Alvarenga Lenio S, de Sousa Luciene Barbosa, de Freitas Denise, Mannis Mark J
Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
Cornea. 2002 Aug;21(6):542-5. doi: 10.1097/00003226-200208000-00002.
To investigate the safety and efficacy of human processed pericardium used as an onlay after pterygium excision.
Twenty-five eyes of 25 patients (11 female, 14 male) with recurrent pterygium were included in this study. The median age was 50 years (range 24-89 years). Twenty-eight percent of the eyes previously had been operated on two or more times. The mean follow-up was 9.4 months (+/- 2.1 months, range 8-15 months). Following bare-sclera surgical removal of recurrent pterygium, a patch of processed human pericardium was sutured to cover the area of excision. The pericardium was not covered with conjunctiva, nor were adjuvant radiation or antimetabolite administered. All patients were treated with a combination of dexamethasone 0.1% / chloramphenicol drops three times per day for 1 month. Ketorolac tromethamine 0.5% three times per day was added to this regimen after complete corneal reepithelialization.
Recurrence (any growth >1 mm onto the cornea) was detected in 12 patients (48%). The mean time of recurrence was 4.1 +/- 1.7 months. Three patients (12.0%) presented a regrowth of fibrovascular tissue not reaching 1 mm of the cornea. Pyogenic granulomas occurred in three patients, and all of them required surgical excision. Corneal thinning was present in one patient and was treated with a therapeutic contact lens and artificial tears with complete resolution and vascularization of the thinned area. No decrease in visual acuity was observed in any patient.
The use of processed pericardium in pterygium surgery is a safe procedure but is associated with a relatively high rate of recurrence. It should only be considered as an option in managing recurrent pterygium when conjunctival autografting is not an available alternative.
研究人处理过的心包作为翼状胬肉切除术后覆盖物的安全性和有效性。
本研究纳入了25例复发性翼状胬肉患者的25只眼（女性11例，男性14例）。中位年龄为50岁（范围24 - 89岁）。28%的眼睛之前接受过两次或更多次手术。平均随访时间为9.4个月（±2.1个月，范围8 - 15个月）。在复发性翼状胬肉的裸巩膜手术切除后，缝合一片处理过的人心包以覆盖切除区域。心包未覆盖结膜，也未给予辅助放疗或抗代谢药物。所有患者均接受0.1%地塞米松/氯霉素滴眼液，每天3次，共1个月的治疗。角膜完全重新上皮化后，在此方案中添加0.5%酮咯酸氨丁三醇，每天3次。
12例患者（48%）检测到复发（角膜上任何生长>1mm）。复发的平均时间为4.1±1.7个月。3例患者（12.0%）出现纤维血管组织再生，但未到达角膜1mm。3例患者发生化脓性肉芽肿，所有患者均需手术切除。1例患者出现角膜变薄，采用治疗性隐形眼镜和人工泪液治疗，变薄区域完全消退且血管化。所有患者均未观察到视力下降。
在翼状胬肉手术中使用处理过的心包是一种安全的手术，但复发率相对较高。只有在结膜自体移植不可行时，才应将其视为治疗复发性翼状胬肉的一种选择。
