羊膜移植联合手术治疗复发性翼状胬肉合并睑球粘连临床疗效观察

Observation on the Effect of Amniotic Membrane Transplantation Combined with Operation on Recurrent Pterygium with Symblepharon

目的:观察羊膜移植联合手术治疗复发性翼状胬肉合并睑球粘连临床疗效。方法:回顾性分析2015年1月~2020年1月期间就诊于西安市第四医院眼表科门诊,确诊为复发性翼状胬肉同时合并部分睑球粘连患者共136例136只眼,其中男54例,女82例;年龄35岁~87岁,平均(64 ±12)岁;追问病史,所有患者在第一次手术前均诊断为原发性翼状胬肉,本次手术前曾于当地医院完成一次手术者98例、两次手术者35例、三次手术者3例;行眼科常规检查、眼表检查并完成眼前节照相,在显微镜下行复发性翼状胬肉切除、睑球粘连分离、结膜穹窿成形联合生物羊膜移植手术,其中,10例患者应用低温等离子手术系统辅助完成该手术。治愈标准:角膜、结膜上皮愈合良好,表面光滑透明,移植片成活,结膜无充血,无增生,角膜残留少许云翳,无明显瘢痕,无明显新生血管,角膜缘自体血管网形成。无明显结膜翼状胬肉样组织增生,眼球运动不受影响;复发标准:角膜创面新生血管及纤维增生,进入角膜缘大于1 mm,球结膜局部充血肥厚。术后随访,评估手术后临床疗效、再复发率及术后并发症等。结果:本次研究共回顾了136例患者,平均术后随访时间为(2.5 ±1.1)年(范围0.5年~5年)。共7例患者术后复发,复发率为5.88%。10例应用低温等离子手术系统辅助完成手术的患者均未复发。1例患者(0.74%)术后发生感染,1周内出现羊膜溶解。其余患者均未出现羊膜植片溶解、裂开及脱落现象,植片愈合好,术后未发生感染及排斥反应。结论:生物羊膜移植是治疗复发性翼状胬肉合并睑球粘连的安全、有效的方法。手术技巧的掌握、手术方式的选择、手术时机的把控,自身因素的防控以及围手术期的规范治疗是减少术后复发的保证。

Aim: To investigate the long-term clinical outcome of biological amniotic membrane transplantation in recurrent pterygium with symblepharon surgery. Methods: A retrospective analysis was performed on 136 eyes of patients diagnosed as recurrent pterygium combined with partial symblepharon surgery in the ocular surface department of Xi’an People’s Hospital (Xi’an Fourth Hospital) from January 2015 to January 2020, including 54 males and 82 females. The age ranged from 35 to 87 years, with an average of (64 ±12) years. After examining the medical history, all the patients were diagnosed as primary pterygium before the first operation. Before this operation, 98 patients had one operation, 35 patients had two operations and 3 patients had three operations. Routine ophthalmological examination, ocular surface examination and anterior segment photography were performed. Recurrent pterygium excision, symblepharon surgery separation and conjunctival fornix forming combined with biological amniotic membrane transplantation were performed under the microscope, in which 10 patients were assisted by low-temperature plasma surgery system. Standard of cure: corneal and conjunctival epithelium healed well, the surface was smooth and transparent, the graft survived, no conjunctival congestion, no hyperplasia, residual corneal cloud, no obvious scars, no obvious new blood vessels, corneal origin from the formation of vascular network. There was no obvious conjunctival pterygium tissue proliferation, and eye movements were not affected. Standard of Recurrence: corneal wound neocascularization and fibroplasia, entering the corneal limbus greater than 1 mm, bulbar conjunctiva hyperemia. Postoperative follow-up was conducted to evaluate the clinical efficacy, recurrence rate and postoperative complications. Results: A total of 136 patients were reviewed in this study. The average postoperative follow-up time was (2.5 ±1.1) years (range 0.5 - 5 years). A total of 7 patients had postoperative recurrence, and the recurrence rate was 5.88%. None of the 10 patients underwent surgery assisted by the cryogenic plasma surgical system had recurrence. Postoperative infection occurred in 1 patient (0.74%) and amniotic membrane melting occurred within 1 week. None of the other patients showed dissolution, debridement or abscission of the amniotic membrane graft. The graft healed well, and no infection or rejection occurred after the operation. Conclusion: Biologic amniotic membrane transplantation is a safe and effective method for the treatment of recurrent pterygium with symblepharon. The mastery of surgical techniques, the selection of appropriate surgical methods, the control of operative timing, the prevention and control of factors from patients and the standard perioperative treatment are the guarantees to reduce postoperative recurrence.