Levy Richard L, Naidu Srilata, Jacobson Lawrence
Department of Ophthalmology, New York University School of Medicine, New York, NY, USA.
Eye Contact Lens. 2005 May;31(3):105-8. doi: 10.1097/01.icl.0000140908.17491.a0.
Despite the established efficacy of mitomycin C (MMC) in preventing recurrence after pterygium surgery, there is no consensus on the optimal operative technique or dose of MMC.
The authors retrospectively evaluated 90 single-headed pterygium resections performed with excision of the entire pterygium to the plica and removal of all Tenon's membrane from the scleral bed and rectus muscle. Bare sclera was exposed to 0.4 mg/mL MMC for 5 minutes for primary pterygia and 6 minutes for recurrent pterygia. These procedures were compared to a previous series of 58 procedures using bare sclera technique with MMC, but without extensive Tenon's membrane removal.
Extensive Tenon's membrane removal was associated with significantly fewer recurrences (6.7% vs. 21%; P< or =0.025) and significantly less pyogenic granuloma formation (24.4% vs. 40%; P< or =0.05). In addition, there were no vision-threatening complications, such as scleral melting or persistent corneal epithelial defects, in any of the patients.
These findings suggest that complete removal of all Tenon's membrane in the affected quadrant combined with topical MMC in the aforementioned dose is a safe method of pterygium excision with a low rate of recurrence and pyogenic granuloma formation.
尽管丝裂霉素C（MMC）在预防翼状胬肉手术后复发方面已证实有效，但对于最佳手术技术或MMC剂量尚无共识。
作者回顾性评估了90例单头翼状胬肉切除术，手术方式为将整个翼状胬肉切除至结膜褶，并从巩膜床和直肌上切除所有Tenon囊膜。对于原发性翼状胬肉，将裸露的巩膜暴露于0.4mg/mL MMC中5分钟，对于复发性翼状胬肉则暴露6分钟。将这些手术与之前一系列采用裸露巩膜技术联合MMC但未广泛切除Tenon囊膜的58例手术进行比较。
广泛切除Tenon囊膜与显著减少的复发率（6.7%对21%；P≤0.025）和显著减少的脓性肉芽肿形成（24.4%对40%；P≤0.05）相关。此外，所有患者均未出现威胁视力的并发症，如巩膜溶解或持续性角膜上皮缺损。
这些发现表明，在受影响象限完全切除所有Tenon囊膜并联合上述剂量的局部MMC是一种安全的翼状胬肉切除方法，复发率和脓性肉芽肿形成率较低。
