Kwon Soo Hyun, Kim Hong Kyun
From the Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, South Korea.
Medicine (Baltimore). 2015 Jan;94(4):e518. doi: 10.1097/MD.0000000000000518.
The aim of this article is to evaluate and classify pathogenetic origins based on morphologic reproliferative patterns in patients who underwent pterygium excision with a conjunctival autograft. In this retrospective, observational case series, a total of 116 eyes of 116 patients with pterygium who underwent pterygium excision with a conjunctival autograft between February 2009 and May 2011 were reviewed. Using consecutively recorded photographs, we evaluated preoperative morphologic severity, postoperative complications, recurrences, and growth patterns. The regrowth of fibrovascular tissue was observed in 14 of our study cases (12.1%). Of these, 5 cases (4.3%) showed clinically significant recurrences. We observed 3 different morphologic patterns of recurrence: regrowth over the epithelial defect; transformation of the conjunctival graft into the pterygial tissue; and regrowth from unexcised pterygial tissue. Each recurrence pattern showed characteristic fibrovascular growth, the origin of this regrowth, and grade of severity. In 25 cases (21.6%), postoperative complications were observed. Of the analyzed variables, age <40 years (P = 0.019; odds ratio [OR], 5.82; 95% confidence interval [CI], 1.34-25.28) and the presence of postoperative complications (P = 0.008; OR, 6.32; 95% CI, 1.62-24.58) were statistically significant in multivariate analyses using logistic regression. The use of conjunctival autografts for pterygium surgery is effective, but recurrences are observed in some cases exhibiting unique pathogenic patterns according to their origin. A complete understanding of the pathogenesis of these lesions based on their morphologic regrowth pattern will help to prevent recurrences in patients who undergo pterygium surgery.
本文旨在根据接受结膜自体移植翼状胬肉切除术患者的形态学再增殖模式，对致病起源进行评估和分类。在这个回顾性观察病例系列中，我们回顾了2009年2月至2011年5月间116例接受结膜自体移植翼状胬肉切除术患者的116只眼睛。利用连续记录的照片，我们评估了术前形态学严重程度、术后并发症、复发情况及生长模式。在我们的研究病例中，有14例（12.1%）观察到纤维血管组织再生。其中，5例（4.3%）出现具有临床意义的复发。我们观察到3种不同的复发形态学模式：上皮缺损处的再生；结膜移植片转变为翼状胬肉组织；未切除的翼状胬肉组织再生。每种复发模式均显示出特征性的纤维血管生长、这种再生的起源及严重程度分级。25例（21.6%）观察到术后并发症。在使用逻辑回归的多变量分析中，年龄<40岁（P = 0.019；比值比[OR]，5.82；95%置信区间[CI]，1.34 - 25.28）和存在术后并发症（P = 0.008；OR，6.32；95%CI，1.62 - 24.58）具有统计学意义。结膜自体移植用于翼状胬肉手术是有效的，但在一些病例中会观察到复发，这些复发根据其起源表现出独特的致病模式。基于形态学再生模式对这些病变的发病机制有全面的了解，将有助于预防接受翼状胬肉手术患者的复发。
