Tan D T, Chee S P, Dear K B, Lim A S
Singapore National Eye Centre, Singapore.
Arch Ophthalmol. 1997 Oct;115(10):1235-40. doi: 10.1001/archopht.1997.01100160405001.
To compare success rates of conjunctival autografting and bare sclera excision for primary and recurrent pterygium in the tropics and to evaluate risk factors for pterygium recurrence.
A prospective, controlled clinical trial was performed in which 123 primary and 34 recurrent pterygia, matched for age and pterygium morphology, were randomized in 2 separate studies to receive either bare sclera excision or conjunctival autograft. The surgical procedures were performed by one surgeon and reviewed at 1, 3, 6, and 12 months after surgery by an independent observer. Pterygium morphology was clinically graded as atrophic, intermediate, or fleshy according to an assessment of pterygium translucency. Risk factors were assessed using likelihood ratio tests. Weibull curves were used to estimate recurrence rates allowing for the interval censoring.
In the group with primary pterygium (mean follow-up, 15.1 months), 38 (61%) of the 62 cases of bare sclera excision (heretofore referred to as the bare sclera group) had pterygium recur in contrast with 1 (2%) of the 61 cases of conjunctival autograft (heretofore referred to as the conjunctival autograph group) (P<.001, likelihood ratio X2 test). Nontranslucency, or fleshiness of the pterygium, and not age was a significant risk factor for recurrence in the bare sclera group (P<.001, likelihood ratio X2 test). In the group with recurrent pterygium (mean follow-up, 13.2 months), 14 (82%) of the 17 bare sclera group had pterygium recur, while no recurrences occurred among 17 cases in the conjunctival autograft group. Nontranslucency was again a highly significant factor for recurrence (P<.001, likelihood ratio X2 test).
Pterygium recurrence is related to pterygium morphology and fleshiness of the pterygium is a significant risk factor for recurrence if bare sclera excision is performed. Conjunctival autografting for primary and recurrent pterygium is effective in reducing pterygium recurrence compared with bare sclera excision.
比较结膜自体移植术与单纯巩膜切除术治疗热带地区原发性及复发性翼状胬肉的成功率，并评估翼状胬肉复发的危险因素。
进行一项前瞻性对照临床试验，将123例原发性翼状胬肉和34例复发性翼状胬肉（根据年龄和翼状胬肉形态匹配）分别纳入两项独立研究，随机接受单纯巩膜切除术或结膜自体移植术。手术由一名外科医生实施，术后1、3、6和12个月由一名独立观察者进行评估。根据翼状胬肉的透明度评估，将翼状胬肉形态临床分级为萎缩型、中间型或肥厚型。使用似然比检验评估危险因素。采用威布尔曲线估计复发率，考虑到区间删失情况。
在原发性翼状胬肉组（平均随访15.1个月），62例单纯巩膜切除术病例（以下简称单纯巩膜组）中有38例（61%）翼状胬肉复发，而61例结膜自体移植术病例（以下简称结膜移植组）中有1例（2%）复发（P<0.001，似然比χ²检验）。在单纯巩膜组中，翼状胬肉的不透明度或肥厚程度而非年龄是复发的显著危险因素（P<0.001，似然比χ²检验）。在复发性翼状胬肉组（平均随访13.2个月），17例单纯巩膜组中有14例（82%）翼状胬肉复发，而结膜移植组的17例中无复发。不透明度再次成为复发的高度显著因素（P<0.001，似然比χ²检验）。
翼状胬肉复发与翼状胬肉形态有关，若行单纯巩膜切除术，翼状胬肉的肥厚程度是复发的显著危险因素。与单纯巩膜切除术相比，结膜自体移植术治疗原发性和复发性翼状胬肉可有效降低翼状胬肉复发率。
