| Surgical treatment is still the main method for pterygium therapy.There are some methods which are accepted by most doctors: 1.simple excision of pterygium ,which is simple and easy for operating and was the main surgery of pterygium before.however, a high rate of recurrence can be as high as 30% -50%,so most of the operators haven,t taken it any more.2. Pterygium excision combined with Mc transplantation, which is a classic treatment of pterygium surgery.the recurrence rate of it is lower compared with simple Pterygium excision ,so it is widely used by Ophthalmology colleagues. 3. Pterygium excision combined with limbal autograft transplantation(LAT), which is a new type of surgery in recent years.The effect of this surgery is so affirmed,and the recurrence rate and complictions of it are lower and fewer than simple pterygium excision and Mc transplantation. As well as LAT is not very difficult surgical operation, it is becoming more acceptable for ophthalmologists. 4. Pterygium excision combined with lamellar keratoplasty, Which is applied to the relatively large size of many of the pterygium or recurrent pterygium,it is still a considered treatment method to use though it can be with a low recurrence rate and the result of it would be better .because the corneal material is scarcity,and high cost and the surgery is relative difficult.This paper retrospectively analyzed 158 cases of 164 patients admitted to the hospital because of pterygium from January 1994 to January 2006 .The eyes were divided into four groups according to the four different methods used for treating pterygium.We summed up the methods which can be with lower recurrence rate and promote visual acuities .Results : 1. Therecurrence rate in each group : the recurrence rate was 40% in group simple excision of pterygium,the recurrence rate was 11.83% in group Pterygium excision combined with Mc transplantation, the recurrence rate was 3.45% in group limbal stem cell transplantation, and the recurrence rate was 5.88% in group lamellar keratoplasty . The recurrence rate of the first group was significantly higher than the other three groups, and the difference was significant compared with the other three groups with statistical analysis. However there was no significant difference between the other three groups. we can conclude From this: Pterygium excision combined with Mc transplantation , Pterygium excision combined with limbal autograft transplantation(LAT),and Pterygium excision combined with lamellar keratoplasty are the better methods to reduce the recurrence rate of pterygium surgery. 2. The patients were divided into three degrees According to pterygium morphology and growth area.we found that the recurrence rate of these were3.33%,20%,33.33% from low to high Comparing with the postoperative recurrence rate. The recurrence rate of one-degree was significantly lower than two-degree and three-degree, and the difference was significant Through statistical analysis.we conclude that the sooner the pterygium is treated. the better the recover it is, and it should be treated in the early stage. 3. Comparing visual acuity of eyes of different periods after pterygium surgery ,we found that 96.7% of patients of one-degree with postoperative visual acuity of 0.8 or above, the results of which were satisfactory. And postoperative visual acuity of most of two-degree and three-degree eyes was as less than 0.6,and the percent of them were 91.3% and 98.1.So we get the conclution that Pterygium should be treated early. 4. Thecorneal Epithelial healing time of each group was: The mean time for the Group I was 8.50±1.20d,the mean time for the Group II was 7.73±0.77d,The mean time for the group III was 4.45±1.02d, and the mean time for the Group IV was 5.65±0.01d. the corneal Epithelial healing time of Group III was faster than the other three groups by statistical analysis (F=25.237, p <0.05).we can conclude that limbal autograft transplantation(LAT) is the best way for the growth of postoperative corneal epithelial cell. There are following understandings based on the clinical results of the pterygium surgery: 1.In order to reduce the recurrence rate of pterygium ,the Surgery should be done under the microscope for thoroughly eliminating of the pterygium corneoscleral.2. Because of the unique biological characteristics of limbal stem cells and lamellar corneal, it is better to use them for surgical treatment of pterygium and it should be extensivlly applicatied and still improvemented . However, the following attentions should be paid to the operation: (1) The hemostasis intraoperative should be in extenso and the blood under the plot should be removed thoroughly in order to facilitate the graft to stick better ,Providing a source of the growth of corneal epithelium postoperative and Promoting the recovery of epithelial. (2) The suture of the graft should be firm to avoid the Pleat and olisthesis of the graft. (3) The limbal should not be cut too deeply to avoid false pterygium and delayed healing .The Surgical operation should be careful in order not to harm rectus and cause scleral perforation. 3. Pterygium should be early treated . the pterygium of the second and third degree are Obviously congestive hypertrophy and deeply violat cornea,so the scope of the operation was larger ,and the bleeding was more , they were adverse for complete resection of the pterygium, and increased therecurrence rate. Moreover, the deep third degree pterygium has become a permanent corneal opacity, and made cornea not to be transparent, leading to the poor visual acuity postoperative. However, the first degree-and second-degree pterygium had advantage to the above, they had less violation of the cornea and made the surgery of pterygium easier after the use of drugs quiescent. We suggest that the surgery of pterygium should be taken earlier when they are in the firsr and second degree to reduce the damage to the cornea; and the surgery of pterygium should be taken in the quiescent stage to facilitate the surgical operation and reduce recurrence rate . |
PDF Full Text Request