Patel Ekta D, Rhee Michelle K
Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY.
Eye Contact Lens. 2022 Jan 1;48(1):3-13. doi: 10.1097/ICL.0000000000000849.
To provide an updated review of surgical techniques and adjuvants for the management of pterygium.
A literature search was conducted in PubMed for studies published since January 2011. "Pterygium surgery" and the MeSH term "Pterygium/surgery" was used. The results were filtered for randomized controlled trials in English, yielding 60 citations.
One study compared topical anesthetic agents. One study compared methods of corneal polishing of the corneoscleral bed after pterygium excision. Numerous studies evaluated the use of conjunctival autograft versus amniotic membrane, superior versus inferior conjunctival autograft, and conjunctival versus limbal-conjunctival autograft. Many studies evaluated graft fixation methods. Several studies evaluated the adjuvant use of mitomycin C, 5-fluorouracil, and bevacizumab. A few studies evaluated the adjuvant use of steroids. Eleven studies evaluated various methods of postoperative management.
Current evidence supports pterygium excision with conjunctival autograft fixation using fibrin glue, followed by patching until the first postoperative visit. Surgical adjuvants and postoperative use of artificial tears and topical cyclosporine 0.05% may further reduce recurrence. Postoperative use of topical steroids is highly variable because there is no consensus regarding the optimal dose, frequency, and duration of treatment.
提供关于翼状胬肉治疗的手术技术及辅助治疗方法的最新综述。
在PubMed上检索自2011年1月以来发表的研究。使用了“翼状胬肉手术”及医学主题词“翼状胬肉/手术”。结果筛选出英文的随机对照试验，共获得60篇文献引用。
一项研究比较了局部麻醉剂。一项研究比较了翼状胬肉切除术后角膜巩膜床角膜抛光的方法。众多研究评估了结膜自体移植与羊膜、上方结膜自体移植与下方结膜自体移植以及结膜自体移植与角膜缘结膜自体移植的使用情况。许多研究评估了移植固定方法。多项研究评估了丝裂霉素C、5-氟尿嘧啶和贝伐单抗的辅助使用。少数研究评估了类固醇的辅助使用。11项研究评估了术后管理的各种方法。
目前的证据支持采用纤维蛋白胶固定结膜自体移植进行翼状胬肉切除，然后包扎直至术后首次复诊。手术辅助治疗以及术后使用人工泪液和0.05%的局部环孢素可能会进一步降低复发率。局部类固醇的术后使用差异很大，因为在最佳剂量、频率和治疗持续时间方面尚无共识。
