自體眼表移植術治瘵翼狀胬肉

目的觀察自體角膜緣(幹細胞)及球結膜的眼表移植衍治瘵翼狀胬肉的瘵效.方法對38例42眼進行期翼狀胬肉采用自體角膜緣及球結膜移植術治瘵.術後隨隨訪5～18個月.結果 41眼移植片Ⅰ期愈合,角膜上皮穩定,無胬肉復發.1眼由于取結膜植片過小,植片皺縮,出現胬肉組織潜在復發可能,占2.38%.結論自體角膜緣及球結膜移植衍治瘵翼狀胬肉是一種安全而有效地阻止胬肉復發的手衍.     

綜合治療翼狀胬肉

手術是治療翼狀胬肉的主要方法,我們曾報道自1990-1994年采用翼狀胬肉根部切除及冷凍聯合術,復發率爲3.7%,在此基礎上,根據角膜緣干細胞理論,我們追加自體角膜緣聯合球結膜移植治療翼狀胬肉32例35眼,效果更滿意,現報告如下:     

復發性翼狀胬肉切除并自體幹細胞移植療效觀察

目的探討翼狀胬肉切除自體幹細胞移植治療復發性翼狀胬肉.方法常規方法切除復發性翼狀胬肉84例(85眼)隨機對43例(44眼)作自體幹細胞移植;41例作結膜移植對照觀察,兩組術後一周内隔日以後每周一次結膜下注射5-FU2mg共6次.結果治療組治愈率爲88.37%,復發率爲11.63%;對照組治愈率爲.85%,復發率爲34.15%.兩組比較差异有顯著性(P≤0.05).結論復發性翼狀胬肉切除幹細胞移植治療配合5-FU結膜下注射,效果滿意手術簡便,值得推廣應用.     

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。     

羊膜移植治療翼狀胬肉

目的評估廣泛切除聯合羊膜移植治療翼狀胬肉的效果.方法對29例(30祗眼)作翼狀胬肉廣泛切除聯合羊膜移植手術,其中復發性胬肉8例8眼(26.7%),原發巨大胬肉7例7眼(23.3%),29例中雙眼胬肉者20例(69.0%).另有10例10眼作單純廣泛胬肉切除.廣泛胬肉切除方法作胬肉體部與球結膜潜行分離,并將胬肉與鞏膜面和肌止部的粘連分離後,在半月襞處甚至連少許半月襞連同胬肉剪除,暴露鞏膜面及肌止部,用深低温保存的羊膜行移植手術.縫合方法作J適當改進,即作間斷固定縫合羊膜瓣,但角膜緣側上下兩角之間免除縫合.術後觀察3～12個月.結果(1)全部病例術後無復發,僅見一例鞏膜面有薄層胬肉樣的結膜增生.術後早期炎癥反應或刺激,羊膜移植與單純胬肉切除相似,拆綫後羊膜移植病例眼部炎癥反應消退快,1周内角膜上皮基本愈合,羊膜無F1染色,術後3～6個月羊膜移植區鞏膜面清澈可見,無胬肉復發傾向.而單純胬肉切除者刮面多有結膜血管與疤痕組織增生現象,并有2例胬肉復發.(2)視力改善程度36.7%患者視力提高2～7行,63.3%患者視力同術前.(3)羊膜移植合并癥僅有一例羊膜下出血.結論廣泛胬肉切除聯合羊膜移植治療復發性胬肉、巨大胬肉等可有效防止復發.手術安全,并達到改善視力的目的.     

自體角膜缘上皮移植聯合缘裂霉素C治瘵翼狀胬肉的臨床觀察

目的評價自體角膜缘部上皮移植聯合絲裂霉素C治瘵原發舆復發性翼狀胬肉的瘵效,尋找一種有效地預防胬肉後發的手術方法.方法采用胬肉切除、應用濃度爲0.1mg/ml、0.2mg/ml的絲裂霉素C貼敷,以及用带有角膜缘部上皮的自體結膜瓣移植的聯合方式,治瘵原發舆後發性胬肉58例(66眼).結果随訪5個月～2年,平均10個月.3眼術後復發,復發率爲4.55%.術中及術後無嚴重并發癥發生.結論自體角膜缘上皮移植,辅加藥物絲裂霉素C治瘵翼狀胬肉是一種防止術後復發的有效方法.     

人羊膜移植治療翼狀胬肉的臨床分析

目的探討人羊膜移植治療翼狀胬肉的可行性及其療效評估.方法選擇18例(18衹眼)翼狀胬肉患者,其中初發性12例.復發性6例,行胬肉切除并行人羊膜移植,術後隨訪3～6個月.結果無一例出現排斥反應及嚴重并發癥,瞼球粘連得到解除,僅一例復發.結論羊膜具有抗原性低,促進眼表上皮化,减輕炎性反應,抑制纖維組織增生和新生血管形成等作用.胬肉切除術後,用羊膜修復眼結膜缺損區的創面,可提供一個理想基底膜,使其迅速上皮化及創口愈合,從而防止胬肉復發.     

帶蒂球結膜與角膜緣上皮移植治療翼狀胬肉

目的 探討帶蒂球結膜與角膜緣上皮移植治療翼狀胬肉.方法采用常規手術方法分離胬肉頭部、頸部及體部.然後剪除變性的筋膜組織至泪阜部.刮除胬肉下角鞏膜面的癍痕組織.暴露光滑鞏膜面并燒灼止血.下方角膜緣自胬肉刮除區使用圓刃刀剖切角膜上皮植片約3×5mm2範圍大小.植片離斷處球結膜沿角鞏膜緣繼續向前剪開約4～5mm左右.距角膜植片連接處球結膜約3～4mm,弧形平行角鞏膜緣剪開.將帶蒂的球結膜與角膜緣上皮向上.牽拉.與上方角鞏膜處球結膜用10/0尼龍經綫縫合1針.用虹膜恢復器調整角膜上皮植片將其覆蓋于胬肉切除處角膜創面上.結果對經治28例32眼術後隨訪觀察3～10月.所有病人術後3天角膜植片水糖開始消退并覆蓋角膜創面.一周後結膜充血逐漸消退.1例内眦部出現角膜肉芽腫表麻後剪除.1例出現淋巴潴留用一次性注射針頭刺破後愈合.命組病例無1例復發.結論本方法采用帶蒂球結膜瓣與上方球結膜拉攏縫合1針,既避免了植片移位,又簡化J操作步驟.并且帶蒂結膜具有原來的血液供應來源,减少了幹細胞再植床的死亡率.是一種比較理想的手術方法。     

自體角膜缘上皮移植聯合5一氟脲嘧啶治瘵翼狀胬肉的臨床觀察

目的觀察自體角膜缘上皮移植聪合5一氟脲嘧啶治瘵翼狀胬肉的瘵效.方法對27例(眼)行自體角膜缘上皮移植聯合5氟脲嘧啶處理植床.結果随訪1～14個月,平均7.8個月.術後復發1例.結論自體角膜缘上皮移植聯合5氟脲嘧啶治瘵是治瘵胬肉的良好方法.     

深低温保存羊膜在結膜重建中的臨床應用

目的評價深低温保存羊膜移植進行結膜重建的手術療效,并分析羊膜移植結膜重建手術成功的基本條件和具體手術方法與操作要點.方法用深低温保存的羊膜治療43例結膜整形患者.無眼球結膜囊狹窄10例,大面積結膜腫瘤13例,瞼球粘連9例,復發性胬肉7例,并嘗試對少數病例(4例)義眼座暴露,進行羊膜修補.結果隨診6～18個月,總治愈率達88.64%,無眼球結膜囊狹窄的治愈率為80%,瞼球粘連的治愈率達88.89%,大面積結膜腫瘤和復發性胬肉的治愈率皆為100%,而應用深低温保存羊膜修補羲眼座暴露,治愈率祗有50%.結論深低温保存的羊膜是一種有良好發展前景的生物材料,羊膜移植結膜重建術後整形外觀良好.在具體實踐中,結膜重建的手術效果不僅與羊膜的制備和保存有關,而且受手術方式的選擇,手術操作技巧以及術後處理的强烈影響.     

Combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C in the treatment of primary pterygium

PURPOSE: To introduce a new technique of conjunctival reconstruction after primary pterygium excision, and to evaluate the efficacy of combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C application in preventing recurrence of primary pterygium. METHODS: In a prospective, non-comparative case series, 43 eyes of 41 consecutive patients with primary pterygium were studied. In all patient eyes, after excision of pterygia, 0.02% mitomycin C was applied topically for 2 min over the exposed scleral surface and "symmetrical conjunctival flap transposition" was performed to reconstruct the conjunctival defect. The main outcome measures were pterygium recurrence or any complications related with surgery or mitomycin C. RESULTS: The mean age of the patients was 47.5 +/- 12.4 years (range 30-70 years). Among the 38 patients who were not lost to follow up, three patient eyes (7.5%) had grade 1, 24 eyes (60.0%) had grade 2 and 13 eyes (32.5%) had grade 3 pterygium. The mean follow up was 12.2 +/- 5.7 months (range 7-28 months). No recurrence or sight-threatening complications were encountered in any patient eye throughout the follow-up period. CONCLUSION: Combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C application may be an effective surgical alternative in preventing recurrence of primary pterygium. Although the procedure seems to be free from severe complications, surgeons and patients should be well aware of the risk of late radiomimetic complications of mitomycin C. Comparative, randomized trials with more number of patients and longer follow up are required to further establish the safety and efficacy of this treatment strategy.     

自体角膜缘移植治疗翼状胬肉的临床观察

目的 探讨自体角膜移植治疗翼状胬肉的疗效。方法 对４２例（４８只眼）初发性和复发性翼状胬肉行自体角膜缘移植术,术后随访３６例（４２只眼）,随访时间４个月～２年,平均９个月。结果 上皮愈合良好、稳定,无新生血管及结产生,角膜光滑,未见复发。结论 自体角膜缘移植可通过提供新的干细胞来源,提高翼状胬肉手术的成功率,降低术后的复发率,是一种有推广价值的手术方法。     

Pterygium surgery: conjunctival rotation autograft versus conjunctival autograft

BACKGROUND AND OBJECTIVES: To compare the safety and efficacy of conjunctival rotation autograft to conjunctival autograft in primary pterygium surgery. PATIENTS AND METHODS: A prospective randomized study was performed of 39 eyes in 31 patients who had undergone pterygium surgery. Nineteen eyes were treated by conjunctival rotation autograft (Group A). Twenty eyes were treated by conjunctival autograft (Group B). Follow up ranged from 8 to 12 months (mean 11 months). Recurrence was defined as postoperative regrowth of 2 mm fibrovascular tissue onto clear cornea in the area of previous pterygium excision. Four eyes were excluded from the study. Delayed wound healing occurred in 11.76% of eyes, and 5.88% of eyes had persistent congestion in Group A. A loose graft was present in 5.55% of eyes, and 5.55% of eyes had dellen formation in Group B. CONCLUSION: We conclude that conjunctival rotation autograft and conjunctival autograft are both equally effective methods to reduce the recurrence rate after pterygium surgery. Conjunctival rotation autograft can be tried as an alternative attractive procedure for pterygium surgery to reduce the chances of recurrence. However, a larger, randomized, prospective double masked study with more patients and a longer follow up will eventually demonstrate the superiority of one procedure over the other.     

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.     

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.     

Comparison of the Efficacy of Pterygium Resection Combined with Conjunctival Autograft versus Pterygium Resection Combined with Amniotic Membrane Transplantation

 PURPOSE:To compare the efficacy of pterygium resection combined with conjunctival autograft versus pterygium resection combined with amniotic membrane transplantation in the treatment of pterygium. METHODS:A total of 118 cases (133 eyes) were randomly assigned to receive pterygium resection combined with conjunctival autograft (n=81) or pterygium resection combined with amniotic membrane transplantation (n=52). Corneal wound healing and neovascularization and the presence or absence of conjunctival proliferation and hyperemia were analyzed at 12 months post-operatively. RESULTS:In the conjunctival autograft group, 6 eyes (7.4%) had recurrent pterygium, while in the amniotic membrane transplantation group, 10 eyes showed recurrence (19.2%, P<0.05, chi-square). Patients in the conjunctival autograft group recovered significantly faster compared with those in the amniotic membrane transplantation group. CONCLUSION:Patients receiving pterygium surgery combined with conjunctival autograft had lower recurrence rates and experience faster recovery compared with those undergoing pterygium resection combined with amniotic membrane transplantation.     

羊膜移植在翼状胬肉术中的应用

目的观察保存人胎盘羊膜移植在翼状胬肉切除术后结膜重建及防止翼状胬肉复发中的疗效。方法对117例（143眼）翼状胬肉行广泛切除后，用保存人羊膜移植修补。结果术后2～3天角膜上皮修复，2～3周结膜血管化完成，与正常结膜不易区分。随访观察2～24月，治愈率91％。结论翼状胬肉切除联合羊膜移植术可有效地降低复发率。     

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.     

改良自体结膜瓣移植治疗翼状胬肉的临床初步报告

目的探讨一种治疗初发性翼状胬肉的新的手术方法,寻求防止初发性翼状胬肉术后复发的最佳手术方法。方法18例（18眼）初发性翼状胬肉,在手术显微镜下进行手术,彻底切除翼状胬肉组织,保留巩膜表面的眼球筋膜囊,同时从上方或下方取条状球结膜转位行改良的自体球结膜移植。术后随访12—20个月,平均（16．09±3．56）月。结果18例（18眼）均治愈,未见胬肉复发。术中术后未见并发症。结论手术显微镜下行保留眼球筋膜囊的翼状胬肉切除联合改良自体球结膜移植手术,术后复发率低,是治疗初发性翼状胬肉的一种新的安全有效的方法。