Mourits M P, Wyrdeman H K, Jurgenliemk-Schulz I M, Bidlot E
Department of Surgical Specialties, Division of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands.
Eur J Ophthalmol. 2008 May-Jun;18(3):327-31. doi: 10.1177/112067210801800301.
To describe and compare long-term (> or = 36 months) effects of patients with 86 primary pterygia treated with bare sclera extirpation (BSE) followed by Beta-RT or by sham irradiation.
Prospective, multicenter, randomized, double-blind study. After BSE of their pterygium, patients were randomized to either Beta-RT or sham irradiation. In the case of Beta-RT, within 24 hours after the operation, a 90Sr eye applicator was used to deliver 2500 cGy to the sclera surface at a dose rate of between 200 and 250 cGy/min. Sham irradiation was given using the same type of applicator without the 90Sr layer. After treatment, both a masked ophthalmologist and a radiation oncologist performed follow-up examinations. These were continued until either a relapse occurred or at least 36 months had elapsed.
Adequate follow-up was available of 86 pterygia in 81 patients, treated between February 1998 and September 2002. Fifty-two (60%) patients were male. The mean age of the patients was 50 years (range: 24-77). After a follow-up of at least 36 months (mean: 40 months, SD:13.9 months), 5 out of 44 eyes (11%) treated with Beta-RT showed a recurrence versus 32 out of 42 eyes (76%) treated with sham-RT (after a mean follow-up of 22 months) (p<0.001). In the Beta-RT group, 80% were satisfied with the cosmetic result, whereas in the sham group this percentage was 41% (p<0.001). In the Beta-RT group, no scar or a white scar could be detected in 86% of the treated eyes, versus in 24% of the sham irradiated eyes (p<0.001). A change of keratometry (Javal) was seen in 5 patients (12%) following Beta-RT compared to 16 (38%) after sham irradiation (p=0.002). Complications were few: a granuloma was seen in three patients after sham irradiation, mild limitation of abduction in two Beta-RT patients versus in five after sham irradiation, and mild scleromalacia in one Beta-RT patient.
Bare sclera extirpation of a pterygium without adjuvant treatment has an unacceptably high recurrence rate and therefore should be considered obsolete. Bare sclera extirpation of a primary pterygium followed by a single-dose Beta-RT is a simple, effective, and safe treatment with lasting results and very few complications.
描述并比较86例原发性翼状胬肉患者接受单纯巩膜切除术(BSE)后接受β射线放疗(Beta-RT)或假照射的长期(≥36个月)效果。
前瞻性、多中心、随机、双盲研究。患者翼状胬肉行BSE术后,随机分为Beta-RT组或假照射组。对于Beta-RT组,术后24小时内,使用90Sr眼敷贴器以200至250 cGy/分钟的剂量率向巩膜表面给予2500 cGy。使用相同类型但无90Sr层的敷贴器进行假照射。治疗后,由一位不知情的眼科医生和一位放射肿瘤学家进行随访检查。随访持续至复发或至少36个月过去。
1998年2月至2002年9月间治疗的81例患者中的86例翼状胬肉获得了充分随访。52例(60%)患者为男性。患者平均年龄为50岁(范围:24 - 77岁)。至少随访36个月(平均:40个月,标准差:13.9个月)后,Beta-RT治疗的44眼中有5眼(11%)复发,而假照射治疗的42眼中有32眼(76%)复发(假照射组平均随访22个月)(p<0.001)。Beta-RT组中,80%的患者对美容效果满意,而假照射组这一比例为41%(p<0.001)。Beta-RT组中,86%的治疗眼未检测到瘢痕或白色瘢痕,而假照射眼为24%(p<0.001)。Beta-RT后5例患者(12%)角膜曲率(Javal)有变化,假照射后为16例(38%)(p = 0.002)。并发症较少:假照射后3例患者出现肉芽肿,Beta-RT组2例患者外展轻度受限,假照射组5例,Beta-RT组1例患者出现轻度巩膜软化。
原发性翼状胬肉单纯巩膜切除术在无辅助治疗时复发率高得令人难以接受因此应被视为过时方法。原发性翼状胬肉单纯巩膜切除术后单次剂量Beta-RT是一种简单、有效且安全的治疗方法,效果持久且并发症极少。