翼状胬肉术后发生巩膜溶解分析

目的:探讨翼状胬肉切除联合使用丝裂霉素C(mitomycin C,MMC)术后巩膜溶解的发生机制及预防、治疗。方法:对2006-11/2010-12我院门诊及住院翼状胬肉切除联合MMC术后巩膜溶解10眼患者进行追踪观察,并通过局部药物或手术方法进行治疗。结果:所有患者病变位于原翼状胬肉切除部位,且局部表现为组织缺血、变薄,部分患者病变区域可透见深层色素膜。通过局部药物或手术治疗,病情得到控制,且在随访期间无复发。结论:翼状胬肉切除手术为降低复发率,可采用联合MMC治疗,但是在MMC的浓度及作用时间上应慎重选择,并且术中应尽量减少局部组织的烧灼,以保证局部的血液供应,预防巩膜溶解的发生。     

翼状胬肉术后巩膜溶解的临床观察

目的探讨翼状胬肉术后巩膜溶解的原因、预防及治疗。方法对本院住院翼状胬肉手术后巩膜溶解7例(8眼)患者进行追踪观察,并通过局部药物进行治疗。结果所有患者病变位于原翼状胬肉切除部位,且局部表现为巩膜组织缺血、变薄,部分患者病变区域可透见棕色色素膜组织。通过药物治疗,所有患者病情得到控制,且在随访期间无复发。结论任何翼状胬肉手术方式都有可能导致巩膜溶解严重的并发症,过分烧灼巩膜面及术后长时间使用糖皮质激素滴眼液为常见原因。一旦发生巩膜溶解,要立即停用糖皮质激素滴眼液,加强营养类药物,多数患者通过药物治疗能够治愈。     

翼状胬肉不同术式后巩膜溶解的观察分析

目的:比较翼状胬肉两种不同手术方式后巩膜溶解的发生概率,探讨产生巩膜溶解的原因,选择合理手术方式.方法:对本院两年来263例翼状胬肉采用两种不同的手术方式,观察术后发生巩膜溶解的情况,并通过局部药物进行治疗.结果:263例翼状胬肉患者,130例采用胬肉切除+结膜瓣转位术,裸露角膜缘3 mm巩膜,术后局部滴0.02％丝裂霉素C(mitomycin C,MMC),胬肉复发26例,发生巩膜溶解6例;133例采用胬肉切除+角膜缘干细胞移植术,术后滴0.02％ MMC,胬肉复发5例,无1例发生巩膜溶解.结论:翼状胬肉术后发生巩膜溶解,是一种严重的手术并发症,可能与术中过度烧灼巩膜面,巩膜板层暴露于MMC有关.采用胬肉切除+角膜缘干细胞移植术,植片覆盖裸露巩膜,促进巩膜表层愈合,术后避免MMC直接浸润巩膜板层故未见此并发症发生.与传统手术方式相比,复发率低,并发症少,是一种安全、有效的翼状胬肉手术方式.     

翼状胬肉术后角巩膜溶解6眼

0引言翼状胬肉是眼科常见病和多发病,治疗以手术为主。但是单纯胬肉切除术后复发率高达20%~70%[1]。近年来国内外眼科学者为了预防翼状胬肉术后复发,不断改进手术方式,同时术中术后联合应用抗代谢药物等方法极大地降低了手术后复发率,但同时也出现了新的术后并发症的发生,有的并发症可严重影响视功能,甚至丧失眼球[2]。现将我院近年来翼状胬肉切除联合丝裂霉素C(MMC)术后角巩膜溶解6眼,报告如下。1临床资料总结我院2003-12/2008-08门诊及住院翼状胬肉切除联合MMC术后角巩膜溶解6眼,其中女5眼,男1眼,年龄50~73岁,2眼为复发性胬肉。显微镜下行胬肉切除术。切除胬肉体部,保留胬肉头部不     

丝裂霉素C联合结膜徙盖术治疗复发性翼状胬肉

目的 探讨丝裂霉素C(MMC)联合结膜徙盖术治疗复发性翼状胬肉的疗效.方法 采用翼状胬肉手术切除联合MMC、结膜徙盖治疗复发性翼状胬肉22例22眼.术中1次性局部应用MMC,胬肉切除后巩膜暴露区用正常结膜组织徙盖.结果 术后随访1～26月,平均10.3±2.9月.术后再次复发率为4.55%,手术成功率为95.45%.并发症,早期浅层点状角膜炎8眼(36%).结论 MMC联合结膜徙盖术可有效地防止复发性病例的再次发生.     

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。     

复发性翼状胬肉切除联合干细胞移植及丝裂霉素C疗效观察

目的:观察复发性翼状胬肉根治性切除联合自体角膜缘干细胞移植术中应用丝裂霉素C(MMC)的临床疗效。方法:对98例98眼复发性翼状胬肉行根治性切除,将术眼上方或下方带有角膜缘干细胞的结膜瓣移植于胬肉处的巩膜上,术中联合用0.2g/LMMC治疗。结果:术后反应轻,移植片存活,复发率2%。结论:根治性切除联合角膜缘干细胞移植术中应用MMC治疗复发性翼状胬肉,方法简单,胬肉组织切除彻底,重建了角膜缘的结构和功能,恢复了角膜缘的屏障,复发率低,安全有效,值得推广。     

手术切除联合羊膜移植治疗翼状胬肉

翼状胬肉术后较易复发使得该病一直属于眼科难治性疾病之一。我们采用显微手术切除局部病变组织联合羊膜移植的方法治疗翼状胬肉,取得了较好的疗效,现报告如下:     

翼状胬肉不同术式的临床疗效探讨

目的评价翼状胬肉不同术式的临床疗效。方法85例(89眼)分为3组在手术显微镜下按3种不同的方法施行手术:第1组31眼施行常规翼状胬肉切除联合丝裂霉素C(MMC)应用;第2组35眼施行翼状胬肉保留球结膜根治性切除联合MMC应用;第3组23眼施行翼状胬肉切除联合自体角膜缘上皮及球结膜移植术。结果随访5～36月,第1组复发率3.23%,第2组与第3组均无复发。结论手术显微镜下翼状胬肉保留球结膜根治性切除联合应用MMC的方法,手术简单,组织损伤小,恢复快,复发率低,是治疗翼状胬肉并防止术后复发的较好的方法。     

逆行镊撕法联合3种手术方式预防翼状胬肉复发的疗效分析

目的:探讨预防翼状胬肉复发的不同手术方法的疗效。方法:将178眼翼状胬肉随机分为3组,分别予以不同手术方法治疗。A组53眼翼状胬肉逆行镊撕法切除,巩膜暴露联合丝裂霉素(MMC);B组69眼行翼状胬肉逆行镊撕法切除,联合MMC及结膜瓣转移术;C组56眼行翼状胬肉逆行镊撕法切除,联合MMC及羊膜移植术。观察3组复发率,角膜上皮愈合时间及并发症发生情况。结果:随访1～3a,A组复发率12.7%,B组复发率4.3%,C组复发率1.1%,B、C组复发率显著低于A组(P<0.05),C组又显著低于B组(P<0.05)。A组角膜上皮愈合天数为4±1.2d,B组为3±0.9d,C组为2±0.8d,C组愈合时间显著低于A、B组(P<0.01)。A组10例发生结膜下出血,B组5例发生结膜下出血,均在1wk内治愈,未见其他严重并发症。结论:翼状胬肉逆行镊撕法切除,联合MMC及羊膜移植术疗效确切,并发症少,复发率低,值得临床推广。     

Corneal Melting Two Weeks after Pterygium Excision with Topical Mitomycin C: Successfully Treated with Lamellar Keratoplasty and Amnion Membrane Transplantation

Purpose

To report the management of a case of corneal melting two weeks after pterygium excision with intraoperative topical mitomycin C (MMC).

Methods

Case report.

Results

A 57-year-old male was referred to our Department for therapy of rapidly progressive corneal melting two weeks after primary pterygium surgery with MMC (0.2 mg/ml) in September 2009. Initial treatment consisted of topical and systemic immunosuppression along with topical antibiotics. Eight days after presentation, the patient underwent successful lamellar keratoplasty and amnion membrane transplantation. Subconjunctival injection of triamcinolone (40 mg/ml) and topical bevacizumab were used to manage the increased fibrovascular activity around the site of the former pterygium.

Conclusion

Topical use of MMC during pterygium surgery may be related to serious postoperative complications such as progressive inflammatory corneal melting. The etiology may be multifactorial, which is related to MMC-induced inflammation and/or induced apoptosis. A therapeutic option is the described combination of systemic and local anti-inflammatory treatment along with lamellar keratoplasty and amniotic membrane transplantation. Adjunctive therapy may be needed if recurrence occurs.Key words: Mitomycin C, Pterygium, Corneal melting, Amniotic membrane, Lamellar keratoplasty     

三种不同术式翼状胬肉切除术的临床对比观察

目的观察丝裂霉素C（MMC）或羊膜移植在翼状胬肉切除术中应用的临床疗效。方法对临床收治的需行翼状胬肉切除术病例随机分为3组进行手术。A组为单纯翼状胬肉切除;B组为翼状胬肉切除联合应用MMC,术中于翼状胬肉切除区巩膜面及结膜下放置0.4 mg/ml MMC 3 min;C组为翼状胬肉切除联合生物羊膜移植,于翼状胬肉切除区巩膜面植入瑞济干燥羊膜植片。术后1周、2周、1个月、3个月、1年、2年检查记录术眼并发症及复发情况。结果随访观察6个月至3年,A组60例（68只眼中）22只眼复发（32.4%）;B组60例（72只眼）中12只眼复发（16.7%）;C组50例（60只眼）中5只眼复发（8.3%）。A组与B组比较、A组与C组比较（P〈0.05）,差异具有显著性;B组与C组比较（P〉0.05）,复发率无显著性差异。结论翼状胬肉切除联合丝裂霉素C或生物羊膜移植手术、手术安全、可以减少翼状胬肉切除术后复发率。     

翼状胬肉术后巩膜融解14例临床分析

目的:探讨翼状胬肉术后巩膜融解发生的原因、处理方法及预防。方法:选取14例均行胬肉单纯切除,11例在术中使用MMC,术后发现巩膜融解后停用激素类眼液,改用非激素类抗生素滴眼液,球结膜下注射妥布霉素+VitC,贝复舒滴眼液、小牛血去蛋白眼用凝胶点眼后加压包封患眼,巩膜融解稳定后,上述眼开放点眼,直至完全修复,对结果进行了回顾性的分析。结果:所有患者均药物保守治愈,巩膜外观平整。结论:翼状胬肉术后巩膜融解的发生与手术方式、手术技巧、术中术后用药及患者体质等多种因素有关,要充分认识翼状胬肉术中、术后处理不当引起巩膜融解的可能性。     

Tectonic corneal lamellar grafting for severe scleral melting after pterygium surgery

PURPOSE: To describe the technique and review the indications and success of tectonic corneal lamellar grafting for the management of severe scleral melts after pterygium surgery. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Twenty cases of severe scleral necrosis after pterygium surgery (1993-1999). INTERVENTION: Tectonic corneal lamellar grafting. Surgery involved (1) removal of all devitalized or infected scleral tissue surrounding the melt; (2) use of lamellar or full-thickness donor corneal tissue, fashioned to fit the scleral defect exactly or a 0.25-mm diameter larger; and (3) placement of a pedicled or free conjunctival flap over the corneal lamellar graft. MAIN OUTCOME MEASURES: Eradication of progressive scleral necrosis, preservation of globe integrity, eradication of infection, and preoperative and postoperative visual acuity. RESULTS: Sixteen (80%) of 20 cases developed severe scleral necrosis that required tectonic surgery after bare sclera pterygium excision with mitomycin C or beta-irradiation. Surgery was also therapeutic to eradicate progressive infection in 6 cases of infective scleritis that did not respond to maximal medical treatment. Scleral melting presented 1 month to 20 years after initial pterygium surgery in healthy, immune-competent adults. Therapeutic and tectonic success was achieved in 19 cases (95%); in 1 case, recurrence of fusarium fungal infection led to severe graft necrosis and intraocular spread. Among the cases of infectious scleritis, three eyes required repeat lamellar grafting to successfully eradicate infection. CONCLUSIONS: Tectonic and therapeutic lamellar keratoplasty, combined with aggressive antibiotic therapy, preserved globe integrity and eradicated infection in cases of severe scleral melting after pterygium surgery.     

Intraoperative mitomycin C versus autologous conjunctival autograft in surgery of primary pterygium with four‐year follow‐up

Purpose: To compare the 4‐year outcome of primary pterygium excision using intraoperative mitomycin C (MMC) with suturing a free conjunctival autograft (CA). Methods: A total of 115 eyes with nasal primary pterygium of 115 patients were included in the study. After randomization into two groups, the eyes were operated on by a single surgeon (GK). After excision of the pterygium, 56 eyes received 0.04% MMC intraoperatively on the bare sclera for 3 min and 59 eyes received a free CA sutured using 7‐0 Vicryl. Postoperative follow‐up was 4 years. Main outcome measures were recurrences, re‐operations, surgery time, complications, visual acuity and astigmatism. Statistical evaluation was performed with the chi‐squared test. Results: The recurrence rate was 38% in the MMC group and 15% in the CA group (p < 0.05). The re‐operation rate of the recurrences was 53% in the MMC group and 29% in the CA group. Average surgery time was 13 minutes (range: 6–22 min) in the MMC group and 26 min (range: 18–32 min) in the CA group (p < 0.01). There was no significant change in best‐corrected visual acuity and astigmatism. One major complication occurred in each group. The most frequently observed complication was delayed epithelial healing (40%) and mild scleral thinning (20%) in the MMC group and suture‐related inflammation in the CA group (10%). Conclusion: Pterygium surgery including free autologous conjunctival grafting is associated with fewer recurrences, re‐operations and complications than using the bare sclera technique together with single‐dose intraoperative MMC.     

带蒂结膜瓣移植联合丝裂霉素治疗翼状胬肉的疗效分析

目的:观察带蒂结膜瓣移植联合丝裂霉素C治疗翼状胬肉的临床效果,探寻减少复发的最佳术式。方法:对131例131眼行翼状胬肉切除术、联合丝裂霉素C湿贴、带蒂结膜瓣移植术,术后点重组牛碱性成纤维细胞生长因子及氧氟沙星滴眼液。结果:患者术后随访观察6mo～2a,131例131眼有4眼复发,复发率为3.1%。结论:带蒂结膜瓣移植联合应用丝裂霉素C湿贴治疗翼状胬肉,复发率较低,手术简单易行,费用低,不失为一种好办法,尤其针对基层医院比较适合。     

自体角膜缘干细胞移植联合丝裂霉素C治疗翼状胬肉

目的:观察自体角膜缘干细胞移植联合丝裂霉素C治疗翼状胬肉的疗效。方法:对60例68眼翼状胬肉应用自体角膜缘干细胞移植,并术中应用0.2g/L丝裂霉素C5min。结果:随访6～24mo,60例未见复发及严重并发症。结论:应用自体角膜缘干细胞移植联合丝裂霉素C治疗翼状胬肉是安全有效的方法。     

Surgical management of scleral perforation after pterygium excision

OBJECTIVE: Scleral perforation is a rare complication occurring after pterygium excision often leading to scleral ulceration and loss of vision. Our purpose is to evaluate the long-term effectiveness and safety of tenonplasty and amniotic membrane transplantation in the management of scleral perforation after pterygium excision. PATIENTS AND METHODS: We performed a retrospective study on patients with scleral perforation after pterygium excision that underwent tenonplasty and amniotic membrane transplantation at Chang Gung Memorial Hospital from 1997 to 1999 and followed up for at least 12 months postoperatively. RESULTS: There were 6 patients, 1 male and 5 females ranging in ages from 46 to 71 years (mean, 63.3). The interval between pterygium excisions to scleral perforation ranged from 3 to 20 years. There were no recurrences during the follow-up period of 12 to 24 months (average, 18.3 months). CONCLUSIONS: Tenonplasty and amniotic membrane transplantation appears to be a relatively simple, safe, and effective method for treating scleral perforation after pterygium excision.     

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。