翼状胬肉切除自体角膜上皮和结膜移植观察

目的观察在手术显微镜下翼状胬肉切除联合自体纯角膜上皮和纯结膜组织移植的临床效果。方法对36例(36眼)鼻侧球结膜原发性翼状胬肉行手术显微镜下切除,并将术眼的颞上侧单纯角膜上皮和单纯结膜组织分别移植到术后角膜创面和结膜缺损(巩膜裸露)处,观察角膜创面上皮修复速度及结膜植片的血管化过程。结果随访观察5～16月,平均10月。36例全部治愈无复发者。角膜上皮植片两天内修复透明光滑,结膜植片2周血管化完成。结论翼状胬肉切除联合自体纯角膜上皮和纯结膜组织移植,取材方便,无排斥反应,术后伤口愈合快,复发率低。     

自体带角膜缘干细胞结膜瓣移植治疗假性胬肉

目的观察取自健眼的自体带角膜缘干细胞的结膜瓣移植治疗外伤后发生的假性胬肉的临床效果。方法对26例（26眼）假性胬肉应用取自健眼的带角膜缘干细胞的结膜瓣移植治疗,术后随访4～12月,对临床资料进行回顾性分析。主要观察指标：术后植片、角膜上皮愈合、胬肉复发及供区创面修复情况。结果所有患眼术后植片水肿3～5d后减轻,7～15d完全消退,拆线后植片血供良好,角膜上皮愈合。仅1例（3．85％）术后13d植片溶解脱落,1月后行2次手术植片成活。3例（11．54％）术后复发;健眼供区创面均恢复良好,均在7d后愈合,1月后充血消退,未影响外观。结论取自健眼的自体带角膜缘干细胞的结膜瓣移植治疗外伤后假性胬肉,术后复发率低,外观良好。     

翼状胬肉根治手术预防结膜复发的效果观察

目的 探讨不同翼状胬肉切除手术预防结膜复发的效果.方法 根据手术方式的不同,将本院接受翼状胬肉切除手术的原发性翼状胬肉患者206例(263眼)分为A、B 2组,A组92例(120眼)接受翼状胬肉根治切除手术,即翼状胬肉切除和结膜瓣转移移植术联合球筋膜广泛切除和翼状胬肉残留的球结膜尽量切除术;B组114例(143眼)仅接受翼状胬肉切除和结膜瓣转移移植术.术后随访3～69个月,平均18.6个月,裂隙灯显微镜检查角膜、结膜及巩膜创面情况,比较2组翼状胬肉患者术后结膜复发的眼数和发生率.结果 A组巩膜创面主要由转移结膜瓣覆盖,水肿、充血轻,其中16眼结膜复发,发生率为13.33%;B组巩膜创面主要由翼状胬肉残留的球结膜覆盖,充血持续1个月以上,其中66眼结膜复发,发生率为46.15%;用x2检验分析,2组结膜复发发生率差异有显著统计学意义(X2=32.75,P＜0.005).结论 翼状胬肉根治切除手术预防结膜复发的效果显著.     

带角膜缘干细胞的自体结膜瓣移植术治疗复发性翼状胬肉

目的:观察带角膜缘干细胞的自体结膜瓣移植术治疗复发性翼状胬肉的临床有效性和实用性。方法:复发性翼状胬肉患者53例57眼。复发性翼状胬肉切除全部病灶组织后移植带角膜缘干细胞的自体结膜瓣,移植结膜瓣取自术眼上方结膜。结果:术眼57眼术后随访1~12mo,3例出现复发,复发率5%。1例发生角巩膜自溶,并手术治疗。余53眼经1~12mo的随访角膜创面愈合良好,植片全部存活,无明显手术痕迹,治愈率93%。结论:采用自体角膜缘干细胞移植术治疗复发性翼状胬肉,手术取材方便、创面修复快,术后复发率低,满足部分患者美观需求,改善了术后效果,是一种理想的术式,值得基层临床推广应用。     

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.     

利用对侧眼睑板结膜瓣移植修复大于3/4的上睑后层缺损

目的 观察利用对侧眼睑板结膜瓣移植修复＞3/4的上睑后层缺损的手术效果.方法 对2008年l月至2009年12月进行治疗的5例上睑后层缺损＞3/4的患者,采取对侧眼睑板结膜瓣移植的方法修复眼睑后层缺损.术后随访6个月到1年.结果 5例患者上睑外形、功能均基本正常,双侧上睑弧度、高度基本对称,无角状畸形及切迹,观功能无影响.结论 利用对侧眼睑板结膜瓣移植修复大于3/4的上睑后层缺损是一种安伞、简便、有效的手术方法.     

自体角膜缘干细胞移植术治疗翼状胬肉

目的探讨用自体角膜缘干细胞移植方法，作术眼角膜缘重建术治疗翼状胬肉的疗效。方法进行期翼状胬肉17例(18眼)，复发性翼状胬肉4例(4眼)，共21例(22眼)，在手术显微镜下切除胬肉的基础上，联合自体带结膜瓣的角膜缘游离植片进行角膜缘移植术。术后对角膜上皮的重建和生长情况严密跟踪观察。结果经过平均13月的随访观察胬肉术后无复发，角膜上皮稳定。供区角膜创面与结膜创面愈合正常。结论在常规切除翼状胬肉的同时联合同侧带结膜瓣自体角膜上皮(干细胞)移植行角膜缘重建术，对防止胬肉复发的效果是肯定的。     

带结膜瓣的自体角膜缘移植治疗翼状胬肉临床观察

目的 :观察用带结膜瓣的自体角膜缘 (干细胞 )移植术治疗翼状胬肉的疗效 ,探索其显微手术技术的改进及其安全性。方法 :选择进行期翼状胬肉 2 5例 2 6眼、复发性翼状胬肉 5例 5眼 ,采取显微手术取同侧眼下方角膜缘带结膜瓣的角膜缘游离移植片进行移植。缝合时强调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严密追踪观察。结果 :经过平均 1年 9个月观察无 1例胬肉复发 ,角膜上皮稳定、泪膜正常、供区角膜创面正常愈合。结论 :同侧眼带结膜瓣自体角膜缘 (干细胞 )移植治疗翼状胬肉为较佳的方法。术后供区角膜创面能正常愈合 ,角膜上皮状态稳定 ,泪膜正常 ,未发现术眼出现干细胞代偿功能不全的有关表现及无 1例胬肉复发。此术式是一种高效安全的治疗胬肉的方法。     

深低温保存异体睑板睑结膜移植修复眼睑缺损的临床观察

目的 评价深低温保存异体睑板睑结膜移植修复,因眼睑肿物切除造成的眼睑缺损的临床效果.方法 采用深低温保存异体睑板睑结膜移植眼睑再造术修复眼睑缺损21例(21只眼).结果 术后随访3～80月,平均46.9月.本组病例共治愈10只眼,好转11只眼,1例(1只眼)因首次手术时切缘未净再次行扩大切除时未更换移植片导致植片脱落.结论 深低温保存异体睑板睑结膜移植修复眼睑缺损,简便易行,保存方便,术后并发症少,临床效果满意.异体睑板睑结膜是理想的眼睑缺损修复的材料.     

不同部位角膜干细胞移植治疗翼状胬肉的疗效分析

目的 观察不同部位角膜干细胞移植治疗翼状胬肉的疗效。方法 选择初发期翼状胬肉24例（25眼），复发性胬肉12例（12眼），采用显微手术，第一种方法，21眼取同侧眼上方带角膜上皮的结膜瓣游离移植片移植，第二种方法；16眼取鼻侧胬肉切除后上下方带角膜上皮的结膜瓣移植片，术后对移植片追踪观察。结果 经最短半年，最长2年6月的观察，利用上方植片移植21眼无复发，利用鼻侧植片移植16眼，1例复发，全部病例角膜上皮正常愈合。结论 37眼术后角膜上皮稳定，角膜创面愈合正常，未发现有干细胞失代偿问题，本文结果证明，对初发侵及角膜内≤2.5mm的患者，采用鼻侧胬肉切除部位上下方带角膜上皮的结膜瓣移植片，效果同样可靠，且手术简单，1例复发与术时缝合欠佳有关。     

Combined mitomycin C application and free flap conjunctival autograft in pterygium surgery

PURPOSE: To evaluate the long-term postoperative outcome and complication rate of combined intraoperative low-dose mitomycin C application and free conjunctival autograft for the treatment of pterygium. METHODS: In a prospective, consecutive, noncomparative case series, a series of 46 consecutive patients (50 eyes) with primary pterygium (43 eyes) or recurrent pterygium (7 eyes) were studied. The patients' ages ranged from 23.0 to 80.0 years (mean, 53.4 years). All patients underwent pterygium excision combined with intraoperative low-dose mitomycin C application (0.02% for 2 minutes) and free conjunctival autograft. The mean follow-up period was 29.2 months (range 12 to 41 months). The main outcome measures were recurrence of pterygium and postoperative complications. RESULTS: Pterygium recurred to a small extent (0.5 mm) in one eye (2%) of a patient with recurrent pterygium. There were no intraoperative complications. Subconjunctival graft hematoma appeared soon after surgery and resolved spontaneously in five eyes (10%). One eye developed transient high intraocular pressure without optic nerve or visual field defect, and one eye developed mild symblepharon. There were no sight-threatening complications or serious side effects. CONCLUSIONS: By applying a single low dose of mitomycin C combined with free conjunctival autograft during pterygium excision, the recurrence rate of pterygium can be markedly reduced.     

Low-dose intraoperative mitomycin-C versus conjunctival autograft in primary pterygium surgery: long term follow-up

PURPOSE: To evaluate and compare the long term safety and efficacy of low-dose intraoperative application of mitomycin-C (0.02%) with conjunctival autograft in primary pterygium surgery. PATIENTS AND METHODS: Of 37 consecutive patients 41 eyes with primary pterygium underwent pterygium excision with either intraoperative mitomycin-C (0.02%) (Group I) or conjunctival autografts (Group II) at random. Mitomycin-C (0.2 mg/mL) was applied for 2.5 minutes on the scleral bed under the conjunctiva. Conjunctival autograft was obtained from upper temporal limbus and secured with 10-0 monofilament nylon. The follow-up period ranged from 14 to 54 months (mean 36 months) for mitomycin-C group and 13 to 58 months (mean 38 months) for conjunctival autograft group. RESULTS: Twenty-one eyes underwent pterygium excision with intraoperative mitomycin-C (0.02%) application (Group I) and 20 eyes were treated using conjunctival autograft (Group II). The mean size of the pterygium was 3.80 mm (range 2.6 to 4.8 mm) in the mitomycin-C group and 3.60 mm (range 2.5 to 4.5 mm) in the conjunctival autograft group. Two (9.52%) eyes treated with intraoperative mitomycin-C had delayed epithelial healing of corneoscleral wound and one (4.76%) eye developed pyogenic granuloma. Three (14.3%) of the 21 eyes in Group I and one (5%) of 20 eyes in Group II had recurrence of pterygium (P = 0.3174). All recurrences occurred in patients below 40 years of age (P = 0.0384). CONCLUSION: We conclude that conjunctival autograft and intraoperative mitomycin-C are both equally effective adjuncts to primary pterygium surgery on long term follow-up. However, future prospective studies with larger numbers of subjects may be carried out to find out the optimum concentration and duration of intraoperative mitomycin-C application.     

Comparison of conjunctival autograft and conjunctival transposition flap techniques in primary pterygium surgery

Purpose

To investigate and compare the efficacy of conjunctival autograft and conjunctival transpositional flap for the treatment of primary pterygium surgery.

Surgically induced necrotizing scleritis after pterygium excision and conjunctival autograft

PURPOSE: To report a case of surgically induced necrotizing scleritis (SINS) after pterygium excision and conjunctival autograft. METHODS: A 55-year-old man presented 2 weeks after excision of primary pterygium with conjunctival autograft in the right eye with severe pain in that eye. He had undergone cataract surgery in that eye 8 months before. The graft was pale and white. The underlying sclera was white and avascular. There was marked inflammation adjacent to the site of surgery and graft. A scraping from the graft surface revealed no organisms in smears, and culture revealed no growth. The conjunctival graft was removed. Amniotic membrane transplantation was performed. After surgery, the amniotic membrane was avascular and pale. Systemic steroid therapy was initiated. RESULTS: Three days after initiation of systemic steroid therapy, the graft became vascularized. Over the next 10 days, the eye quietened, conjunctival and scleral inflammation lessened, and the graft was well accepted. CONCLUSIONS: Surgically induced necrotizing scleritis is a rare complication of pterygium excision with conjunctival autograft. A pale graft with underlying avascular sclera and surrounding inflammation should arouse suspicion of this complication.     

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.     

Two cases of dermolipoma

BACKGROUND: Dermolipoma is an uncommon benign tumor, congenitally occurring on the conjunctiva, and may be present at other sites. The appearance of dermolipoma closely resembles orbital fat prolapse and limbal dermoid, and therefore it is necessary to take this into account in diagnosis. Postoperative complications such as blepharoptosis, diplopia, or keratoconjunctivitis sicca can develop. CASE REPORT: The first case was a 52-year-old female patient referred for the treatment of an orbital fat prolapse in her right eye. Another case, an 8-year-old female patient, was referred for the treatment of a bulbar conjunctival tumor in her left eye. In both cases, dermolipoma was suspected because the tumor did not show in the limbus and it did not change in size even when the eyeball was pressed. There was no external ear anomaly, facial dissymmetry, or cervical abnormality. The tumors were surgically removed without any conjunctival loss. Neither case had any postoperative complications. CONCLUSIONS: If the special features of dermolipoma are understood, it is easy to distinguish this tumor from other disorders. Most of the postsurgical complications are caused by excessive conjunctival loss resulting in symblepharon. Avoiding harm to the conjunctiva is important to prevent such complications.     

翼状胬肉切除联合角膜缘干细胞移植术远期疗效分析

目的探讨翼状胬肉切除联合角膜缘干细胞移植及附加综合辅助治疗措施治疗翼状胬肉的临床远期疗效。方法回顾分析113例（117只眼）翼状胬肉切除联合角膜缘干细胞移植术病例,其中65只眼仅行常规手术,52只眼行常规手术联合综合辅助治疗。结果 65只眼仅行常规手术有4只眼复发,复发率为6.15%;52只眼行常规手术联合综合辅助治疗措施后2只眼复发,复发率为3.85%。经统计学分析,P〈0.05,差异有统计学意义。结论翼状胬肉切除联合角膜缘干细胞移植术治疗翼状胬肉安全、有效,尽量排除不利因素,采取综合辅助治疗措施可更有效地减少民办状胬肉术后复发率。     

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.     

The intraoperative use of mitomycin-C in excision of ocular surface neoplasia with or without limbal autograft transplantation.

PURPOSE: To evaluate the efficacy of intraoperative mitomycin-C in excision of ocular surface neoplasia for prevention of recurrence. METHODS: Seven patients (eight eyes), three men and four women, aged 56 to 87 years (mean, 73.8 years), with lesions suspicious for corneal or conjunctival neoplasia, were operated on between October 1998 and March 2000. During excision of the lesion, mitomycin-C 0.02% was applied intraoperatively for 5 minutes. In two cases, excision was combined with conjunctival limbal autograft transplantation. All excised lesions were sent for histopathologic evaluation. RESULTS: During the follow-up period ranging from 6 to 28 months (mean, 16 months) one patient (one eye) died of an unrelated cause. Histopathologic study showed four cases of squamous cell carcinoma, one case of carcinoma in situ, two cases of dysplasia, and one case of actinic keratosis. Of the eight eyes, no clinical recurrence of the lesion occurred in seven eyes, whereas one eye with squamous cell carcinoma showed mild recurrence 5 months after surgery and was successfully treated with topical mitomycin-C. Up to the last follow-up of this case 10 months later, the lesion did not recur. CONCLUSION: The excision of conjunctival and corneal epithelial neoplasia combined with the intraoperative use of mitomycin-C seems to reduce the recurrence rate. The combined use of mitomycin-C and conjunctival limbal autograft transplantation in two cases did not alter the surgical outcome. More cases and a longer follow-up are needed to establish the efficacy of such an approach.     

Outcome of different techniques of pterygium excision with conjunctival autografting in pediatric population: Our experience in central India

Aim:

To analyze surgical outcome of pterygium excision with conjunctival autografting in pediatric population ≤16 years.

Settings and Design:

Retrospective case series.

Materials and Methods:

A case sheet review of 145 patients (167 eyes) aged ≤16 years consecutively presented with pterygium from April 2008 to August 2014 in the single center was done. Twenty-six eyes of 25 children who underwent pterygium excision with conjunctival autograft were analyzed. Different techniques used to secure conjunctival autograft in a position were multiple interrupted 8-0 vicryl sutures, single 8-0 vicryl suture in the center of graft and sutureless glue free. Outcome measures were a failure of surgery and recurrence.

Results:

Of the total 167 eyes, 26 eyes of 25 children, mean age 13.07 ± 3.08 years (range 7–16 years) were managed surgically with pterygium excision and conjunctival autograft. The rest of the patients were managed conservatively. In 18 eyes, the graft was secured with multiple sutures, in 6 eyes with a single suture, whereas in 2 eyes, sutureless glue-free graft opposition was done. Mean follow-up was 8.03 months. No case of graft retraction, graft dehiscence or graft displacement was found. Recurrence occurred in 6 eyes and managed surgically.

Conclusions:

Occurrence of pterygium is not uncommon in the pediatric population. A single suture or sutureless glue-free technique may be good alternative for securing conjunctival autograft after pterygium excision in children.