翼状胬肉切除术后巩膜溶解6例临床分析

Clinical analysis of six cases of scleral melting after pterygium surgery

目的探讨翼状胬肉术后巩膜溶解的原因、处理及预防。方法对翼状胬肉切除术后出现巩膜溶解的6例（6眼）进行回顾性分析。6例中3例为翼状胬肉单纯切除术，3例为翼状胬肉切除联合角膜缘干细胞移植术，1例血沉、C反应蛋白升高及类风湿因子升高，1例血糖升高。治疗方法：停用糖皮质激素类药物，给予左氧氟沙星、重组牛碱性成纤维细胞生长因子滴眼液滴眼，2例巩膜溶解严重者1例行带蒂球结膜移植，另一例先后行带蒂球结膜移植联合羊膜移植及异体板层角巩膜移植。结果经治疗，除1例失访者外，其余5例病情均得到控制，巩膜溶解获得治愈。结论任何翼状胬肉切除手术方式术后均有可能发生巩膜溶解的严重并发症，其中翼状胬肉单纯切除术后巩膜溶解更为严重，主要与免疫因素、手术损伤导致巩膜缺血有关。应加强预防。

Objective To analyze the cause, therapy and prevention of the scleral melting after pterygium surgery. Methods The clinical data of 6 eyes of 6 cases with scleral melting after pterygium surgery were retrospectively reviewed. Three cases had received simple pterygium excision and others received pterygium excision combined with limbal-conjunctival autograft. Blood sedimentation, C-reactive protein and rheumatoid factor of one case were elevated. Blood sugar of one case was elevated. In all patients the glucocorticoid eyedrop was withdrawn and they were treated with levofloxacin and recombinant bovine basic fibroblast growth factor bFGF cycdrops. One case of severe scleral melting was treated with conjunctival flap coverage of the lesion. The other case of severe sclcral melting was treated with conjunctival flap coverage combined with amniotic membrane transplantation and lamellar sclera transplantation. Results Five cases were cured after the treatment. One case was out of connection. Conclusion Operation for pterygium could cause scleral melting which is more serious after simple pterygium excision. Topical damages induced by immunoreaction and surgery might contribute to the scleral melting.