Katircioğlu Yasemin Arslan, Altiparmak Ugur Emrah, Duman Sunay
Department of Ophthalmology, S.B. Ankara Research & Training Hospital, Ophthalmology Clinics, Ankara. Turkey.
Orbit. 2007 Mar;26(1):5-13. doi: 10.1080/01676830600972724.
To compare three techniques combined with excision in the treatment of primary and recurrent pterygium: amniotic membrane transplantation, conjunctival autograft, and conjunctival autograft plus mitomycin C.
Forty-nine eyes of 49 subjects (30 primary, 19 recurrent pterygium) were included in this study. Combined with excision, 25 eyes (18 primary, 7 recurrent pterygium) were treated with conjunctival autografts (Group 1), and 16 eyes (12 primary, 4 recurrent pterygium) were treated with amniotic membrane transplantation for the closure of the defect (Group 2). In 8 eyes (all recurrent pterygium) low-dose mitomycin C (0.02%) was applied topically to the defect area and a conjunctival autograft was applied thereafter (Group 3). The three groups were compared with regard to the recurrence of pterygium and the defect area requiring treatment.
The number and percentages of recurrence seen in groups 1, 2 and 3 were as follows: 4 (16%), 4 (25%), and 0(-), respectively. For the treatment of primary pterygium cases, amniotic membrane closure and conjunctival autograft closure were comparable in effectiveness (p > 0.05). In the treatment of recurrent pterygium, there was no significant difference between the three techniques (p > 0.05). Amniotic membrane closure and conjunctival autografts were equally effective for the treatment of both primary and recurrent pterygium (p > 0.05). The graft size was significantly larger in the cases with recurrent pterygium (p = 0.016).
Amniotic membrane closure and conjunctival autografts seem to be equally effective in the prevention of recurrence of primary pterygium. Conjunctival autografts combined with mitomycin C are as effective as the above two techniques to prevent recurrence in the treatment of recurrent pterygium. Due to the larger area of subconjunctival fibrosis, a larger defect area is created after the excision of pterygium tissue and a larger graft is needed to close this defect in recurrent pterygium. This factor can guide the surgeon during the planning of the surgery to choose the most appropriate technique for closure of the defect.
比较三种与切除术联合应用治疗原发性和复发性翼状胬肉的技术：羊膜移植术、自体结膜移植术以及自体结膜移植联合丝裂霉素C。
本研究纳入了49例患者的49只眼（原发性翼状胬肉30只眼，复发性翼状胬肉19只眼）。联合切除术，25只眼（原发性翼状胬肉18只眼，复发性翼状胬肉7只眼）接受了自体结膜移植治疗（第1组），16只眼（原发性翼状胬肉12只眼，复发性翼状胬肉4只眼）接受了羊膜移植术以封闭缺损（第2组）。8只眼（均为复发性翼状胬肉）在缺损区域局部应用低剂量丝裂霉素C（0.02%），随后进行自体结膜移植（第3组）。比较三组翼状胬肉的复发情况以及需要治疗的缺损面积。
第1组、第2组和第3组的复发例数及百分比分别如下：4例（16%）、4例（25%）和0例（-）。对于原发性翼状胬肉病例的治疗，羊膜封闭术和自体结膜移植封闭术在有效性方面相当（p>0.05）。在复发性翼状胬肉的治疗中，三种技术之间无显著差异（p>0.05）。羊膜封闭术和自体结膜移植术在原发性和复发性翼状胬肉的治疗中同样有效（p>0.05）。复发性翼状胬肉病例的移植片尺寸显著更大（p=0.016）。
羊膜封闭术和自体结膜移植术在预防原发性翼状胬肉复发方面似乎同样有效。自体结膜移植联合丝裂霉素C在治疗复发性翼状胬肉时预防复发的效果与上述两种技术相同。由于结膜下纤维化面积更大，翼状胬肉组织切除后会形成更大的缺损区域，因此在复发性翼状胬肉中需要更大的移植片来封闭该缺损。这一因素可指导外科医生在手术规划过程中选择最合适的缺损封闭技术。
