Randomised controlled study of conjunctival autograft versus amniotic membrane graft in pterygium excision

AIM: To determine whether amniotic membrane can be used as an alternative to conjunctival autograft after pterygium excision. METHODS: 287 eyes with either primary or recurrent pterygium were included in this study. All eyes were randomised to undergo conjunctival autograft or amniotic membrane transplantation after pterygium excision by a single surgeon. 106 eyes in primary pterygium and 14 eyes in the recurrent group were treated with conjunctival autograft, and 148 eyes in primary pterygium and 19 eyes in the recurrent group were treated with amniotic membrane transplantation. Patients were followed up at 6 weeks and 6 months after operation. The main outcome measurement was recurrence rate after surgery. RESULTS: In the conjunctival group, the recurrence rate was 12.3%, 21.4% and 13.1% for primary, recurrent and all pterygia, respectively. In the amniotic membrane group, the recurrence rate was 25.0%, 52.6% and 28.1% for primary, recurrent and all pterygia, respectively. The recurrence rate for all pterygia in the amniotic membrane group was significantly higher than that in the conjunctival group (p = 0.003). CONCLUSIONS: Amniotic membrane graft had a higher recurrence rate than conjunctival autograft. However, it is an alternative choice, especially for advanced cases with bilateral heads or patients who might need glaucoma surgery later.     

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.     

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.     

羊膜移植与结膜移植治疗翼状胬肉的比较

目的:比较翼状胬肉切除联合羊膜移植或游离自体结膜移植对原发性胬肉的治疗效果。方法:对65例74眼行翼状胬肉切除联合羊膜移植术,对61例69眼行翼状胬肉切除联合游离自体结膜移植术,观察两组病例术后疗效。结果:术后随访12～20mo,随访期内,羊膜移植组5例复发,复发率6.7%,结膜移植组8例复发,复发率11.6%。结论:两种方式均能显著降低胬肉术后复发率,但羊膜移植更为理想。     

Limbal-conjunctival autograft transplantation for recurrent pterygium

PURPOSE: To assess the usefulness of limbal-conjunctival autograft transplantation (LCAT) for the treatment of recurrent pterygium. PATIENTS AND METHODS: Seventeen eyes with advanced recurrent pterygium underwent LCAT All had already been treated at least twice either by simple excision (n=15) or by conjunctival rotation autograft (n=2). Three eyes (17.65%) had symblepharon at the time of surgery, so LCAT was combined with amniotic membrane transplantation. The autograft was taken from the supero-lateral part of the same eye and transferred to the area where the pterygium had been excised. RESULTS: During 6-18 months of follow-up no postoperative complications occurred. In 15 eyes (88.24%) no pterygium recurrence was recorded; recurrence occurred in two eyes (11.76%) after 8 and 5 months. In three eyes with a combined symblepharon formation, remission of both pterygium and symblepharon growth was obtained. CONCLUSIONS: LCAT seems to be a promising and safe procedure for recurrent pterygium.     

自體结膜角膜缘上皮和异體羊膜移植术治疗翼状胬肉的临床研究

目的 觀察自體结膜角膜緣上皮移植術和异體羊膜移植術治療翼狀胬肉的臨床效果。方法 對55例(73只眼)行自體結膜角膜緣上皮移植術,隨訪1-17月,平均8.9月;對35例(46只眼)行异體羊膜移植術,隨訪1-14月,平均7.7月。结果兩組病例中初發性翼狀胬肉均無復發,而復發性翼狀胬肉的復發率分别為10.53％和6.67％,兩者無顯著性差异(P>0.05),但后者術后反應輕、上皮恢復快。结論 自體結膜角膜緣上皮移植術和异體羊膜移植術均是治療翼狀胬肉的良好方法,以后者為佳,治療翼狀胬肉的關鍵在于初發性手術方式的選擇。     

角膜缘上皮移植与羊膜移植治疗原发性翼状胬肉的对比观察

目的：对比观察翼状胬肉切除联合角膜缘上皮移植术与羊膜移植术对原发性翼状胬肉复发率的影响。
　　方法：采用随机对照分组的方法将我院手术治疗的原发性翼状胬肉患者99例103眼随机分为A,B两组。 A组为角膜缘上皮移植术组( n=54眼),采用翼状胬肉切除联合角膜缘上皮移植术;B组为羊膜移植术组( n=49眼),采用翼状胬肉切除联合羊膜移植术。术后随访1a,以泪膜破裂时间( breaking-up time,BUT)、复发率等指标作为分析参考指标。
　　结果：术后1a,联合角膜缘上皮移植术组有4眼(7.4%)复发。联合羊膜移植术组有11眼(22.5%)复发。两组复发率比较,差异有统计学意义( P<0.05)。两组间BUT比较无统计学意义(P>0.05)。
　　结论：相比羊膜移植术,翼状胬肉切除联合角膜缘上皮移植术治疗原发性翼状胬肉,能更有效的降低术后复发率。     

Amniotic membrane transplantation with conjunctival autograft for recurrent pterygium

OBJECTIVE: To study the effect of amniotic membrane transplantation (AMT) combined with either limbal autograft transplantation (LAT) or conjunctival autograft transplantation (CAT) in recurrent pterygium. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Twenty-seven eyes of 27 patients with recurrent pterygium. The mean number of prior surgeries was 3.1 (range, 1-10). Fifteen eyes each had restriction of ocular movement and symblepharon before surgery. INTERVENTION: Patients were treated by AMT with either LAT (n = 15) or CAT (n = 12). MAIN OUTCOME MEASURES: Recurrence of pterygium, improvement in ocular movement, and symblepharon formation. RESULTS: Twenty-three (85.2%) of 27 eyes showed no recurrence with a mean observation period of 67.0 weeks. Fourteen eyes (93.3%) each showed improvement in ocular movement restriction and symblepharon after AMT. In four eyes that developed recurrence, three had LAT and one had CAT combined with AMT, suggesting that there was no difference in surgical outcome between LAT and CAT. CONCLUSIONS: AMT with CAT is a safe and effective method for recurrent pterygium, especially that associated with ocular movement restriction and symblepharon. Considering the potential adverse effects associated with limbal excision, AMT plus CAT may be preferred over AMT plus LAT.     

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。     

Amniotic membrane graft for primary pterygium: comparison with conjunctival autograft and topical mitomycin C treatment

AIM: To study the efficacy and safety of amniotic membrane graft as an adjunctive therapy after removal of primary pterygium, and to compare the clinical outcome with conjunctival autograft and topical mitomycin C. METHODS: 80 eyes of 71 patients with primary pterygia were treated with excision followed by amniotic membrane graft. The result was compared retrospectively with 56 eyes of 50 patients receiving conjunctival autograft, and 54 eyes of 46 patients receiving topical mitomycin C. Patients were followed for at least 6 months, and the averaged follow up periods for the three groups were 13.8, 22.8, and 18.4 months, respectively. RESULTS: There were three recurrences (3.8%) in the amniotic membrane graft group, three recurrences (5.4%) in the conjunctival autograft group, and two recurrences (3.7%) in the topical mitomycin C group. There was no significant difference in recurrence rate among the three groups (p = 0.879). No major complications occurred in the amniotic membrane graft group or the conjunctival autograft group. One case of infectious scleritis due to scleral ischaemia occurred in the topical mitomycin C group. CONCLUSION: This study showed that amniotic membrane graft was as effective as conjunctival autograft and mitomycin C in preventing pterygium recurrence, and can be considered as a preferred grafting procedure for primary pterygium.     

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。     

羊膜移植或联合自体角膜缘移植治疗翼状胬肉

目的观察单纯羊膜移植与联合自体角膜缘移植治疗翼状胬肉的疗效。方法将翼状胬肉85例（93眼）随机分成两组，A组44例（45眼）行羊膜移植术，B组41例（48眼）行自体角膜缘移植联合羊膜移植术。术后平均随访2年，比较两组的治愈情况及复发率。结果A组有4眼复发，其中有3眼是复发性翼状胬肉，复发率8．89％（4／45）。B组仅1眼复发，复发率为2．08％（1／48）。两组复发率差异有统汁学意义（P〈0．05）。结论自体角膜缘移植联合羊膜移植术有利于翼状胬肉术后的眼表重建，临床疗效优于单纯羊膜移植术。     

羊膜和桥状结膜瓣移植治疗翼状胬肉

目的研究翼状胬肉切除加羊膜和桥状结膜瓣移植治疗翼状胬肉的疗效。方法31例翼状胬肉患者两眼分别行翼状胬肉切除加羊膜和桥状结膜瓣移植和单纯翼状胬肉切除加羊膜移植，比较二者治疗后翼状胬肉复发率。结果随访1．5a。前者翼状胬肉复发率为3.22％，后者复发率为16．12％。二者相比有显著性差异（P〈0．01）。结论翼状胬肉切除加羊膜和桥状结膜瓣移植治疗翼状胬肉远期复发率低，值得推广。     

胬肉切除联合结膜瓣移植治疗原发性翼状胬肉的疗效分析

目的:探讨翼状胬肉切除联合游离结膜瓣移植术治疗原发性翼状胬肉的疗效及对泪膜功能的影响。方法:选择2018-01/2019-10我院收治的120例126眼原发性翼状胬肉患者作为研究对象,按照随机数字表法分为2组,结膜移植组62例64眼行翼状胬肉切除联合游离结膜瓣移植术治疗,羊膜移植组58例62眼行翼状胬肉切除联合羊膜移植治疗。测定术前,术后3、6mo时泪液分泌长度(SⅠt)、泪膜破裂时间(BUT)、角膜荧光素染色(FL)评分、非侵入性首次泪膜破裂时间(NIBUT)、泪河高度(TMH)、结膜杯状细胞数量,采用眼表疾病指数(OSDI)评估患者生活质量,于术后6mo时评估治疗效果及复发情况。结果:结膜移植组及羊膜移植组患者角膜上皮平均修复时间、症状持续时间比较均无差异(P>0.05)。术后6mo结膜移植组患者BUT(11.11±2.77s vs 10.01±2.41s)、NIBUT(10.01±1.52s vs 9.52±0.98s)高于羊膜移植组(P<0.05),FL评分(0.44±0.10分vs 0.50±0.11分)低于羊膜移植组(P<0.05)。术后两组患者结膜杯状细胞数量均明显增加(P<0.05),术后3、6mo时结膜移植组患者结膜杯状细胞数量多于羊膜移植组(311.41±58.45/mm2vs 285.46±68.96/mm2,342.41±66.89/mm2vs 314.41±70.12/mm2,均P<0.05)。术后两组患者OSDI评分均显著降低(P<0.05),结膜移植组、羊膜移植组患者OSDI评分组间无差异(P>0.05)。两组患者总体疗效无差异(P>0.05);结膜移植组及羊膜移植组患者复发率分别为6.3%、6.5%,组间无差异(P>0.05)。结论:翼状胬肉切除联合自体结膜瓣移植在术后恢复及预防翼状胬肉复发方面与羊膜移植相当,对患者泪膜功能稳定性有更好的改善效果。     

Sutureless amniotic membrane transplantation combined with narrow-strip conjunctival autograft for pterygium

To study the efficacy and safety of sutureless amniotic membrane transplantation combined with narrow-strip conjunctival autograft and to investigate the clinical outcomes. Thirty eyes of 30 patients with primary pterygia were treated in this institutional study with excision followed by sutureless amniotic membrane transplantation combined with narrow-strip conjunctival autograft using fibrin glue tissue adhesive. The main outcome measures were the operating time for ocular surface reconstruction, the size of the pterygium and of the conjunctival autograft, postoperative complications, subjective complaints, and recurrences. The mean pterygium size was 3.12 ± 0.92 mm and the mean operating time was 4.58 ± 1.10 min. Twenty-nine patients (96.7%) had no complaints after first postoperative week. Twenty-eight (93.3%) patients had no recurrences after 1 year follow-up. The sutureless amniotic membrane transplantation combined with narrow-strip conjunctival autograft is an effective procedure with low rate of recurrence. This technique can be considered as a preferred grafting procedure for primary pterygium but further randomized controlled studies including larger populations are needed.     

羊膜移植联合自体角膜缘干细胞移植对复发性翼状胬肉的效果分析

目的:探讨羊膜移植联合自体角膜缘干细胞移植术治疗复发性翼状胬肉的效果及其影响因素。方法:对复发的翼状胬肉患者行胬肉切除 羊膜移植 自体角膜缘干细胞移植术,观察术后植片情况、角膜创面愈合时间、取材区愈合情况和患者症状;随诊观察术后复发率。结果:28例(32只眼)复发翼状胬肉患者行胬肉切除 羊膜移植 自体角膜缘干细胞移植,随诊6~12个月,平均7.6个月,角膜创面上皮愈合时间为3~7d,平均(4.4±1.5)d;最后复诊时28例(32只眼)患者中4只眼复发,复发率为12.5%;所有患者取材区实现上皮化愈合。结论:翼状胬肉切除联合羊膜移植和自体角膜缘干细胞移植能有效地减少复发性翼状胬肉的术后复发;对角膜缘受累范围大的患者应注意医源性角膜缘干细胞损害的风险。眼科学报2007;23:227-230.     

翼状胬肉上结膜反向移植联合羊膜移植治疗复发胬肉

目的：观察胬肉上结膜反向移植联合羊膜移植治疗复发性翼状胬肉的疗效。

方法：回顾性系列病例研究。回顾2009-01/2012-01本院确诊的复发性翼状胬肉26例26眼,均为经历一次手术,手术方法为翼状胬肉切除联合自体角膜缘干细胞移植术,复发1a以上病例。本次研究中,切除胬肉组织时,将其上结膜充分游离后切下保存,羊膜覆盖胬肉切除后裸露巩膜面,再将保留的胬肉上的结膜植片反向覆盖羊膜上缝合。术后1,2wk; 1mo及3mo观察结膜植片愈合情况、羊膜溶解吸收时间、角膜创面修复时间、角膜新生血管及胬肉复发率。术后随访12mo。

结果：结膜植片愈合时间6.03±2.76d,羊膜溶解吸收时间14.26±3.64d,角膜创面修复时间5.42±1.58d。术后3mo,胬肉切除后裸露巩膜面新生结膜及结膜植片愈合良好,无明显胬肉术后并发症。术后1a,再度复发2例,复发率8%,治愈率92%。

结论：对于复发性翼状胬肉,因传统自体角膜缘干细胞移植已经创伤部分角膜缘及眼表结膜瘢痕,单纯结膜移植,或单纯羊膜移植,术后胬肉复发率偏高,本方法取胬肉上结膜反向移植,避免大面积创伤眼表,取材容易,而且良好控制术后翼状胬肉复发问题,不失为一种解决复发性翼状胬肉的良好选择。     

羊膜移植与自体角膜缘移植治疗翼状胬肉的初步疗效对照

目的 比较评价新鲜羊膜移植与自体角膜缘移植在翼状胬肉治疗中的效果。方法 翼状胬肉患者42例48眼。分为羊膜移植组及角膜缘移植组，每组24眼。分别行翼状胬肉切除联合新鲜羊膜移植和自体角膜缘移植。术后随访12～19个月，观察翼状胬肉复发率。结果 羊膜移植组6眼（26％）复发，角膜缘移植组3例（13．6％）复发。在初发性胬肉治疗中两组分别有3眼（20％）、2眼（14％）复发；在复发性胬肉治疗中两组分别有3眼（37％）、1眼（12．5％）复发。结论 在防止胬肉复发方面，羊膜移植与角膜缘移植在治疗初发性胬肉中疗效相当；角膜缘移植治疗复发性胬肉疗效优于羊膜移植。