Yaisawang Sudarat, Piyapattanakorn Pittaya
Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
J Med Assoc Thai. 2003 Jun;86 Suppl 2:S215-23.
Recurrence of pterygium is the most common failure of the pterygium operation. The use of conjunctival autograft after pterygium excision has shown a low recurrence rate. However, it has a board range of variations regarding the recurrence rates, which may be influenced by many factors. From the authors' clinical observation, it was found that the recurrence rate was higher in patients who received inadequate post-operative topical corticosteroid treatment.
To study the association between adequacy of post-operative topical corticosteroids and recurrence rate in patients with primary pterygium who underwent excision with conjunctival autograft.
Retrospective, case-control study.
A total of 142 eyes of 137 patients with primary pterygium who underwent excision with conjunctival autograft between January 1996 and June 2002 were enrolled in this study. These patients were evaluated for recurrence of their pterygia and adequacy of post-operative topical corticosteroids by chart review, re-examination, self-reported questionnaire, and interview. Cases were patients with recurrent pterygium. Controls were from patients without recurrence.
There were 21 recurrences (14.8%) of a total of 142 eyes treated. Five of the 21 recurrences occurred in good compliant patients with adequate post-operative topical corticosteroid therapy. Sixteen recurrences occurred in patients with inadequate post-operative topical corticosteroids. In this group, 6 cases missed their follow-up schedules, 3 cases were lost to follow-up after 1.5-2 months, 1 case had poor compliance with treatment, and 6 cases were steroid responders then the treatment was discontinued or changed to a weaker preparation. The study demonstrates significant association between the adequacy of post-operative topical corticosteroid and pterygium recurrence rate. The odds ratio was 190.4 (95% CI, 36.61-951.84).
A high recurrence rate was found in patients who received inadequate post-operative topical corticosteroid. However, the recurrence rate was much lower from 14.8 per cent to 4 per cent when the patients with inadequate corticosteroid therapy were excluded. The study provides evidence that post-operative topical corticosteroids appear to play a role in reducing the pterygium recurrence rate.
翼状胬肉复发是翼状胬肉手术最常见的失败情况。翼状胬肉切除术后使用自体结膜移植术已显示出较低的复发率。然而，其复发率存在广泛的差异，这可能受多种因素影响。从作者的临床观察发现，术后局部应用皮质类固醇治疗不足的患者复发率较高。
研究原发性翼状胬肉患者行自体结膜移植切除术后局部应用皮质类固醇的充足程度与复发率之间的关联。
回顾性病例对照研究。
本研究纳入了1996年1月至2002年6月期间137例原发性翼状胬肉患者行自体结膜移植切除术的142只眼。通过病历审查、复查、自我报告问卷和访谈对这些患者的翼状胬肉复发情况及术后局部应用皮质类固醇的充足程度进行评估。病例为翼状胬肉复发的患者。对照来自未复发的患者。
在总共治疗的142只眼中有21例复发（14.8%）。21例复发中有5例发生在术后局部皮质类固醇治疗充足且依从性良好的患者中。16例复发发生在术后局部皮质类固醇治疗不足的患者中。在这组患者中，6例未按随访计划进行随访，3例在1.5 - 2个月后失访，1例治疗依从性差，6例为类固醇反应者，随后治疗中断或改为较弱的制剂。该研究表明术后局部应用皮质类固醇的充足程度与翼状胬肉复发率之间存在显著关联。比值比为190.4（95%可信区间，36.61 - 951.84）。
术后局部应用皮质类固醇不足的患者复发率较高。然而，当排除皮质类固醇治疗不足的患者后，复发率从14.8%大幅降至4%。该研究提供了证据表明术后局部应用皮质类固醇似乎在降低翼状胬肉复发率方面发挥作用。
