翼状胬肉的治疗:我们的经验和简化治疗算法。

Shreesha Kumar Kodavoor, Ashalyne James Joseph, Shreyas Ramamurthy, Ramamurthy Dandapani
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引用次数: 0

摘要

目的:探讨翼状胬肉的各种治疗方法,并提出手术治疗的简化治疗算法。方法:对 9219 只眼睛进行回顾性分析:对 9219 只眼睛进行回顾性分析。第一组包括原发性单头翼状胬肉患者,大部分患者接受了结膜自体移植(CAG)翼状胬肉切除术。CTG-P (翼状胬肉结膜组织移植)、AMG(羊膜移植)和下部 CAG 则用于该组中常规结膜自体移植为相对禁忌症的其余患者。第二组包括原发性双头翼状胬肉患者,他们接受了垂直/水平分割 CAG、带/不带角膜缘定向、下部 + 上部 CAG、CTG-P 和 CAG + CTG-P。第三组包括复发性单头翼状胬肉患者,他们接受了 ER(扩大切除)+ LCAG(结膜自体移植)、LCAG + MMC(丝裂霉素-C)、CAG + MMC(丝裂霉素-C)和 CAG。第四组包括复发性双头翼状胬肉患者,他们接受了LCAG和CAG+SLET分割手术。结果:四组患者翼状胬肉复发率均较低。第一组、第二组、第三组和第四组的复发率分别为 0.47%、3.63%、2.86% 和 7.69%。讨论我们的主要目标是获得最小的复发率和良好的美容效果。对于双头翼状胬肉,我们采用水平或垂直劈开式 CAG,无论是否保持角膜缘方向,都能取得良好的可比效果。同样,下+上CAG、CTG-P、CAG+CTG-P和AMG的复发率也很低。在复发性翼状胬肉中,ER + LCAG/CAG,加/不加 MMC 等辅助手段的复发率也很低。因此,所有这些方法都是可行的选择。与之前的翼状胬肉研究相比,我们这项研究的主要优势在于样本量大、随访时间长。结论:我们研究的所有方法复发率都很低。我们根据研究结果制定了翼状胬肉治疗算法。缩写:CAG = 结膜自体移植;CTG-P = 翼状胬肉结膜组织移植;ER = 扩大切除;MMC = 丝裂霉素-C。
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Management of pterygium: our experience and a simplified treatment algorithm.

Aim: To explore various approaches in the management of pterygium and to propose a simplified treatment algorithm for its surgical management. Methods: A retrospective analysis of 9219 eyes was done. Group I included patients with primary single-head pterygium, most undergoing pterygium excision with conjunctival autograft (CAG). CTG-P (Conjunctival tissue graft from pterygium), AMG (Amniotic membrane graft), and inferior CAG were done in the remaining patients in this group in which conventional conjunctival autograft was a relative contraindication. Group II included patients with primary double-head pterygium who underwent vertical/horizontal split CAG, with/without limbal orientation, Inferior + Superior CAG, CTG-P, and CAG + CTG-P. Group III included patients with recurrent single-head pterygium who underwent ER (Extended resection) + LCAG (Limbal conjunctival autograft), LCAG + MMC (Mitomycin-C), CAG + MMC (Mitomycin-C) and CAG. Group IV included patients with recurrent double-head pterygium who underwent split LCAG and CAG + SLET. Results: All the four groups reported a low incidence of pterygium recurrence. Recurrence was observed at a rate of 0.47%, 3.63%, 2.86%, and 7.69% in Group I, Group II, Group III and Group IV respectively. Discussion: We mainly aimed to get minimal recurrence and good cosmetic outcomes. In double-head pterygium, we could achieve good and comparable outcomes with horizontal or vertical split CAG, with or without maintaining limbal orientation. Similarly, Inferior + Superior CAG, CTG-P, CAG+CTG-P, and AMG also showed low recurrence rates. In recurrent pterygium, ER + LCAG/CAG, with/without adjuncts like MMC showed low recurrence rates. Thus, all of these methods were found to be viable options. The main strength of our study, compared to previous studies on pterygium was its large sample size and long duration of follow-up. Conclusion: All the methods we studied had a low recurrence rate. We have formulated a treatment algorithm for pterygium management based on our outcomes. Abbreviations: CAG = Conjunctival autograft, CTG-P = Conjunctival tissue graft from pterygium, ER = Extended resection, MMC = Mitomycin-C.

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