant difference in mean pain scores experienced during anaesthetic administration (p = 0.01). There was no significant difference in mean pain scores experienced during surgery (p = 0.55). No adverse events were noted. CONCLUSION: In light of these results, we conclude that topical administration of lidocaine 2% gel can be used as an alternative method of anaesthesia in pterygium surgery, especially for patients with needle phobia.     

The results of amniotic membrane transplantation for primary pterygium compared with conjunctival autograft

PURPOSE: To study the efficacy and safety of amniotic membrane transplantation as an adjunctive therapy after surgical excision of primary pterygium and to compare the clinical outcome with that of conjunctival autograft. METHODS: Eighty-six eyes of 78 patients with primary pterygium were operated on by a single surgeon (N.T.). All patients were randomized to undergo amniotic membrane or conjunctival autograft transplantation as an adjuvant therapy after pterygium excision. Forty-four eyes in 39 patients were treated with amniotic membrane transplantation (AM group), and 42 eyes of 41 patients were treated with conjunctival autograft (CG group). Patients were followed up at 1 week, 1, 3, 6, and 12 months postoperation. The main outcome measurement was a recurrence rate after surgery. RESULTS: The mean follow-up was 14.40 +/- 5.4 months in the AM group and 12.35 +/- 3.13 months in the CG group. There were 18 recurrences (40.9%) in the AM group and two (4.76%) in the CG group, which was significantly different among both groups (P < 0.007). The cumulative proportion that were recurrence-free at 12 months was 0.6 +/- 0.15 for the AM group and 0.95 +/- 0.07 for the CG group (P = 0.0003, Log-rank test). The cumulative nonrecurrence rate at 6 and 12 months in all patients stratified by age and sex was not significantly different (P = 0.28 and P = 0.9, Log-rank test). No major complications were observed in either group. CONCLUSION: The surgical results of primary pterygium excision followed by amniotic membrane and conjunctival autograft transplantation were compared. It was found that amniotic membrane transplantation for pterygium surgery has an unacceptably high recurrence rate.     

增殖细胞核抗原和胰岛素样生长因子Ⅱ在翼状胬肉组织中的表达

目的:研究增殖细胞核抗原(proliferating cell nuclear antigen,PCNA)和胰岛素样生长因子Ⅱ(insulin-like growth factor-Ⅱ,IGF-Ⅱ)在翼状胬肉中表达的关系。方法:应用免疫组织化学SABC法检测40例原发性翼状胬肉组织标本,10例正常结膜组织标本中PCNA和IGF-Ⅱ蛋白的表达情况。结果:翼状胬肉组中PCNA,IGF-Ⅱ表达均高于正常结膜组(P<0.01),IGF-Ⅱ与PCNA蛋白表达之间的相关系数为0.731(P<0.01)。结论:翼状胬肉为一种具有肿瘤潜能的增生性眼表疾病。IGF-Ⅱ通过促进细胞增殖参与了翼状胬肉的发生、发展。     

两种不同术式治疗翼状胬肉的疗效比较

目的:比较带干细胞的自体结膜转位术与带干细胞的自体结膜移植术治疗翼状胬肉的临床效果。方法:患者50例(60眼)分为2组,A组采用胬肉切除联合带干细胞的自体结膜转位术,B组采用胬肉切除联合带干细胞的自体结膜移植术。每组的手术时间及术后效果进行比较。结果:结膜及角膜的上皮化均在术后2～5d内完成,随访6～12mo,每组均有1例复发,复发率无组间差异。A组手术时间25±8min,B组43±11min,组间差异显著(P<0.05t-test)。结论:两种手术方法均可以有效治疗及防止胬肉复发,比较而言,带干细胞的自体结膜转位术更简单、易于操作,患者亦愿意接受。     

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。     

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.     

VEGF、SDF-1、Ki-67、PCNA及Survivin与翼状胬肉的关系分析

目的：分析血管内皮生长因子(vascular endothelial growth factor,VEGF)、基质细胞衍生因子-1(stromal cell-derived factor 1,SDF-1)、肿瘤增殖抗原(Ki-67)、增殖细胞核抗原(proliferating cell nuclear antigen,PCNA)及生存素(Survivin)与翼状胬肉的关系。

方法：选取2013-01/2015-05于本院进行诊治的79例106眼翼状胬肉患者为观察组,同时期的79例正常结膜者为对照组,然后将两组的组织VEGF、SDF-1、Ki-67、PCNA及Survivin阳性细胞数分级及染色强度分级进行比较,并比较其中不同性别、分期及分型患者的检测结果,同时以Logistic分析上述指标与翼状胬肉的关系。

结果：观察组的组织VEGF、SDF-1、Ki-67、PCNA及Survivin阳性细胞数分级及染色强度分级均高于对照组,不同分期及分型患者的检测结果也存在一定差异(均P<0.05),而不同性别患者间的检测结果则无明显差异(均P>0.05),经Logistic分析显示,上述组织指标均与翼状胬肉有密切的关系。

结论：翼状胬肉组织中的VEGF、SDF-1、Ki-67、PCNA及Survivin表达呈现异常状态,上述指标均与翼状胬肉有密切的关系。     

原发性翼状胬肉两种治疗方法的疗效观察

目的:探讨原发性翼状胬肉两种治疗方法的疗效观察。方法:A组25例采用翼状胬肉切除联合丝裂霉素术治疗,B组10例采用自体球结膜+角膜缘干细胞移植术治疗。根据角膜创面恢复、结膜伤口愈合、胬肉有无复发进行观察。结果:A组患者术后角膜上皮第3～7d恢复,结膜充血10～15d消退,3例复发;B组患者术后角膜上皮第2d恢复,结膜充血7～10d消退,1例复发。结论:翼状胬肉切除术联合丝裂霉素和自体球结膜+角膜缘干细胞移植术都能降低胬肉复发率,二者相比较,自体球结膜+角膜缘干细胞移植术优于翼状胬肉切除联合丝裂霉素。     

The efficiency of limbal conjunctival autografting in pterygium surgery

PURPOSE: To investigate the efficiency of limbal conjunctival autografting technique in pterygium surgery. METHODS: Eighty-four eyes of 68 patients with pterygium were treated by simple excision technique and 29 eyes of 24 patients with pterygium were treated by limbal conjunctival autografting technique. The definition of recurrence was fibrovascular tissue over the limbus onto the cornea in the area of previous pterygium excision. RESULTS: The ages of the patients were between 25 and 88. The follow-up periods ranged from 6 to 25 months. The patients treated by simple excision technique were followed up for 6 to 25 (average 15+/-6) months and the patients treated by limbal conjunctival auto-grafting technique were followed up for 7 to 24 (average 17+/-5) months. The recurrence rates were 27% (23 eyes) and 7% (2 eyes), respectively. There was a statistically significant difference in the recurrence rate between the patients who underwent simple excision and those who underwent limbal conjunctival autografting (p=0.016). CONCLUSIONS: Limbal conjunctival autografting is an effective surgical technique for the treatment of pterygium. It has a low recurrence rate when compared with the simple excision technique.     

Efficacy and safety of recurrent pterygium surgery using human processed pericardium

PURPOSE: To investigate the safety and efficacy of human processed pericardium used as an onlay after pterygium excision. METHODS: Twenty-five eyes of 25 patients (11 female, 14 male) with recurrent pterygium were included in this study. The median age was 50 years (range 24-89 years). Twenty-eight percent of the eyes previously had been operated on two or more times. The mean follow-up was 9.4 months (+/- 2.1 months, range 8-15 months). Following bare-sclera surgical removal of recurrent pterygium, a patch of processed human pericardium was sutured to cover the area of excision. The pericardium was not covered with conjunctiva, nor were adjuvant radiation or antimetabolite administered. All patients were treated with a combination of dexamethasone 0.1% / chloramphenicol drops three times per day for 1 month. Ketorolac tromethamine 0.5% three times per day was added to this regimen after complete corneal reepithelialization. RESULTS: Recurrence (any growth >1 mm onto the cornea) was detected in 12 patients (48%). The mean time of recurrence was 4.1 +/- 1.7 months. Three patients (12.0%) presented a regrowth of fibrovascular tissue not reaching 1 mm of the cornea. Pyogenic granulomas occurred in three patients, and all of them required surgical excision. Corneal thinning was present in one patient and was treated with a therapeutic contact lens and artificial tears with complete resolution and vascularization of the thinned area. No decrease in visual acuity was observed in any patient. CONCLUSIONS: The use of processed pericardium in pterygium surgery is a safe procedure but is associated with a relatively high rate of recurrence. It should only be considered as an option in managing recurrent pterygium when conjunctival autografting is not an available alternative.