翼状胬肉上结膜反向移植联合羊膜移植治疗复发胬肉

Pterygium conjunctiva reverse transplantation combined with amniotic membrane transplantation for the treatment of recurrent pterygium

目的:观察胬肉上结膜反向移植联合羊膜移植治疗复发性翼状胬肉的疗效。方法:回顾性系列病例研究。回顾2009-01/2012-01本院确诊的复发性翼状胬肉26例26眼,均为经历一次手术,手术方法为翼状胬肉切除联合自体角膜缘干细胞移植术,复发1a以上病例。本次研究中,切除胬肉组织时,将其上结膜充分游离后切下保存,羊膜覆盖胬肉切除后裸露巩膜面,再将保留的胬肉上的结膜植片反向覆盖羊膜上缝合。术后1,2wk;1mo及3mo观察结膜植片愈合情况、羊膜溶解吸收时间、角膜创面修复时间、角膜新生血管及胬肉复发率。术后随访12mo。结果:结膜植片愈合时间6.03±2.76d,羊膜溶解吸收时间14.26±3.64d,角膜创面修复时间5.42±1.58d。术后3mo,胬肉切除后裸露巩膜面新生结膜及结膜植片愈合良好,无明显胬肉术后并发症。术后1a,再度复发2例,复发率8%,治愈率92%。结论:对于复发性翼状胬肉,因传统自体角膜缘干细胞移植已经创伤部分角膜缘及眼表结膜瘢痕,单纯结膜移植,或单纯羊膜移植,术后胬肉复发率偏高,本方法取胬肉上结膜反向移植,避免大面积创伤眼表,取材容易,而且良好控制术后翼状胬肉复发问题,不失为一种解决复发性翼状胬肉的良好选择。

AIM： To observe the curative effects of pterygium conjunctiva reverse transplantation combined with amniotic membrane transplantation for treatment of recurrent pterygium. METHODS： A retrospective case series study. Twenty-six eyes of 26 cases with recurrent pterygium in our hospital from January 2009 to January 2012 underwent pterygium excision combined with autologous limbal stem cell transplantation and recurred more than one year. In this study, when the pterygium tissue was excised, the conjunctiva was cut and preserved after it was fully free, then the preserved conjunctiva was put reversely to cover the amniotic membrane and sutured after amniotic membrane covering the bare conjunctiva. The conjunctival graft healing condition, amniotic membrane dissolution, corneal wound repair, corneal neovascularization and pterygium recurrence rate 1 week, 2 weeks, 1 month, and 3 months after operation were observed. The follow-up period was 12 months.RESULTS： Conjunctival graft healing time was 6.03±2.76 days, amniotic membrane dissolved absorption time was 14.26±3.64 days, corneal wound repair time was 5.42±1.58 days. In postoperative 3 months, new conjunctiva in bare sclera surface and conjunctival graft healed well, no obvious pterygium postoperative complications. In postoperative 1 year, 2 cases with recurrent pterygium recurred, pterygium recurrence rate was 8%, cure rate was 92%.CONCLUSION： For recurrent pterygium, due to the traditional autologous corneal limbal stem cell transplantation has injured partial limbal and conjunctival scar, the postoperative pterygium recurrence rate is very high after single conjunctival transplantation or amniotic membrane transplantation. This method takes the pterygium conjunctiva reverse transplantation and avoids large area wound of ocular surface, obtains surgery materials easily and controls the postoperative recurrence of pterygium well, which is a good choice for treating recurrent pterygium.