自体角膜缘干细胞移植与结膜瓣转位治疗翼状胬肉的对比研究

目的 探讨自体角膜缘干细胞移植与结膜瓣转位治疗翼状胬肉的疗效.方法 将126例(214眼)翼状胬肉患者随机分为2组:角膜缘干细胞移植组58例92眼,结膜瓣转位组68例122眼,分别在手术显微镜下行胬肉切除联合自体角膜缘干细胞移植术和胬肉切除联合结膜瓣转位术,术后随访1 a,观察并比较2组复发率和并发症情况.结果 术后1 a,自体角膜缘干细胞移植组4眼复发,复发率为4.35%,结膜瓣转位组23眼复发,复发率为18.85%,2组术后复发率比较差异有显著统计学意义(P=0.002<0.01).角膜缘干细胞组无一眼发生睑球粘连,而结膜瓣转位组有9眼出现睑球粘连.结论 自体角膜缘干细胞移植是治疗翼状胬肉的一种有效方法 .     

翼状胬肉切除联合丝裂霉素加自体结膜瓣角膜缘干细胞移植术的临床体会

目的探讨翼状胬肉切除联合丝裂霉素加自体结膜瓣角膜缘干细胞移植术的临床疗效。方法对226例259眼翼状胬肉患者做翼状胬肉切除,0.2mg/mlMMC棉条湿敷翼状胬肉根部2分钟,生理水冲洗后,取自体结膜瓣角膜缘干细胞移植。结果术后随访平均18个月,复发率为0.77%,显效率为3.44%,治愈率为95.75%。结论翼状胬肉切除联合丝裂霉素加自体结膜瓣角膜缘干细胞移植术,治愈率高,复发率低,安全有效。     

自体带结膜瓣的角膜缘移植治疗翼状胬肉

目的 观察采用巩膜隧道刀切取的自体带结膜瓣的角膜缘移植片治疗翼状胬肉的临床疗效.方法 对52例(60眼)采用翼状胬肉切除和自体带结膜瓣的角膜缘移植的翼状胬肉的资料进行回顾性研究.术后随访6～12月,观察术后角结膜植片生长情况,供区创面修复时间及翼状胬肉复发情况.结果 供区创面修复为7～10 d,角结膜植片生长良好.2眼复发,复发率3.33%.结论 采用巩膜隧道刀切取的自体带结膜瓣的角膜缘移植片能有效地降低翼状胬肉术后的复发率.     

5-Fu在原发性翼状胬肉手术治疗中作用的对比观察

目的对比观察5-氟尿嘧啶(5-FU)在显微逆行切除联合自体带结膜瓣角膜缘干细胞移植方法治疗翼状胬肉中对角膜创面修复时间和复发率的影响。方法回顾性临床病例研究。收集2016年3~6月原发性翼状胬肉87例87只眼,分为2组,A组47例行显微逆行切除联合5-FU及自体带结膜瓣角膜缘干细胞移植,B组40例行显微逆行切除联合自体带结膜瓣角膜缘干细胞移植术,术后随访6~12个月,平均9.2个月。结果两组患者术后角膜创面修复时间:A组平均为(3.94±1.22)d,B组平均为(3.85±1.25)d,两组间差异无统计学意义(t=0.324,P>0.05);复发率:A组2.1%(1/47),B组15%(6/40),两者比较差异有统计学意义(χ2=4.84,P<0.05)。结论5-FU在显微逆行切除联合自体带结膜瓣角膜缘干细胞移植方法治疗翼状胬肉角膜创面中,对修复时间无明显影响,但可降低复发率。     

翼状胬肉显微切除联合丝裂霉素C加自体带角膜缘上皮结膜移植术观察

目的 探讨翼状胬肉显微手术方法,观察翼状胬肉切除联合应用丝裂霉素C(MMC)加自体带角膜缘上皮的结膜移植术治疗翼状胬肉的疗效。方法 对1251例1326只眼,在手术显微镜下剖切分离球结膜与病变组织,切除胬肉并做广泛的变性球筋膜切除,在结膜下放置0.2 mg/ml的MMC棉片,彻底冲洗后将同侧眼颞上方带有角膜缘上皮的结膜瓣移植到胬肉处的巩膜上。术后随访12～72月,平均27.5月,观察复发情况。结果 术后反应轻,移植片存活,37只眼复发,复发率为2.79％。结论 翼状胬肉显微手术切除联合应用丝裂霉素C加自体带角膜缘上皮的结膜移植术,术后复发率低,是一种安全、有效的方法。     

复发性翼状胬肉不同手术方法的疗效的临床分析

目的探讨不同手术方式治疗复发性翼状胬肉的疗效。方法选取复发性翼状胬肉患者60例(60只眼)随机分成两组:A组30个病人(30只眼)翼状胬肉切除联合冻干羊膜移植术;B组30个病人(30只眼)翼状胬肉切除联合带自体角膜缘干细胞结膜瓣移植术。结果两组病人术后随访6个月至2年,翼状胬肉切除联合冻干羊膜移植术组与翼状胬肉切除联合带自体角膜缘干细胞结膜瓣移植术组术后复发率分别为:36.7%和10%,差异具有统计学意义(P<0.05).结论复发性翼状胬肉的治疗中翼状胬肉切除联合带自体角膜缘干细胞结膜瓣移植术相对于翼状胬肉切除联合冻干羊膜移植术疗效更明确。     

翼状胬肉两种手术方法的临床效果比较

目的 对比两种手术方法治疗翼状胬肉的临床效果.方法 翼状胬肉46例（51只眼）随机分成两组,每组均为23例.第1组,翼状胬肉切除加自体角膜缘干细胞移植 第2组,翼状胬肉切除加带蒂结膜瓣转移术中联合应用丝裂霉素C.观察术后角膜上皮修复、角膜缘新生血管及翼状胬肉复发情况.结果 术后随诊6～36月,第1组中有1只眼复发（4.35%）,第2组有2只眼复发（8.70%）.结论 翼状胬肉切除加自体角膜缘干细胞移植及翼状胬肉切除加带蒂结膜瓣转移术中联合应用丝裂霉素C均能有效阻止胬肉复发.但前者在手术安全性、舒适性、术后并发症等方面更具优势.     

单纯胬肉切除、角膜缘干细胞移植与带蒂结膜瓣移植治疗翼状胬肉疗效比较

目的比较单纯胬肉切除、角膜缘干细胞移植及带蒂结膜瓣移植术治疗翼状胬肉的疗效，探讨降低术后复发率的方法。方法667例（718眼）翼状胬肉，采用上述三种术式治疗，术后随访5～20个月观察胬肉复发情况。结果单纯胬肉切除术组62例（62眼），6眼胬肉复发，复发率为9．68％。联合角膜缘干细胞移植术组430例（462眼），3眼复发，复发率0．65％。联合带蒂结膜瓣移植术组175例（194眼），2眼复发，复发率1．03％。单纯切除组与其他两组复发率之间差异具有统计学意义（P〈0．01）。联合角膜缘干细胞移植组与联合带蒂结膜瓣移植组之间差异不具有统计学意义（P〉0．05）。结论胬肉切除联合角膜缘干细胞移植术治疗翼状胬肉其复发率与联合带蒂结膜瓣移植术相比无明显优势。两者术后复发率均明显低于单纯胬肉切除术。     

自体角膜缘干细胞移植治疗角膜缘功能衰竭症

目的　探讨自体角膜缘干细胞移植在角膜缘功能衰竭症治疗中的作用。方法　将 83例 90眼初发性翼状胬肉、外伤性角膜缘板层缺损及角膜缘碱烧伤患者随机分为A、B组。A组为自体角膜缘干细胞移植组 (干细胞治疗组 ) 4 2例 4 5眼 ,其中 30眼翼状胬肉行翼状胬肉切除联合自体角膜缘干细胞移植术 ,外伤性角膜板层损伤 10眼、角膜缘碱烧伤 5眼行自体角膜缘干细胞移植术 ;B组为传统单纯翼状胬肉切除 ,外伤性角膜缘板层损伤、碱烧伤行结膜瓣移植术 (对照组 ) ,4 1例 4 5眼 ,其中翼状胬肉 30眼行单纯翼状胬肉切除 ,外伤性角膜缘板层缺损 11眼、碱烧伤 4眼行结膜瓣移植术 ,术后观察角膜上皮修复时间、角膜缘新生血管、角膜透明度、泪膜破裂恢复时间以及胬肉复发率 ,术后随诊 6～ 2 4月。结果　A组术后角膜上皮修复时间 2～ 4d、BUT(6 .7± 0 .8)d ,无角膜缘新生血管生长 ,术后翼状胬肉复发率为 0 ,角膜透明 ;B组术后角膜上皮修复时间 5～ 7d ,BUT(7.9± 0 .5 )d ,角膜缘有 3～ 8支新血管生长 ,角膜有不同程度的云翳 ,翼状胬肉复发率 13.33% ,A、B 2组各项指标比较有统计学差异。结论　自体角膜缘干细胞移植治疗角膜缘功能衰竭症是一种简单、安全、有效的手术方法。     

带角膜缘的自体结膜瓣移植术治疗翼状胬肉的疗效

目的:观察用带角膜缘的自体结膜瓣移植术治疗翼状胬肉的临床效果。方法:翼状胬肉50例56眼,采取显微手术取同侧眼上方带角膜缘的游离结膜瓣进行移植。行翼状胬肉切除联合带角膜缘的自体结膜瓣进行移植,缝合时注意移植片移植床上角膜缘各自准确对位吻合,术后对角膜上皮化及植片生长情况随访观察。结果:术后随访6～12mo,角膜上皮平整光滑,泪膜正常,供区角结膜创面正常愈合,术后角膜透明或仅遗留少许云翳,无新生血管长入,无1例复发。结论:用带角膜缘的自体结膜瓣移植术治疗翼状胬肉,有利于重建角膜缘功能,是一种治疗翼状胬肉安全有效的手术方法。     

自体角膜缘移植联合球结膜移植治疗翼状胬肉

目的探讨治疗巨大翼状胬肉及复发性翼状胬肉的有效方法。方法对27例(27眼)巨大翼状胬肉及复发性翼状胬肉行胬肉切除加自体球结膜移植或自体角膜缘移植联合球结膜移植术。Ⅰ组8例(自体球结膜移植组)翼状胬肉单纯切除后取同眼颞上方球结膜移植于巩膜暴露区,Ⅱ组19例(自体角膜缘移植联合球结膜移植组)翼状胬肉单纯切除后取同眼颞上方结膜角膜缘上皮组织移植于巩膜暴露区。所有病例均在手术显微镜下操作。结果术后平均随访9.4月,自体球结膜移植组复发1例,自体角膜缘移植联合球结膜移植组未见复发。结论自体角膜缘移植联合球结膜移植治疗翼状胬肉疗效良好。     

环孢霉素A在防止翼状胬肉复发中的作用

目的:评价环孢霉素A滴眼剂对防止翼状胬肉复发的作用。方法:将75眼随机分为3组(A,B,C)。A组接受单纯翼状胬肉切除术,B组接受翼状胬肉切除联合自体干细胞移植术,C组接受翼状胬肉切除联合术后应用0.5g/LCSA。对所有眼术前、术后进行检查,评价其复发率,然后进行统计学分析。结果:经过平均6mo随访后,A组有11眼(44%)复发,B组未见复发,C组3眼(12%)复发。经过平均6mo的随访,结果发现组间有显著统计学差异。结论:翼状胬肉单纯切除联合术后局部使用0.5g/L环孢霉素A滴眼剂可以有效防止翼状胬肉的复发。     

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.     

Management of primary pterygia using free conjunctival and limbal-conjunctival autografts without antimetabolites

PURPOSE: To report the incidence of recurrence after primary pterygium surgery using either a free conjunctival or limbal-conjunctival autograft without antimetabolites. METHODS: One hundred eleven eyes of 90 patients underwent pterygium resection; a free conjunctival autograft was used in 88 surgeries and a free limbal-conjunctival autograft in 24; the latter technique was reserved for dark-skinned patients, under age 30, and with a history of recurrent pterygium in the contralateral eye. RESULTS: Mean age was 42.5 years (range, 23-75), and 50% of the patients were male. Mean follow-up was 9 months (range, 3-12). There were 2 recurrences (1.8%), both observed in the third postoperative month. CONCLUSIONS: With a good surgical technique, the incidence of recurrence after primary pterygium surgery is very low, making the use of antimetabolites unnecessary.     

不同手术方法对初发性翼状胬肉患者眼表的影响

目的:评价不同手术方法对初发翼状胬肉患者眼表的影响。方法:将39眼随机分为3组(A,B,C)。A组(13眼)接受单纯翼状胬肉切除术,B组(13眼)接受翼状胬肉切除联合自体干细胞移植术,C组(13眼)接受翼状胬肉切除联合术中应用0.2g/L MMC。对所有眼术前、术后7d;1,3mo进行Schirmer s test和泪膜破裂时间(BUT)检查,然后进行统计学分析。结果:术前、术后3组患者Schirmer s test和BUT检查未见明显异常。结论:经过短期随访,3种不同手术方式对初发翼状胬肉患者的眼表无明显影响。     

Corneal topographic changes after four types of pterygium surgery

PURPOSE: To evaluate effects of different pterygium surgeries on corneal topography. METHODS: Pre- and postoperative computerized videokeratography was performed on 120 eyes of 115 patients undergoing pterygium removal. Four techniques were used: bare sclera, excision with mitomycin C, limbal-conjunctival autograft, and conjunctival autograft. Corneal spherical power, topographical astigmatism, pre- and postoperative topographic irregularity, and surgically induced astigmatism were compared among surgical approaches. RESULTS: Mean topographic astigmatism value decreased significantly 4 months postoperatively. The difference among the postoperative astigmatism values at 4 months was statistically significant (P < .001). Statistically significant differences were noted between the type of surgery and surgically induced astigmatism (P < .05), mean topographical astigmatism (P < .05), and spherical power (P < .05), but no significant difference was observed in topographic irregularity (P = .067). The amount of corneal steepening in each group was 0.06 +/- 0.5 for conjunctival autograft, 0.02 +/- 0.3 for limbal-conjunctival autograft, 2.34 +/- 1.1 for bare sclera, and 1.70 +/- 0.4 for mitomycin C. The mitomycin C group produced the most induced astigmatism and the limbal-conjunctival autograft group produced the least induced astigmatism. CONCLUSIONS: Although pterygium surgery significantly reduces refractive astigmatism and topographic irregularity, spherical power increases and the cornea becomes steeper. This steepening is apparent with the bare sclera or excision combined with mitomycin C approaches. Surgeons should consider the possibility of recurrence and the effects of different types of surgeries on topography.     

自体结膜角巩膜缘移植治疗原发性翼状胬肉(英文)

目的:评价自体结膜角巩膜缘移植术治疗原发性翼状胬肉的有效性。方法:原发性翼状胬肉患者15例(15眼),接受自体结膜角巩膜缘移植术。切除翼状胬肉后,植片的角膜缘部分与翼状胬肉切除处的角膜缘对位缝合,植片的上皮面向上。纤维血管组织在原翼状胬肉区遮盖角膜1mm以上定为复发。结果:随访平均8mo,所有的患者既无一例复发也无并发症发生。结论:单纯翼状胬肉切除联合自体结膜角巩膜缘移植是一种治疗原发性翼状胬肉安全有效的手术方法。     

Minimally invasive pterygium surgery: a new approach for prevention of recurrence

PURPOSE: To introduce a novel approach for pterygium excision, to report recurrence rates, and to compare with conjunctival autografting. DESIGN: A comparative, prospective clinical case series design was used. METHODS: The study population consisted of 155 patients with unilateral primary or recurrent pterygia. All patients underwent pterygium excision, either by conventional conjunctival autografting (Group A) or by the minimally invasive pterygium excision (MIPE) technique (Group B). The new technique involves making a limbal incision of the conjunctiva through the body of pterygium, removing the head of the pterygium by blunt dissection, keeping the adjacent Tenon capsule intact, and performing a small conjunctival autograft to cover the epithelial defect. The recurrence rate of each technique was compared statistically. RESULTS: There were 84 patients in Group A and 71 patients in Group B. The recurrence rates were 18% at 1 year after surgery in the conjunctival autografting technique and 4.2% in the MIPE technique. The MIPE technique had significantly lower recurrence rates compared with conjunctival autografting technique (p<0.0001). CONCLUSIONS: The MIPE technique had lower recurrence rate and fewer postoperative complications than the conjunctival autografting technique. Preserving the Tenon capsule and minimizing conjunctival excision in pterygium surgery does not appear to increase the recurrence rate in the 1- year period. However, the effectiveness of this technique in preventing recurrences needs to be proven with more than 1-year results, which we plan to report in the future.     

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。     

Anterior segment indocyanine green angiography in pterygium surgery with conjunctival autograft transplantation

PURPOSE: To assess indocyanine green angiography (ICGA) as a method for monitoring autograft perfusion after pterygium excision with limbal-conjunctival autograft transplantation (LCAT) and to compare ICGA with anterior segment fluorescein angiography (ASFA). DESIGN: Nonrandomized prospective interventional case series. METHODS: Twelve eyes of 11 patients with primary pterygium treated by excision and limbal-conjunctival autograft transplantation were studied in a clinical practice. Anterior segment fluorescein angiography and ICGA findings for autograft vascularization after pterygium surgery were compared in 12 eyes of the 11 patients. Graft perfusion was monitored for 1 month with ASFA and ICGA, on days 1,7, and 30 post-surgery. RESULTS: With ASFA no graft perfusion was observed by postoperative day 30; only five grafts were isofluorescent with some vascularization, while the remaining seven grafts were hypofluorescent without any vascularization. In contrast, ICGA showed that, on postoperative day 1, all 12 grafts were hypofluorescent with multiple hyperfluorescent foci at the graft margin in the late phase and that, by postoperative day 7, 10 grafts were hypofluorescent and appeared to be perfused, originating from the episcleral vascular bed. On day 30, ICGA demonstrated isofluorescent grafts in 10 eyes with some conjunctival and episcleral vascular patterns on the graft itself, including the conjunctiva adjacent to the graft. By this stage, perfusion of the graft was complete. CONCLUSION: Indocyanine green angiography is useful for monitoring graft perfusion after LCAT in pterygium surgery. Further studies are needed to identify the implications of graft perfusion for therapy following LCAT in patients with pterygium.