翼状胬肉不同术式后巩膜溶解的观察分析

Observation and analysis of posterior scleral dissolution in different operation of pterygium

:20-22
 
目的:比较翼状胬肉两种不同手术方式后巩膜溶解的发生概率,探讨产生巩膜溶解的原因,选择合理手术方式。方法:对本院两年来263例翼状胬肉采用两种不同的手术方式,观察术后发生巩膜溶解的情况,并通过局部药物进行治疗。结果:263例翼状胬肉患者,130例采用胬肉切除+结膜瓣转位术,裸露角膜缘3 mm巩膜,术后局部滴0.02%丝裂霉素C(mitomycin C, MMC),胬肉复发26 例,发生巩膜溶解6例;133例采用胬肉切除+角膜缘干细胞移植术,术后滴0.02% MMC,胬肉复发5例,无1例发生巩膜溶解。结论:翼状胬肉术后发生巩膜溶解,是一种严重的手术并发症,可能与术中过度烧灼巩膜面,巩膜板层暴露于MMC有关。采用胬肉切除+角膜缘干细胞移植术,植片覆盖裸露巩膜,促进巩膜表层愈合,术后避免MMC直接浸润巩膜板层故未见此并发症发生。与传统手术方式相比,复发率低,并发症少,是一种安全、有效的翼状胬肉手术方式。
Objective: To compare the occurrence probability of posterior scleral dissolution in two different surgical methods, and to explore the reasons for the dissolution of the scleral. Methods: Using two different surgical methods on 263 cases of pterygium submitted in our hospital in 2 years, observed the occurrence of scleral at postoperative, and treated with topical drugs. Results: Two hundred and sixty three cases of patients with pterygium, 130 cases of pterygium resection and conjunctival flap transposition, bare 3 mm limbus sclera, postoperative topical mitomycin C (MMC). The recurrence of pterygium in 26 cases, scleral melting in 6 cases; 133 cases of pterygium excision and limbal stem cell transplantation, MMC (0.02% MMC drip after operation, 5 cases of recurrent pterygium, no scleral melting occurred in 1 case. Conclusion: The scleral dissolution occurred after pterygium surgery is a serious complication, which may be related to the excessive burning of the scleral surface, and the lamellar exposure to MMC. Excision of pterygium and corneal limbal stem cell transplantation  were used to cover the exposed scleral, promote the surface healing of the wound, and avoid the MMC direct infiltration of the lamina. Compared with the traditional operation mode, the recurrence rate is low, and the complication is little. It is a safe and effective surgical method. 
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  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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