丝裂霉素C术中应用预防翼状胬肉复发的前瞻性研究

目的　前瞻性研究术中应用丝裂霉素Ｃ降低翼状胬肉术后复发的效果;方法　将７８ 眼单纯翼状胬肉患者随机分为两组,单纯切除法切除胬肉后,其中一组在术中一次性应用０ ．２ｇ·Ｌ－１ 的丝裂霉素Ｃ于球结膜和巩膜之间,５ｍｉｎ 后冲去;结果　平均随访２５ｍｏ,用药组胬肉的复发率为５ ．２％ ,未用药组复发率为３２ ．４％ ;结论　术中应用丝裂霉素Ｃ能够达到降低胬肉复发的目的,同时也避免了严重并发症的发生。     

高三尖杉酯碱预防翼状胬肉术后复发

目的探讨局部注射高三尖杉酯碱减少翼状胬肉术后复发的效果。方法６３例翼状胬肉患者随机分为３组：Ａ组２９例２９眼,术前局部注射高三尖杉酯碱;Ｂ组１６例１６眼术前局部注射地塞米松;Ｃ组１８例１８眼术前不用药。术后观察其眼部反应、复发率及行增殖细胞核抗原（ＰＣＮＡ）免疫组化染色检查。结果术后平均随访１９．１ｍｏ,复发率分别为：Ａ组和Ｂ组分别为３．４０％和６．２５％（Ｐ＞０．５０）,Ｃ组２７．７７％（Ｐ＜０．０５,与Ａ组相比较）。病理结果显示,Ａ组ＰＣＮＡ阳性率（６．０１±３．８５）％,Ｂ组（１０．２８±４．１８）％,Ｃ组（１１．５３±３．６２）％．Ａ组与Ｂ组、Ｃ组比较均有显著性差异（Ｐ＜０．０５）。结论术前翼状胬肉局部注射高三尖杉酯碱可以减少翼状胬肉术后复发。     

翼状胬肉的治疗进展

翼状胬肉作为眼科常见病,其治疗方法有多种,本文将对该病的治疗进展作一概述,以期对翼状胬肉的治疗有较全面的了解,同时为临床工作者提供参考。     

翼状胬肉不同术式预防复发的对比研究

目的采用翼状胬肉切除联合丝裂霉素及羊膜移植术和翼状胬肉切除联合丝裂霉素及自体角膜缘干细胞移植术,与以往传统的胬肉切除及暴露角膜缘巩膜术方法进行对比研究。方法将翼状胬肉随机分为3组,每组50例,A组:胬肉切除及暴露角膜缘巩膜术组50例(50眼);B组:翼状胬肉切除联合丝裂霉素及羊膜移植术组50例(50眼);C组:翼状胬肉切除联合丝裂霉素及自体角膜缘干细胞移植术组50例(50眼)。术后随访3~22月,对3种不同术式预防复发进行研究。结果A组复发10眼(20.00%),B组复发3眼(6.00%),C组复发2眼(4.00%)。B组和C组与A组对比差异有统计学意义(P<0.01),B组与C组对比差异无统计学意义(P>0.05)。结论翼状胬肉切除联合丝裂霉素及羊膜移植术和翼状胬肉切除联合丝裂霉素及自体角膜缘干细胞移植术都能有效预防翼状胬肉复发。     

蝉花散结合手术治疗复发性翼状胬肉临床观察

目的观察手术切除联合口服中药蝉花散治疗复发性翼状胬肉的临床疗效。方法 74例(82只眼)复发性翼状胬肉患者随机分为治疗组38例(42只眼)和对照组36例(40只眼),2组均采用撕拉式并钝性分离联合丝裂霉素手术治疗,治疗组在施行手术的基础上于术前1周至术后2周口服中药蝉花散。随访12个月,比较2组病例的治疗效果及复发情况。结果治疗组治愈39只眼,再次复发3只眼;对照组治愈31只眼,再次复发9只眼,治疗组疗效优于对照组(c2=3.868,P=0.049)。结论手术切除联合口服蝉花散治疗复发性翼状胬肉疗效满意,能有效降低再次复发率。     

Transplantation of amniotic membrane and limbal autograft for patients with recurrent pterygium associated with symblepharon

AIM—Treatment of recurrent pterygium associated with symblepharon requires both suppression of fibrosis and reconstruction of limbal barrier. To achieve this, human amniotic membrane was transplanted and limbal autografts performed.
METHODS—Four patients with severe symblepharon resulting from multiple surgeries for pterygium were treated. Human amniotic membrane was obtained at caesarean section and preserved until surgery. After excision of the fibrous tissues, the amniotic membrane was placed on the sclera, and a limbal autograft transplantation was performed using limbal tissues taken from the affected eye.
RESULTS—Recurrence of symblepharon was not observed in any of the patients and significant suppression of the subconjunctival fibrosis was achieved. Ocular movement improved in all cases. Complete remission of pterygium regrowth occurred in three cases, and a slight (about 1 mm) recurrence occurred in one case. The limbal donor site showed the presence of mild depressions without the formation of pseudopterygium.
CONCLUSION—Transplantation of human amniotic membrane with a limbal autograft appears to be a promising surgical treatment for reconstructing the ocular surface in patients with recurrent pterygium associated with symblepharon.

Keywords: pterygium; limbal transplantation; amniotic membrane; symblepharon     

Meta-analysis on the recurrence rates after bare sclera resection with and without mitomycin C use and conjunctival autograft placement in surgery for primary pterygium

BACKGROUND/AIMS—Bare sclera resection with and without use of mitomycin C and conjunctival autograft placement are three surgical techniques currently in use for the treatment of primary pterygium. The purpose of this study was to determine through a meta-analysis the risk for postoperative pterygium recurrence comparing the three surgical treatment modalities.
METHODS—A search through Medline for randomised controlled clinical trials comparing at least two of the three surgical techniques in the treatment of primary pterygium, along with a hand search of all references in relevant papers, was conducted. All eligible clinical trials were graded for quality utilising the Detsky score; those studies with a score of 0.5 or greater were included. The main outcome measurements were the pooled odds ratios and 95% confidence intervals for the risk of pterygium recurrence. These were calculated utilising the Mantel-Haenszel method.
RESULTS—Five eligible studies with an adequate quality score were retrieved, three comparing bare sclera resection with and without mitomycin C use, one comparing bare sclera resection with conjunctival autograft placement, and one comparing both. The pooled odds ratio for pterygium recurrence in patients who had only bare sclera resection was 6.1 (95% confidence intervals, 1.8 to 18.8) compared with the patients who had conjunctival autograft placement and 25.4 (9.0 to 66.7) compared with the patients who received mitomycin C.
CONCLUSIONS—The odds for pterygium recurrence following surgical treatment of primary pterygium are close to six and 25 times higher if no conjunctival autograft placement is performed or if no intra/postoperative mitomycin C is used, respectively. Surgeons and clinical triallists should not be encouraged in the use of bare sclera resection as a surgical technique for primary pterygium.

Keywords: meta-analysis; bare sclera resection; pterygium; mitomycin C     

翼状胬肉切除联合三种应用丝裂霉素C的方法比较

本文观察翼状胬肉手术三种应用丝裂霉素Ｃ的方法对防止术后翼状胬肉复发的作用，采用随机分组方法对８３例１１２眼原发性翼状胬肉进行病例对照研究。丝裂霉素Ｃ的应用方法分别为术中应用（０．４ｍｇ／ｍｌ），术后一周内应用及手术一周后应用（０．２ｍｇ／ｍｌ）。结果：术中应用丝裂霉素Ｃ组翼状胬肉复发率为８．３％，术后一周内应用组复发率为１６．１％，手术一周后应用组为２０．７％，三组间的复发率无统计学差异，对照组为３２．１％，与治疗组比较具有明显统计学差异。术后一周内应用丝裂霉素组角膜创面愈合延迟。结论：翼状胬肉切除术中或术后应用丝裂霉素Ｃ可防止术后复发。术中应用丝裂霉素Ｃ方法简单，不影响角膜创面的愈合。     

富血小板纤维蛋白移植在翼状胬肉切除术中的应用

目的:比较富血小板纤维蛋白(PRF)移植和自体角膜缘干细胞移植应用于翼状胬肉切除术的效果。方法:将62例62眼原发性翼状胬肉随机分为第1组(32眼)和第2组(30眼),翼状胬肉切除后,第1组用自体角膜缘干细胞作为移植物,第2组用PRF作为移植物覆盖裸露巩膜。PRF通过术前抽取患者自身静脉血后离心和压制制得。术后随访6mo,评估手术时间、并发症和复发率,并进行组间比较。结果:第1组和第2组的平均手术时间分别为27.3±4.3、22.0±4.0min,两组有差异(t=4.990,P<0.01)。术后第1组未出现肉芽肿,第2组出现肉芽肿1眼,两组无差异(P=0.484)。第1组和第2组术后均复发1眼,两组无差异(P=1.000)。第1组和第2组术前眼压分别为14.69±2.44、14.96±2.93mmHg,两组无差异(t=0.399,P=0.691)。第1组和第2组术后眼压分别为14.68±1.65、15.11±2.12mmHg,两组无差异(t=0.888,P=0.378)。PRF移植组术后PRF膜溶解时间为3.5±0.8d。结论:PRF移植应用于翼状胬肉切除术安全有效,操作更加简单省时,是一种有临床应用前景的方法。     

角膜缘干细胞移植术治疗原发性翼状胬肉

目的：评价自体角膜缘干细胞移植治疗原发性翼状胬肉的安全性和有效性。

方法：前瞻性观察性研究。采用自体角膜缘干细胞移植术治疗鼻侧原发性翼状胬肉264例(男性142例,女性122例)。患者平均年龄54.22±15.24岁。翼状胬肉术后1、3、7d及1、3、6、9、12、36mo进行定期随访。评估手术时间,角膜上皮愈合时间,术后复发率和手术并发症。

结果：平均手术时间为25.7±2.6min。经过至少3a的术后随访,术后角膜上皮愈合时间为3.85±0.72d。14例患者出现眼科并发症。本研究未发现虹膜睫状体炎、睑球粘连、角膜溃疡等威胁视力的严重并发症。结膜移植片水肿5例,肉芽肿形成3例,结膜下血肿6例。随访3a,11例患者复发,复发率为4.17%,首次出现复发时间为3mo,平均8mo。

结论：经长期随访,自体角膜缘干细胞移植术无严重并发症,复发率低,是治疗原发性翼状胬肉安全有效的方法。我们还建议对于原发性翼状胬肉手术,12mo的术后随访为最佳时间。