丝裂霉素C局部贴敷辅助自体角膜缘结膜移植术治疗翼状胬肉

Clinical study of using intraoperative mitomycin C combined with limbal conjunctival autograft transplantation in the treatment of pterygium

目的探讨术中局部使用丝裂霉素c贴敷能否进一步提高自体角膜缘结膜移植术治疗原发及复发翼状胬肉的效果。方法将2005年至2009年在天津医科大学总医院眼科门诊确诊为翼状胬肉的114例患者（134眼）按随机数字表法分为A、B2组。A组59例70眼（原发63眼，复发7眼），采用翼状胬肉切除联合自体角膜缘结膜移植术，并于术中局部使用0．02％丝裂霉素C：B组55例64眼（原发57眼，复发7眼），采用同样手术方法，但术中不使用丝裂霉素C。比较2组术后角膜上皮生长情况、翼状胬肉复发率、视力及术后并发症。患者平均随访时间（23．3＋8．6）个月（12～65个月）。数据采用独立样本t检验和卡方检验。结果A组病例角膜上皮生长时间平均为（4．0±0．8）d，略长于B组的（3．4±0．6）d（t=3．71，P〈0．05）。2组翼状胬肉复发率均为3％（X2=0．008，19〉0．05）。A组术后视力不变或提高者为74％，B组为65％（X。=1．301，P〉0．05）。术后并发症主要包括角膜上皮延迟愈合，角膜缘结膜植片松脱，角膜缘小凹形成，结膜上皮下囊肿等。A组并发症发生率为6％，B组为5％（X。=0．071，P〉0．05）。结论术中局部应用丝裂霉素C对于自体角膜缘结膜移植术治疗原发及复发翼状胬肉的辅助作用有限．而且可能引起角膜上皮延迟愈合等并发症。

Objective To determine whether intraoperative mitomycin C （MMC） can enhance the efficacy of limbal conjunctival autograft transplantation （LCAT） for the treatment of primary and recurrent pterygium. Methods This was a prospective case-control study. One hundred and thirty-four eyes of 114 patients with primary and recurrent pterygium were randomly divided into 2 groups. In group A, 63 eyes with primary pterygium and 7 eyes with recurrent pterygium were treated with pterygium resection and LCAT combined with a local application of MMC. In group B, 57 eyes with primary pterygium and 7 eyes with recurrent pterygium underwent pterygium resection and limbal conjunctival autograft transplantation alone. Epithelial regeneration, rate of pterygium recurrence, visual prognosis and complications were evaluated and compared between the two groups. The mean follow-up was 23.3＋8.6 months with a range from 12 to 65 months. Data were analyzed using an independent t test and chi-square test. Results No intraoperative complications were found in any eyes. Postoperative corneal epithelial regeneration took an average of 4.0±0.8 days and 3.4±0.6 days in groups A and B, respectively （t=-3.71, P〉0.05）. The rate of pterygium recurrence was 3% in both groups （X2=0.008, P〉O.05）. Postoperative visual acuity improved or remained stable in 74% of group A and 65% of group B （X2=1.301, P〉0.05）. Postoperative complications included delayed corneal epithelial recovery, limbal conjunctival autograft lag, corneal dellen, and subepithelial inclusion cyst in group A （6%） and group B （5%） （X2=0.071, P〉0.05）. Conclusion Intraoperative use of MMC does not enhance the efficacy of LCAT for the treatment of pterygium and may lead to a delay in corneal epithelial recovery.