Wong V A, Law F C
Department of Ophthalmology, University of British Columbia, Vancouver, Canada.
Ophthalmology. 1999 Aug;106(8):1512-5. doi: 10.1016/S0161-6420(99)90445-1.
To determine whether using mitomycin C (MMC) before applying conjunctival autograft is better than conjunctival autograft alone in preventing the recurrence of pterygia in an Asian-Canadian population.
Nonrandomized, retrospective, comparative case series.
A total of 159 patients were included in the study. Seventy patients (76 eyes) received MMC (0.25 mg/ml for 1 minute) with conjunctival autograft; 89 patients (98 eyes) received conjunctival autograft alone.
All patients had primary (first-occurrence) pterygia excised and conjunctival autograft applied with or without MMC adjunct.
Recurrence of pterygia was monitored for up to 1 year after the operation. Any complications (e.g., scleral thinning and necrosis) were documented.
Patients' pterygia were examined on presentation and were graded 1 through 3. Grade 1 pterygia were fibrovascular proliferations extending up to one quarter the diameter of the cornea; grade 2 extended between one quarter to one half the distance across the cornea; and grade 3 extended beyond the visual axis. In the more severe pterygia group (grades 2 and 3 combined), there was significantly less pterygium recurrence in the MMC/autograft group (7%) compared with the autograft alone-treated group (26%). There was no significant difference in recurrence between groups for less severe grade pterygia (grade 1). The recurrence rate of all pterygia in the MMC/autograft group was 9% compared with 18% for the conjunctival autograft group. This difference was not statistically significant, however, because of a small sample size. There were no significant complications in either group and no difference between groups in complication rates.
The authors suggest using MMC in patients with more severe pterygia as an adjunct to conjunctival autograft to lower the recurrence rate. Combining the use of MMC with conjunctival autograft allows for decreased dosage and time of intraoperative exposure of mitomycin, thereby making it safer for application.
确定在亚裔加拿大人群中，在应用结膜自体移植术前使用丝裂霉素C（MMC）是否比单纯结膜自体移植术更能有效预防翼状胬肉复发。
非随机、回顾性、对照病例系列研究。
共纳入159例患者。70例患者（76只眼）在结膜自体移植术时使用MMC（0.25mg/ml，持续1分钟）；89例患者（98只眼）仅接受结膜自体移植术。
所有患者均接受原发性（初发性）翼状胬肉切除，并在使用或不使用MMC辅助的情况下进行结膜自体移植。
术后长达1年监测翼状胬肉的复发情况。记录任何并发症（如巩膜变薄和坏死）。
患者就诊时检查翼状胬肉并分为1至3级。1级翼状胬肉为纤维血管增生，延伸至角膜直径的四分之一；2级延伸至角膜直径的四分之一至二分之一；3级延伸至视轴以外。在较严重的翼状胬肉组（2级和3级合并）中，MMC/自体移植组的翼状胬肉复发率（7%）显著低于单纯自体移植治疗组（26%）。较轻级别的翼状胬肉（1级）组间复发率无显著差异。MMC/自体移植组所有翼状胬肉的复发率为9%，结膜自体移植组为18%。然而，由于样本量小，这种差异无统计学意义。两组均无显著并发症，并发症发生率组间无差异。
作者建议在较严重翼状胬肉患者中使用MMC作为结膜自体移植的辅助手段以降低复发率。将MMC与结膜自体移植联合使用可减少丝裂霉素的剂量和术中暴露时间，从而使其应用更安全。
