翼状胬肉的研究现状

翼状胬肉是我国常见的眼表疾病,病因及发病机制复杂。手术是去除本病的惟一方法,但术后复发率很高。临床上应根据翼状胬肉的类型(原发性或继法性)、病变分期、程度、部位及角膜缘状态的不同而选择恰当的手术方式,以达到最大限度地提高手术愈后效果、降低复发率及减少并发症的目的。     

人眼结膜上皮细胞体外培养治疗翼状胬肉

目的 探讨体外分离培养结膜上皮细胞治疗翼状胬肉的方法.方法 将126例翼状胬肉患者(均为单眼患者)随机分为2组.治疗组58例,术前2周取其穹隆部结膜(1mm×1mm)剪成0．5mm×O．5mm大小后种植于羊膜上体外培养,术中逆行切除胬肉组织,再将培养好的结膜上皮植片移植于结膜创口,缝合固定.对照组68例,单纯切除翼状胬肉,暴露角巩膜缘.两组术后均行妥布霉素眼膏及滴眼液治疗,预防感染.结果 接种在羊膜上的结膜组织,8d左右融合成膜状,细胞为复层上皮细胞.植片3d后开始呈透明或半透明状,1周时可见新生血管长入,植片与周围结膜逐渐融合,2周左右植片与周围结膜完全融合.术后随访1～2年.治疗组复发2例(3．45％),对照组复发23例(33．82％),两组问复发率差异显著,有统计学意义(x2=16．3．P<0．01).所有患者眼球活动自如,未发生睑球粘连、疤痕增生等并发症.结论 体外分离培养结膜上皮细胞治疗翼状胬肉是一种理想的方法.     

Das Kniepterygium-Syndrom

Zusammenfassung Die Kasuistik des sog. Kniepterygium-Syndroms wird referiert und diskutiert. Die Mehrzahl der Fälle ist sporadisch. Familiäres Vorkommen kann mit einer Ausnahme durch ein autosomal-dominantes Gen mit wechselnder Expressivität erklärt werden. Nur in einer Beobachtung (Kopits) scheinen die Eltern von 3 betroffenen Kindern frei von Mißbildungen gewesen zu sein. Heterogenie kann deshalb noch nicht ausgeschlossen werden. Eigene Beobachtungen (3 sporadische, 1 familiärer Fall: Vater und 2 Söhne) dokumentieren die Symptomatik: meist einseitiges Kniepterygium, Anomalien des Nagelwalles, Syndaktylie, Aplasie der Labia maiora bzw. des Scrotum oder nur Kryptorchismus, Lippen-Kiefer-Gaumen-Spalte, Unterlippenfisteln, konnatale Synechien zwischen Ober- und Unterkiefer, Ancyloblepharon filiforme adnatum. Die Streckhemmung des Beins ist durch einen vom Sitzhöcker zur Ferse tastbaren derben Strang bedingt. An der Beugeseite des Beins verläuft eine charakteristische narbige Einziehung der Haut.

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The popliteal pterygium syndromeA dominant autosomal malformation syndrome

Case reports concerning the so-called Popliteal Pterygium Syndrome and discussed. Most cases are isolated. Familial occurrence may be explained — with one exception — by an autosomal-dominant gene with variable expressivity. Since in only one family with 3 affected children the parents do not exhibit any malformation, heterogeny is not to be excluded. Personal observations (3 isolated, one familial: father and both sons affected) illustrate the complete syndrome: predominantly unilateral popliteal pterygium, anomalies of the skin around the nails, syndactyly, aplasia of the labia maiora, of the scrotum respectively or cryptorchidism only, cleft lip and palate, congenital fistulae of the lower lip, congenital bands of mucous membrane extending between the jaws as well as ankyloblepharon filiforme adnatum.The reason for the incomplete extension of the legs is to be sought in an inelastic subcutaneous cord which is papable from the ischial tuberosity to the heel and which is accompanied by a visible scar.

     

5-fluorouracil vs. beta-irradiation in the prevention of pterygium recurrence

The aim of this study was to compare 5-fluorouracil (5-FU) with beta-irradiation in the prevention of pterygium recurrence. A retrospective non-randomised review of cases of fleshy pterygium treated with bare scleral excision and adjuvant 5-FU were compared with similar morphologically appearing pterygia, matched for age and sex, treated with bare scleral excision and adjuvant beta-irradiation. All surgeries were carried out at the university college hospital and Ojulowo eye hospital, Ibadan, Nigeria. Twenty-seven eyes of 24 patients who had pterygium excision with adjuvant treatment with 5-FU were compared with 31 eyes of 24 patients who were treated with excision and beta-irradiation. The mean age for the 5-FU group was 46.1 years while that for the beta-irradiation group was 46.9 years. Both sexes were equally represented, 12 males and 12 females. There were seven (25.9%) initial recurrences in the 5-FU group but four of these became atrophic, and therefore, cosmetically acceptable leaving three eyes (11%) with unacceptable recurrent pterygia. The beta-irradiation group, however, had seven (22.5) initial recurrence but five of these became atrophic and fell short of the cornea, leaving two (6.5%) with clinically unacceptable recurrence. The difference was, however, not statistically significant (Zc = 0.74 and p > 0.1). The associated complications were mostly mild in both groups and included cornea opacity of 10 (37%) complications, conjunctivitis of three (11%) complications, sclera granuloma of three (11%) complications and conjunctiva necrosis of one (3.7%) complication for the 5-FU group, and while the beta-irradiation group had corneal opacity of one (3.7%) complication and conjunctivitis of three (11%) complications. The non-statistical significance of a lower-pterigium recurrence rate with use of beta-irradiation for the treatment of fleshy pterygium compared with 5-FU may have been partly due to the small number of patients studied. A randomised-controlled study using a larger sample size is therefore proposed. However, the fact that over half of those with initial recurrence in the 5-FU group became atrophic (and therefore cosmetically acceptable) over time as well as less cost implication in the purchase of 5-FU relative to Strontium-90 association with few and mild complications makes it a desirable adjuvant therapy in depressed economies. However, beta-irradiation still has a place when cost issue is not an inhibiting factor in view of its clinically superior outcome.     

结膜瓣平整程度与初发翼状胬肉术后复发的关系

目的:探讨初发翼状胬肉术后复发的影响因素。方法:对初发翼状胬肉行胬肉切除加结膜瓣转移术,按术后结膜瓣缝合平整程度分为3组,平整组共计36例,39眼;欠平整组共计41例,48眼;不平整组共计19例,22眼。观察各组手术1个月后的睑裂部充血率及结膜瓣平整程度与复发的关系。结果:平整组手术1个月后的睑裂部充血率为7.2%,欠平整组为18.1%,不平整组为30.8%。入选96例109眼的复发率为13.8%,3组的复发率依次为5.1%、12.5%、31.8%。平整组与不平整组复发率差异有统计学意义(P<0.05)。结论:结膜瓣缝合平整可缩短术后愈合时间,减少睑裂部结膜充血及结膜下新生血管形成,是减少术后复发的重要因素。     

自体结膜角膜缘移植与自体结膜移植治疗复发性翼状胬肉

目的　观察比较自体结膜角膜缘移植与自体结膜移植治疗复发性翼状胬肉的疗效。方法　回顾分析1998年 1月～ 2 0 0 0年 6月所手术的有完整随访记录的 76例 (81只眼 ) ,其中 37只眼行自体结膜角膜缘移植术 ,44只眼行自体球结膜移植术 ,术后随访 12～ 31月 ,平均 19月。结果　自体结膜角膜缘移植组 2只眼复发 ,复发率5 .41% ,自体结膜移植组 9例复发 ,复发率 2 0 .45 %。两组复发率经统计学处理差异有显著性 (x2 =3.89,P <0 .0 5 )。结论　自体结膜角膜缘移植术是治疗复发性翼状胬肉的一种较理想的手术方式     

冷冻治疗早期翼状胬肉的临床观察

目的探讨一种治疗早期翼状胬肉的非手术方法。方法对329例（478眼）早期翼状胬肉，用F22冷冻翼状胬肉的体、颈结合部位60～65s，结合胬肉大小情况冷冻2～5个点位、1～3次。结果随访6个月至6年，显效295例，占61．7％，有效121例占25．3％。总有效率87．0％，无一例出现严重并发症，无一例短期翼状胬肉快速生长。结论F22冷冻治疗早期翼状胬肉有较好疗效。     

微量曲安奈德联合角膜缘干细胞移植治疗翼状胬肉

目的观察微量曲安奈德结膜下注射联合角膜缘干细胞移植治疗翼状胬肉和防止复发的效果。方法对58例翼状胬肉患者术前1周采用曲安奈德0．8～2．0mg于翼状胬肉处注射，1周后行自体角膜缘千细胞移植术。结果植片愈合好。角膜创面光滑透明，无角膜新生血管形成，术后复发率低及无并发症。结论微量曲安奈德结膜下注射联合角膜缘干细胞移植可安全有效地预防翼状胬肉切除术后肉芽组织增生，及翼状胬肉术后的复发。     

自体角膜缘上皮移植治疗翼状胬肉的临床观察

评价角膜上皮移植预防翼状肉切除后复发的作用。方法根据胬肉生长与角膜缘干细胞基质微循环功能障碍有关。对４０例４６眼原发性和复发性胬肉进行手术切除联合自体角膜缘上皮移植术。结果追踪观察２月至２年，仅２眼胬肉术后复发，占５％。     

顺行、逆行切除法在初次翼状胬肉术中的疗效比较

目的研究顺行、逆行切除法在初次翼状胬肉术中的疗效比较。方法自2005年1月-2006年12月共收治翼状胬肉病例168例，其中顺行切除法中痊愈49例，好转6例，复发29例，总有效率65．48％；逆行切除法中痊愈61例，好转3例，复发20例，总有效率76．19％。经x^2检验，P〈0．05。结论在初次翼状胬肉切除术中，逆行切除法与顺行切除法比较，具有成功率高、复发率低的特点。