Clinical evaluation of the quantitative locator for conjunctiva resection used as an instrument for the treatment of conjunctivochalasis

Background The crescent excision of the inferior bulbar conjunctiva has been advised as a surgical procedure in the management of conjunctivochalasis refractory to medical treatments. However, it is difficult for this procedure to design how much conjunctival tissue should be excised. This study aimed to present a quantitative Iocator for conjunctiva resection and evaluate its effect on the treatment of conjunctivochalasis （CCh）. Methods Poly β-hydroxyethyl methacrylate resin/β-hydroxyethyl methacrylate （HEMA, water gel） was used as the material to make the quantitative Iocator which was designed to suit the specific patient. Forty-six patients with bilateral symptomatic CCh were included in this prospective study. Of the patients, while the right eye underwent the popularly used crescent-shaped conjunctiva resection （group I）, the left eye was treated with conjunctiva resection assisted by the quantitative Iocator （group II）. International Ocular Surface Disease Index （OSDI）, scores of remnant conjunctiva fold, complications and conjunctival cut healing, height of tear meniscus, tear break-up time （BUT）, and time of surgery were evaluated. Tasting chloromycetin test （TCT） was used to evaluate how the lacrimal duct worked. Results OSDI in group II （8.82±2.36） was significantly lower than that in group I （14.67±2.21） （t=12.22, P 〈0.01）. The amount of conjunctiva fold remaining in group II was less than that in group I. Scores of remnant conjunctiva fold in group I were significantly higher than those in group II （t=31.85, P 〈0.01）. While evaluation scores of conjunctival cut healing in group I were lower than those in group II, scores of complication in group I were significantly higher than those in group II at 8 weeks after surgery （t=89.60, P 〈0.01）. There was no significant difference in eyes with normal BUT （X^2=0.031, P=0.985） between the two groups, as the case was in eyes with positive TCT （X^2=0.14, P=0.930） and in eyes with normal height of tear meniscus （X^2=0.48, P=0.780）. Mean surgery time in group II （（17.11±2.08） minutes） was significantly shorter than that in group I （（25.22±4.78） minutes） （t=13.84, P 〈0.01）. Conclusion A quantitative Iocator can be used as an effective, safe, and less time-consuming instrument to facilitate conjunctival excision for symptomatic CCh treatment.

羊膜移植联合广泛切除术治疗翼状胬肉的疗效分析

目的:分析羊膜移植联合广泛翼状胬肉切除术治疗翼状胬肉的美容及预后效果。方法:选择2013年3月-2017年3月笔者医院收治的80例翼状胬肉患者为研究对象,随机分为观察组和对照组,每组40例。其中对照组41眼,采用单纯广泛翼状胬肉切除术治疗;而观察组43眼,在对照组基础上,给予羊膜移植术治疗。比较两组患者治疗效果、护理满意度及并发症发生情况等。结果:观察组治愈率为95.3%明显高于对照组的53.7%,而复发率(4.7%)显著低于对照组(46.3%),差异具有统计学意义(P<0.05)。观察组总满意度为92.5%显著高于对照组的77.5%,差异有统计学意义(P<0.05)。观察组并发症发生率(巩膜溶解软化、巩膜坏死)明显低于对照组,差异具有统计学意义(P<0.05)。结论:羊膜移植联合广泛翼状胬肉切除术治疗翼状胬肉效果显著,可大大提高护理满意度,改善患者美容效果,在临床中值得应用推广。

手术治疗结膜松弛症临床疗效观察

目的:探讨结膜新月形切除术、结膜缝线固定术治疗结膜松弛症的疗效。方法:对27例48眼结膜松弛症患者随机分组,分别应用结膜新月形切除、结膜缝线固定术进行治疗,术后随访观察疗效。从术后患者自觉症状、裂隙灯显微镜观察结膜松弛改善情况及泪河和泪膜破裂时间(BUT)的变化进行观察分析。结果:术后1wk,结膜新月形切除术组有效率为92%,结膜缝线固定术组有效率为88%。术后1mo,结膜新月形切除术组有效率为92%,结膜缝线固定术组有效率为83%。结论:两种手术方法治疗结膜松弛症方法简单,疗效明确。

翼状胬肉切除联合自体球结膜移植术的疗效观察

目的分析总结翼状胬肉切除联合自体球结膜移植术的方法及疗效。方法对65例(76眼)初发性翼状胬肉患者行翼状胬肉切除联合自体球结膜移植术,观察术后反应、移植片生长情况及翼状胬肉复发情况。结果 65例(76眼)其角膜创面上皮于1～3d修复,未见植片排斥反应发生,术后随访3～12个月,复发2眼,占2.6%。结论翼状胬肉切除联合自体球结膜移植术治疗翼状胬肉,创面修复快,植片无排异,能有效防止翼状胬肉术后复发,是治疗翼状胬肉较好的手术方法。

表面麻醉下老年性结膜松驰症手术治疗体会

目的研究分析老年性结膜松弛症患者的临床手术治疗方式。方法对2010∽2013年我院的老年性结膜松弛症患者16例,行表面麻醉和新月形结膜切除治疗,对患者的术后治疗效果进行观察分析。结果临床以无溢泪、无干涩和异物感作为治愈标准,共有81.25%的患者治愈,有18.75%的患者症状好转,溢泪、干涩、异物感等症状均改善明显。全部患者都接受了0.5∽2年的跟踪随访,没有出现复发和并发症病例。结论老年性结膜松弛症患者接受表面麻醉以及行新月形结膜切除治疗的临床效果优秀,患者的治愈率较高,且无明显并发症,安全可靠。

局部切除术联合冷冻治疗结膜恶性黑色素瘤生存率分析

目的研究局部切除术联合冷冻治疗结膜恶性黑色素瘤的生存率及预后因素。方法回顾性研究2003年7月至2018年1月该院眼科诊治的26例结膜恶性黑色素瘤病例资料和临床病理特点,分析局部切除联合冷冻治疗结膜恶性黑色素瘤的预后因素。结果26例患者5年总体生存率、复发率、转移率分别为56.7%、68.5%、52.4%。随着临床分期的增加,患者5年生存率明显降低(χ^(2)=9.531,P=0.009),T1期、T2期和T3期的生存率分别为85.1%、54.5%、50.0%。与其类似,随着肿瘤厚度增加,生存率明显降低(χ^(2)=4.644,P=0.031),肿瘤厚度<2.0 mm与≥2.0 mm的生存率分别为87.5%、36.5%。肿瘤侵犯泪阜与否(χ^(2)=1.694,P=0.193)和组织病理学特点(χ^(2)=3.336,P=0.189)差异无统计学意义。结论结膜恶性黑色素瘤分期和厚度与患者预后明显相关,早期诊断及治疗可明显提高患者生存率。