头部撕除联合带蒂结膜瓣移植术治疗原发性翼状胬肉

目的观察翼状胬肉头部撕除联合带蒂结膜瓣转位移植术治疗原发性翼状胬肉的疗效,探讨治疗原发性翼状胬肉的手术方法以及对翼状胬肉早期进行手术的可行性。方法原发性翼状胬肉患者15例(20眼),胬肉头部侵入角膜<2mm5眼,2～3mm12眼,达瞳孔缘3眼。由同一人进行手术,均采用显微镜下胬肉头部撕除联合带蒂结膜瓣转位移植术。术后定期随访观察疗效。结果翼状胬肉20眼,术后随访中均未复发。术后胬肉头部侵入角膜<2mm的5眼角膜术区透明,2～3mm12眼中9眼及达瞳孔缘3眼裂隙灯下观察术区角膜有淡淡云翳。手术前后视力变化:胬肉头部侵入角膜<2mm的5眼术前术后视力无变化,其余头部>2mm的15只眼中有12只眼术后视力有不同程度的提高。美容效果:所有患者于裂隙灯下均不易发现曾行过翼状胬肉手术。结论该手术方式能安全地切除原发性翼状胬肉,获得良好的视力和美容效果,且操作方便实用,具有在临床推广应用的价值。对原发性翼状胬肉可尽早手术。

Tearing off Head and Sliding Conjunctival Flap with a Base for the Treatment of Primary Pterygium

Objective To investigate the efficacy of tearing off the head combined with conjunctival flap transplantation with a base in the treatment of primary pterygium and the surgical procedures, and to study the feasibility of excising pterygium in the early stage.Methods Operations were performed on 15 patients (20 eyes) with primary pterygium. Five heads of the pterygium invaded the cornea by less than 2 mm, 12 by 2 to 3 mm, still 3 invaded the rim of the pupil. All of the operations were performed by one surgeon under a microscope in the manner of tearing off the pterygium head combined with conjunctival flap transplantation with a base. Regular follow-up was carried out to evaluate the efficacy of our sugical treatment.Results The median follow-up was 13.5 months (8 months to 1 year and 7 months). No reccurence was found during the follow-up. No corneal nebula could be found in the 5 eyes in the less than 2 mm group, while corneal nebula could be found in 9 of the 12 eyes in the 2 to 3 mm group and all the rest 3 eyes where the heads invaded the rim of the pupils. Visual acuity was not improved in the 5 eyes where the heads of the pterygiums invaded the corneas by less than 2 mm.Visual acuity was improved in 12 of the other 15 eyes where the heads of the pterygium invaded the corneas greater than 2 mm. Cosmetic effect was satisfactory and all eyes looked nomal even with a slitlamp.Conclusion This operation can remove primary pterygium safely and improve visual acuity with cosmetic effect. It was proved to be a practical method to treat primary pterygium. Maybe we should operate on primary pterygium as soon as we find it.