翼状胬肉切除联合自体角膜干细胞移植术后巩膜融解

Scleral Melting After Pterygium Excision with Corneal Limbal Stem Cells Autotransplantion

目的:探讨翼状胬肉切除联合自体角膜干细胞移植术后巩膜融解的原因及处理方法。方法:回顾性分析276例2001年3月至2006年8月在我院行翼状胬肉切除联合自体角膜干细胞移植术治疗原发性翼状胬肉患者,术后有7例(2.54%)术区巩膜出现融解坏死,取坏死组织涂片、微生物培养及病理检查,并对7例患者进行血清学检查。1例融解范围大者行带蒂球结膜瓣转位移植,修补将要穿孔处。7例采用贝复舒眼药水点眼并泰利必妥眼膏包眼,每天换药,持续3-5 d。待有血管长入术区巩膜时改为环孢霉素A眼水点眼4次/d。结果:7例患者细菌及真菌培养均未见微生物生长,病理检查:7例均未见白细胞浸润。1例修补术后及另外6例均恢复良好,眼球运动正常,视力同未行胬肉切除术前时视力。随访12-24月,7例术区外观无异常变化。结论:手术因素造成的局部损伤缺血及诱发的免疫反应等可能是自体角膜干细胞移植术后巩膜融解的因素。

Objective： To analyze the causes and treatments of scleral melting after pterygium excision with corneal limbal stem cells autotransplantion. Methods： The clinic data of 276 patients were reviewed who had undergone pterygium excision with corneal limbal stem cells autotransplantion. Seven of all the cases （2.54%） presented with necrotizing scleritis. The recrotic samples were studied by pathologic and microbiological methods. One case whose scleral melted seriously was operated with conjunctiva tissue patch grafs. All the seven patients were treated with bFGF （re- combinant bovine basic fibroblst growth factor） eye drops and Tarivid ophthalmic ointment daily about for 3-5 days. And until new blood vessels presented in the lesions, they were treated with cyclosporine A eye drops four times a day. Results： No microorganisms or leukocytic infiltration were found in the necrotic tissues in the seven cases. All patients＇ visions were successfully recovered. The eye balls could move normally. No abnormalities in these areas were found during a period of 12 to 24 months of follow-up. Conclusion： Surgery-induced topical damages and immunoreaction might contibute to the scleral melting after pteygium excision with corneal limbal stem autotransplantion.