Sheppard John D, Mansur Arnulfo, Comstock Timothy L, Hovanesian John A
Virginia Eye Consultants, Norfolk, VA, USA.
Airala's Laser and Cataract Institute, Miami, FL, USA.
Clin Ophthalmol. 2014 Jun 13;8:1105-18. doi: 10.2147/OPTH.S55259. eCollection 2014.
Pterygium, a sun-related eye disease, presents as wing-shaped ocular surface lesions that extend from the bulbar conjunctiva onto the cornea, most commonly on the nasal side. Pterygia show characteristic histological features that suggest that inflammation plays a prominent role in their initial pathogenesis and recurrence. Appropriate surgery is the key to successful treatment of pterygia, but there is also a rationale for the use of anti-inflammatory agents to reduce the rate of recurrence following surgery. Multiple surgical techniques have been developed over the last two millennia, but these initially had little success, due to high rates of recurrence. Current management strategies, associated with lower recurrence rates, include bare sclera excision and various types of grafts using tissue glues. Adjunctive therapies include mitomycin C and 5-fluorouracil, as well as the topical ocular steroid loteprednol etabonate, which has been shown to have a lower risk of elevated intraocular pressure than have the other topical ocular steroids. Here, the surgical management of pterygium is presented from a historical perspective, and current management techniques, including the appropriate use of various adjunctive therapies, are reviewed, along with an illustrative case presentation and a discussion of the conjunctival forceps designed to facilitate surgical management. Despite thousands of years of experience with this condition, there remains a need for a more thorough understanding of pterygium and interventions to reduce both its incidence and postsurgical recurrence. Until that time, the immediate goal is to optimize surgical practices to ensure the best possible outcomes. Loteprednol etabonate, especially the ointment formulation, appears to be a safe and effective component of the perioperative regimen for this complex ocular condition, although confirmatory prospective studies are needed.
翼状胬肉是一种与阳光相关的眼部疾病，表现为从球结膜延伸至角膜的翼状眼表病变，最常见于鼻侧。翼状胬肉具有特征性的组织学特征，提示炎症在其初始发病机制和复发中起重要作用。适当的手术是成功治疗翼状胬肉的关键，但使用抗炎药物以降低术后复发率也有其合理性。在过去两千年中已开发出多种手术技术，但由于复发率高，这些技术最初成效甚微。目前与较低复发率相关的管理策略包括单纯巩膜切除术和使用组织胶水的各种类型的移植术。辅助治疗包括丝裂霉素C和5-氟尿嘧啶，以及局部眼用类固醇氯替泼诺，与其他局部眼用类固醇相比，它已被证明具有较低的眼压升高风险。在此，从历史角度介绍翼状胬肉的手术管理，并回顾当前的管理技术，包括各种辅助治疗的适当使用，同时给出一个病例说明以及对旨在促进手术管理的结膜镊的讨论。尽管对这种疾病已有数千年的经验，但仍需要更深入地了解翼状胬肉以及降低其发病率和术后复发率的干预措施。在此之前，当前的目标是优化手术操作以确保获得最佳结果。氯替泼诺，尤其是软膏制剂，似乎是这种复杂眼部疾病围手术期治疗方案中一种安全有效的成分，尽管还需要进行前瞻性对照研究。
