自体角膜缘上皮移植术治疗翼状胬肉的临床分析

目的:比较传统的单纯胬肉切除术与自体角膜缘上皮移植术治疗翼状胬肉的疗效。方法:随机将89例(124只眼)翼状胬肉患者分成A组46例(63只眼)、B组43例(61只眼),A组行自体角膜缘上皮移植术联合翼状胬肉切除术治疗;B组行传统的单纯翼状胬肉切除术,术后随访比较两组术后胬肉复发情况。结果:随访结果,A组5例(5只眼)患者失访,3例患者(3只眼)复发,复发率为5.17%;B组5例(5只眼)患者失访,13例患者(18只眼)复发,复发率为32.14%,组间比较差异具有统计学意义(P<0.001)。结论:自体角膜缘上皮移植术能有效治疗翼状胬肉且能防止复发。     

翼状胬肉切除联合角膜缘干细胞移植术后视力及角膜散光变化观察

目的:研究翼状胬肉对角膜散光及视力的影响。方法:对翼状胬肉手术治疗的72只眼(50例)进行视力、屈光度、角膜曲率及对胬肉进入角膜缘长度的测定,对62只患眼进行手术前后屈光度的对比。结果:72只眼均有不同程度的散光,与胬肉进入角膜缘长度相关,以顺规性散光为主。胬肉切除术后1个月散光度数下降,视力提高。结论:翼状胬肉可引起顺规性散光,散光程度与胬肉大小有显著相关性。胬肉切除术可使角膜散光得以改善,提高视力。     

Handing it to pterygium: Explaining pterygium laterality

PurposeTo evaluate any correlation between pterygium laterality and patient handedness.MethodsOur study represents a retrospective observational study of a series of consecutive pterygium patients recruited from two centres. Each patient was assessed for their handedness which was compared to the laterality of their presenting pterygium. Patients that possessed bilateral disease comparisons between pterygium size and handedness were made. Correlation statistics were performed to compare patient handedness and pterygium location (right or left). For patients possessing bilateral disease only, the pre-surgical differences between lengths and areas of pterygium were calculated and compared.ResultsA total of 219 patients were recruited into our study. 172 patients possessed unilateral disease and in 47 patients, the disease was bilateral. A significant association was identified between handedness and pterygium laterality (p < 0.001). Patients with right-sided pterygia were more likely to be right-handed (OR 2.327) and left-sided presentations who were more likely to be left-handed (OR 5.717). For bilateral presentations, patients were found to have longer (mean increase 3.50 ± 0.47 mm) and larger (mean increase 4.38 ± 0.48 mm²) pterygia in the eye ipsilateral to their dominant hand.ConclusionsA new insight of handedness as a contributing factor to pterygium laterality is consistent with evidence relating to the asymmetrical development of cortical cataract as well as to theories underlying the geometry of ocular UV exposure. A more complete understanding of factors contributing to ocular insolation may further inform as to improved protective measures and provides further evidence for the role of peripheral light focusing in pterygium pathogenesis.     

复发翼状胬肉显微切除联合羊膜及自体角膜缘移植临床分析

目的 比较显微镜下胬肉切除羊膜移植术(Amniotic membrane transplantation,AMT)与联合羊膜移植+自体带结膜的角膜缘移植术(Limbal autograft transplantation,LAT)治疗复发性翼状胬肉手术效果.方法 将2003年5月至2005年9月就诊的80例103眼复发性翼状胬肉患者按就诊顺序编号后,按随机数字表的方法分为两组.AMT组:40例52眼完成常规胬肉切除术后,联合AMT手术;联合AMT+LAT组:40例51眼完成常规胬肉切除术后,先行羊膜移植术,再联合带结膜的自体角膜缘组织移植.结果 ①AMT组,平均随访(14.6±2.4)月,12眼复发,复发率23.08%; 52眼中合并有睑球粘连、眼球运动障碍18眼,随访期间12眼睑球粘连获得解除,眼球运动障碍消失;6眼改善.②联合AMT+LAT组,平均随访(15.4±1.4)月,4眼复发,复发率7.84%;51眼中合并有睑球粘连、球运动障碍19眼,随访期间14眼睑球粘连获得解除,眼球运动障碍消失;5眼改善.两组比较差异有统计学意义(P＜0.05).结论 在显微镜下采用显微技术操作联合AMT+LAT治疗复发胬肉可降低复发率,减少并发症.     

Autogenous lamellar scleral graft in the treatment of scleral melt after pterygium surgery

BACKGROUND: We report a case series of three patients who developed scleral melting 18-26 months after pterygium removal with beta-irradiation that refused to use any donor tissue. CASE SERIES: All patients presented with constant pain, redness and foreign body sensation on their eye. RESULTS: Initial evaluation revealed the presence of an area of scleral melt and epithelial defect with an underlying calcific plaque over the necrotic area in the nasal conjunctiva. Fluorescein staining and pooling was present at the base of the defect, indicating epithelial loss, in two patients. No signs of infection were present, and screening for associated systemic risk factors for melting was negative in all cases. The patients refused to use any kind of donor tissue to cover the area of melting. An autogenous lamellar scleral graft harvested from the superotemporal quadrant and an advancement of the nasal tenon was used. CONCLUSION: The use of autologous sclera and tenon has been described in the treatment of avulsive corneoscleral wounds and corneal fistulas. This case series describes the successful management of scleral melting with autogenous tissues.     

角膜缘干细胞移植与羊膜移植治疗翼状胬肉疗效比较

目的 比较角膜缘干细胞移植联合丝裂霉素C与羊膜移植联合丝裂霉素C治疗翼状胬肉疗效.方法 将54例(65只眼)患者随机分为两组,角膜缘干细胞移植组(28例35只眼):采用角膜缘干细胞移植联合丝裂霉素C治疗翼状胬肉;羊膜移植组(26例30只眼):采用羊膜移植联合丝裂霉素C治疗翼状胬肉.术后随访6至12个月,分析不同手术复发率及角膜创面愈合时间.结果 角膜缘干细胞移植组1只眼复发,复发率为2.86%;羊膜移植组7只眼复发,复发率为23.33%,两组比较有显著性差异(x2=4.532,P<0.05).角膜创面平均愈合时间角膜缘干细胞移植组为4.67d,羊膜移植组为6.48d,两组比较有显著性差异(t=5.92,P<0.05).结论 角膜缘干细胞移植联合丝裂霉素C能有效地治疗翼状胬肉,角膜创而修复较快,复发率低,是一种安全、有效的手术方法.     

翼状胬肉显微手术切除后角膜干细胞移植

目的:观察各种类型翼状胬肉显微手术切除后角膜干细胞移植的疗效。方法:手术显微镜下根治性切除翼状胬肉后,采用角膜干细胞移植,联合眼表面重建术,共治疗各种类型的翼状胬肉46例(57眼)。结果:术后随访12~24个月,所有患者未出现球结膜明显的纤维血管增生及角膜浸润,无1例复发。结论:显微镜下切除各种翼状胬肉,同时移植角膜干细胞,能取得较好的疗效。     

封冻羊膜移植治疗翼状胬肉及眼化学烧伤的临床观察

目的:观察封冻羊膜移植治疗翼状胬肉及眼化学烧伤的临床效果。方法:采用封冻羊膜移植术治疗眼表疾病患者66例(81眼),其中翼状胬肉56例(71眼)、急性重度眼表碱烧伤10例(10眼)。结果:翼状胬肉患者术后1~4周正常上皮沿羊膜生长,无1例发生感染。经过6~12月的随访观察,有8眼复发,手术成功率为88.7%,复发率为11.3%;重度眼表碱烧伤患者除2例术后1周发生羊膜脱落溶解外,其余8例术后羊膜移植片平伏,获得成功重建眼表。结论:封冻羊膜移植能有效减少翼状胬肉的复发率;对于重度碱烧伤患者阻止角膜穿孔,减轻炎症反应,阻止角膜缘新生血管侵入有效。     

角膜缘干细胞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治疗翼状胬肉的效果。方法对87例(95只眼)翼状胬肉患者行显微镜下翼状胬肉切除并做角膜缘干细胞移植,术后随访观察12～24个月。结果术后复发3只眼,复发率3.44%。结论翼状胬肉切除联合自体角膜缘干细胞移植治疗翼状胬肉的效果是肯定的,是一种理想的手术方法。     

翼状胬肉中Ki-67和VEGF的表达

目的了解Ki-67和VEGF在翼状胬肉组织中的表达。方法用免疫组织化学SP法对36例初发型翼状胬肉患者切除的翼状胬状组织进行Ki-67和VEGF的检测并与正常人结膜组织进行对照。结果Ki-67在所有的翼状胬肉组织上皮中均有表达,头部最为明显,全层均有不同程度的表达。在正常的结膜上皮内对Ki-67的表达较胬肉上皮明显减弱,仅在基底细胞层散在表达。VEGF在翼状胬肉上皮明显减弱,仅在基底细胞层散在表达。VEGF在翼状胬肉上皮基底细胞层细胞,血管内皮细胞以及成纤维细胞有阳性表达。结论翼状胬肉组织上皮中有Ki-67和VEGF的过度表达,提示翼状胬肉组织上皮中存在增殖调控的异常,上皮细胞可能发生了转化,上皮细胞在翼状胬肉的发生发展中可能起着关键的作用。