羊膜移植和自体角膜缘干细胞移植治疗翼状胬肉

目的:探讨羊膜移植与自体角膜缘干细胞移植治疗翼状胬肉的疗效。方法:选取82例85眼翼状胬肉患者随机分为两组,A组:40眼,行翼状胬肉切除联合羊膜移植,B组:45眼,行翼状胬肉切除联合自体角膜缘干细胞移植。结果:随访9～32mo,A组术后复发2例,复发率5%;B组无复发,治愈率为100%,两组复发率无统计学意义。结论:两种方法治疗翼状胬肉均取得良好效果,翼状胬肉切除联合自体角膜缘干细胞移植疗效更加理想。     

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.     

角膜缘干细胞联合羊膜移植治疗翼状胬肉疗效观察

目的:观察自体角膜缘干细胞移植与羊膜移植术治疗翼状胬肉的临床疗效。方法:将126例142眼翼状胬肉患者随机分成A,B组,A组64例72眼行翼状胬肉切除联合角膜缘干细胞移植术;B组62例70眼行翼状胬肉切除联合羊膜移植术,术后1wk;1mo及3mo,观察比较移植片生长、角膜创面修复、角膜新生血管及胬肉复发率。术后随访24mo。结果:A、B两组角结膜上皮愈合时间分别为(2.6±0.4)d和(3.2±0.7)d,两组比较差异有显著性差异(P<0.05);A组2例2眼翼状胬肉复发,治愈率为97.1%,复发率2.9%;B组9例12眼翼状胬肉复发,治愈率为81.8%,复发率18.2%;两组比较差异有统计学意义(P=0.003)。结论:自体角膜缘干细胞移植与羊膜移植术均可有效防止翼状胬肉的复发,具有方便、创伤小,修复快,术后患者自觉症状轻,复发率低等优点。     

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。     

翼状胬肉角膜缘干细胞移植与羊膜移植的比较

目的　观察自体角膜缘干细胞移植与羊膜移植治疗翼状胬肉术后临床效果。方法　翼状胬肉 14 2例 (15 0眼 ) ,随机分为A、B两组。A组 92例 (98眼 )行胬肉切除联合自体角膜缘干细胞移植 ;B组 5 0例 (5 2眼 )行胬肉切除联合羊膜移植。观察术后患者自觉症状、角膜愈合情况、新生血管及胬肉组织增生。结果　翼状胬肉切除联合角膜缘干细胞移植较联合羊膜移植术后不适症状轻时间短 ,角膜创面愈合快。随访 1～ 2年角膜缘干细胞移植组胬肉复发 7眼 ,睑球粘连 1眼 ,羊膜移植组胬肉复发 7眼 ,其它并发症 3眼。结论　角膜缘干细胞移植及羊膜移植均有助于降低翼状胬肉术后复发率 ,是治疗翼状胬肉的良好术式。但两者相比较前者术式明显优于后者 ,是处理翼状胬肉最佳术式。     

胬肉切除结膜自体移植和羊膜移植的疗效

目的：研究目的是胬肉切除后羊膜移植是否能替代结膜自体移植。方法：我们对13例（13眼）原发性胬肉和1眼复发性胬肉施行胬肉切除及结膜自体移植术。另外1眼原发性胬肉和5例（5眼）复发性胬肉施行胬肉切除及羊膜移植术,所有患者术后随访12-18个月,平均14个月。结果：结膜自体移植组14眼手术成功,随访期间无1例复发。羊膜移植组2眼复发,1眼羊膜溶解。结论：羊膜移植可用于胬肉切除术,但有减低复发率方面,羊膜移植不如结膜自体移植。     

角膜缘干细胞移植与羊膜移植及单纯胬肉切除治疗复发性翼状胬肉的疗效比较

目的 比较自体角膜缘干细胞移植与新鲜羊膜移植及单纯胬肉切除治疗复发性翼状胬肉的疗效.方法 对复发性翼状胬肉166例(176只眼),随机分为A、B、C 3组,A组67例,72只眼,行复发性翼状胬肉切除联合自体角膜缘干细胞移植术.B组58例,59只眼,行复发性翼状胬肉切除联合新鲜羊膜移植术.C组43例,45只眼,行单纯胬肉切除.手术后随访6～60个月.比较3组患者的症状,创伤愈合情况,胬肉复发情况.结果 A组72只眼中年复发28只眼,复发率39%,B组59只眼中复发28只眼,复发率47.5%.C组45只眼中复发39例,复发率86.6%.结论 自体角膜缘干细胞移植与新鲜羊膜移植较单纯胬肉切除明显降低复发性翼状胬肉手术后复发率.而自体角膜缘干细胞移植比新鲜羊膜移植更有效降低复发性翼状胬肉的复发率.     

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。     

不同移植术治疗翼状胬肉

目的比较新鲜人羊膜移植、保存人羊膜移植、自体带角巩膜缘干细胞的结膜瓣移植及异体角膜缘干细胞移植联合羊膜移植治疗翼状胬肉的临床疗效。方法对196例202眼翼状胬肉患者随机组合分为A、B、C、D组。A组70眼行翼状胬肉切除联合新鲜羊膜移植术;B组75眼行翼状胬肉切除联合保存人羊膜移植术;C组39眼行翼状胬肉切除联合自体带角巩膜缘干细胞的结膜瓣移植术;D组18复发性翼状胬肉不适宜提供自体角膜缘而采用异体角膜缘干细胞移植联合羊膜移植术。术后随访6-12个月,对各组术后行动态观察及疗效进行回顾性分析。结果A组70眼术后复发16眼,复发率为22.86%;B组75眼术后复发17眼,复发率为22.67%;C组39眼术后复发3眼,复发率为7.69%;D组18眼术后复发5眼,复发率为27.78%;A组与B组比较(χ2=3.33,P>0.05);A组与C组比较(χ2=4.003,P<0.05);A组与D组比较(χ2=0.18,P>0.05);B组与C组比较(χ2=6.84,P<0.05);B组与D组比较(χ2=0.21,P>0.05);C组与D组比较(χ2=3.89,P<0.05);A组与C组、B组与C组、C组与D组具有显著差异性。结论自体自体带角巩膜缘干细胞的结膜瓣移植是目前治疗翼状胬肉较理想的手术方法。而异体角膜缘干细胞移植联合羊膜移植术后胬肉复发的主要原因是免疫排斥反应。     

翼状胬肉:羊膜移植和自体结膜瓣移植

目的:比较原发性和复发性翼状胬肉羊膜移植术和自体结膜瓣移植术的效果,测定指标为术后复发率。方法:对从2004-04/2006-02连续翼状胬肉病例作前瞻性研究。患者被随机分为2组:羊膜移植组(26例)和自体结膜瓣移植组(24例)。所有病例均用羊膜移植术或自体结膜瓣移植术,并广泛切除纤维血管组织。随访24mo观察复发和并发症。手术操作由同一位手术医师施行。对人口统计变数、手术技术、复发和术后并发症的相关性进行分析。结果:患者男女比例为4∶1,右眼与左眼的比例为3∶2。其中70%翼状胬肉是原发性,30%为复发。最常见的临床症状是眼部充血和视力下降,最常见的并发症是复发和角膜瘢痕。随访1mo,羊膜移植组和自体结膜瓣移植组的复发率分别为3.8%,8.3%,随访24mo后比例上升为46.2%,25%。结论:自体结膜瓣移植术后2a随访的成功率更好。翼状胬肉羊膜移植术复发率高,不被广泛接受。     

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.     

角膜缘自体结膜移植和羊膜移植治疗原发性翼状胬肉的疗效

目的：观察角膜缘自体结膜移植和羊膜移植治疗原发性翼状胬肉的临床效果。

方法：选取2013-01/2015-12深圳人民医院收治的翼状胬肉患者96例96眼,依据手术方式分为两组,其中LCAT组46例46眼,行翼状胬肉切除联合角膜缘自体结膜移植术; AMT组50例50眼,行翼状胬肉切除联合羊膜移植术。比较两组患者手术用时,术后随访12mo,比较两组角膜上皮修复所需时间、术后并发症以及复发情况。

结果：LCAT组和AMT组手术用时分别为33.83±1.65、23.60±1.51min,LCAT组高于AMT组,差异有统计学意义(t=-31.683,P<0.001)。LCAT组和AMT组术后角膜上皮修复所需时间分别为4.04±0.95、4.67±1.18d,LCAT组低于AMT组,差异有统计学意义(t=-2.922,P=0.004); LCAT组复发1例1眼,复发率2%,AMT组复发3例3眼,复发率6%,两组复发率比较,差异无统计学意义(P=0.618)。LCAT组术后2wk术区发生结膜肉芽肿1例1眼,AMT组术后未见严重并发症。

结论：角膜缘自体结膜移植术和羊膜移植术治疗原发性翼状胬肉术后恢复快,并发症少,复发率低,是安全有效的手术方式。     

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.     

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。     

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。     

The recurrence of pterygium after different modalities of surgical treatment

Purpose

To assess and compare the recurrence rate of pterygium after limbal stem cell transplantation versus amniotic membrane transplantation (AMT) as ocular surface reconstructing measures in recurrent pterygium, also evaluation of the use of antimetabolite drugs as adjunctive therapy for AMT.

Patients and methods

Prospective randomized comparative study included 60 eyes of 48 patients with recurrent pterygia. Informed consents were taken from all patients.Primary pterygium excision was performed 6–15 months ago; the cases were divided randomly into three equal groups:Group 1: included 20 eyes with excision of the pterygium and application of limbal stem cell transplantation with conjunctival autograft, group 2: included 20 eyes with excision of the pterygium followed by AMT and group 3: included 20 eyes in which surgical excision of pterygium was followed by intra-operative application of low-dose of MMC (0.05%) for 3 min then using AMT.

Results

The study included 36 males and 12 females of age ranged from 28 to 52 years. The recurrence rate was 2 eyes in group 1 (10%) (limbal stem cell transplantation + conjunctival autograft), 6 eyes in group 2 (30%) (AMT) and 4 eyes (20%) in group 3 (MMC + AMT). The rate of recurrence was significantly different between the three groups (P < 0.001).

Conclusions

Limbal stem cell transplantation together with conjunctival autografting proved to be more effective in prevention of pterygium recurrence and in rapid restoration of normal epithelial morphology. MMC in addition to AMT decreases the incidence of recurrence.Abbreviations: AMT, amniotic membrane transplantation; MMC, mitomycin C     

Vascularization is more delayed in amniotic membrane graft than conjunctival autograft after pterygium excision

PURPOSE: To monitor the development of graft vascularization by indocyanine green angiography (ICGA) after pterygium excision with limbal-conjunctival autograft transplantation (LCAT) and amniotic membrane transplantation (AMT). DESIGN: Randomized prospective interventional case series. METHODS: Anterior segment ICGA findings at one, seven, and 30 days after surgery were evaluated in eyes with primary pterygium treated by excision and LCAT (14 eyes of 14 patients) or AMT (13 eyes of 13 patients), and the results for graft vascularization were compared. RESULTS: All conjunctival autografts showed early vascularization from underlying episcleral vascular bed as multiple hyperfluorescent foci at the graft margin on postoperative day 7; graft vascularization was complete on postoperative day 30. In contrast, all grafts in AMT group showed no graft vascularization at any stage after pterygium surgery. This delay of vascularization with AMT persisted until one month after surgery. CONCLUSIONS: Anterior segment ICGA is useful to monitor graft vascularization after pterygium surgery. Graft health after LCAT may be demonstrated by early graft vascularization and perfusion; however, there is a delay in graft vascularization after AMT that may be related to the antiangiogenic effects of the membrane. Further study is needed to demonstrate the relationship between this delay of graft perfusion and early postoperative pterygium recurrence.