角膜缘干细胞移植术中结膜瓣的宽与窄对原发性翼状胬肉的疗效比较

目的:对比下方角膜缘干细胞窄结膜瓣与宽结膜瓣移植联合丝裂霉素C治疗原发性翼状胬肉的长期效果与复发率.方法:采用回顾性研究,共纳入146例(193眼)原发性翼状胬肉患者.其中91例采用下方角膜缘干细胞窄结膜瓣移植联合丝裂霉素C治疗(NI-LCAT组),102例采用下方角膜缘干细胞宽结膜瓣移植联合丝裂霉素C治疗(WI-LCAT组).随访对比两组复发率、供体区、植片植床情况与相应并发症.结果:NI-LCAT组与WI-LCAT组复发率分别为3.3％与4.9％,两者差异无统计学意义.两组植片植床情况未见明显差别.两组供体区最常见并发症均为轻中度结膜瘢痕(NI-LCAT组18.6％,WI-LCAT组13.2％).其他并发症包括结膜下上皮囊肿与受体区肉芽肿发生率在两组间差异无统计学意义.Kaplan-Meier生存分析显示两组间累积手术成功率差异无统计学意义.结论:下方角膜缘干细胞窄结膜瓣与宽结膜瓣移植联合丝裂霉素C治疗原发性翼状胬肉复发率相似.相比宽结膜瓣组,窄结膜瓣组对结膜供体区创伤较小,对保留上下方结膜更为有效.

Narrow versus wide inferior limbal conjunctival autograft transplants combined with Mitomycin C in primary pterygium surgery:a comparative study

AIM: To compare long-term outcomes and recurrence rates of narrow versus wide inferior limbal conjunctival autograft transplants combined with Mitomycin C in primary pterygium surgery.

METHODS: This retrospective study included 146 consecutive patients(193 eyes)with primary pterygium. Ninety-one eyes had a narrow inferior limbal conjunctival autograft transplant(NI-LCAT)and 102 had a wide inferior limbal conjunctival autograft transplant(WI-LCAT)combined with Mitomycin C application. Outcome measures included recurrence rate, residual conjunctival bed status, and complications.

RESULTS: The recurrence rate in the NI-LCAT and WI-LCAT group was 3.3% and 4.9%, respectively(P=0.844). The grade of residual bed appearance in the NI-LCAT group was similar to the WI-LCAT group. Mild to moderate conjunctival scarring at the donor site was the most common complication in both groups(18.6% and 13.2% in NI-LCAT and WI-LCAT groups, respectively). There were no significant differences in the incidence of any other complications including subconjunctival epithelial cyst and granuloma at the recipient site between the two groups. Kaplan-Meier survival analysis showed that the cumulative probabilities of success between the two groups were not statistically significantly different.

CONCLUSION: Both NI-LCAT and WI-LCAT combined with Mitomycin C in primary pterygium surgery have low recurrence rates. Compared with WI-LCAT, NI-LCAT technique is found to be less traumatic and an effective surgery in terms of preserving the superior and inferior conjunctiva.