Options and Adjuvants in Surgery for Pterygium A Report by the American Academy of Ophthalmology
Options and Adjuvants in Surgery for Pterygium A Report by the American Academy of Ophthalmology
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DOI：
10.1016/j.ophtha.2012.06.066
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发表时间：
2013-01-01
期刊：
影响因子：
13.7
通讯作者：
Shtein, Roni M.
中科院分区：
文献类型：
--
作者：
Kaufman, Stephen C.;Jacobs, Deborah S.;Shtein, Roni M.
目的：评估目前的手术选择和辅助治疗原发性和复发性翼状胬肉的结果和安全性。方法：PubMed和科克伦图书馆数据库的文献检索最后一次进行于2011年1月，使用关键词，并仅限于随机对照试验报告翼状胬肉手术干预。检索仅限于以英文发表的文章，并产生了120篇引文。对引文摘要和全文（如有必要）进行审查，以确定报告复发作为结局指标且平均随访至少6个月的随机对照试验。五十一项研究比较裸露的巩膜切除术，结膜或角膜缘自体移植，术中丝裂霉素C，术后丝裂霉素C，羊膜移植原发性和复发性翼状胬肉符合这些入选标准。结果：四项研究表明，结膜或角膜缘自体移植手术比羊膜放置更有效。在大多数原发性或复发性翼状胬肉的研究中，与单纯巩膜切除术相比，翼状胬肉切除术期间或之后使用结膜或角膜缘自体移植物或丝裂霉素C可减少复发。在少数直接比较两种技术的研究中，自体结膜或角膜缘移植术的结局与术中丝裂霉素C的结局相似。有证据表明，增加术中丝裂霉素C的浓度和暴露时间与疗效增加相关。在研究的佐剂中，只有丝裂霉素C与威胁视力的并发症相关，包括巩膜变薄、溃疡和结膜上皮形成延迟;有证据表明，随着暴露浓度和持续时间的增加，并发症也会增加。有相互矛盾的证据是否增加年龄是防止复发，但翼状胬肉的形态学特征被证明会影响复发率.Conclusions：证据表明，裸巩膜切除翼状胬肉的结果在一个显着较高的复发率比切除伴随使用某些佐剂。自体结膜或角膜缘移植术在降低翼状胬肉复发率方面上级羊膜移植术。在其他辅助治疗中，有证据表明丝裂霉素C和结膜或角膜缘自体移植物可降低翼状胬肉手术切除后的复发率。此外，数据表明，与单独使用结膜或角膜缘自体移植物或丝裂霉素C相比，使用结膜或角膜缘自体移植物与丝裂霉素C的组合进一步降低了翼状胬肉切除术后的复发率。需要进一步研究以确定丝裂霉素C的长期效应、最佳给药途径、剂量和治疗持续时间。由于没有足够的数据来推荐一种特定的上级辅助剂，因此诸如资源的可获得性、翼状胬肉的原发或复发状态、患者的年龄以及外科医生或患者的偏好等因素可能会影响外科医生对辅助剂的选择。Ophthalmology 2013; 120：201-208（C）2013，美国眼科学会。
Objective: To assess the outcomes and safety of current surgical options and adjuvants in the treatment of primary and recurrent pterygium.Methods: Literature searches of the PubMed and the Cochrane Library databases were last conducted in January 2011 using keywords and were restricted to randomized controlled trials reporting on surgical intervention for pterygium. The searches were limited to articles published in English and yielded 120 citations. Citation abstracts, and if necessary the full text, were reviewed to identify randomized controlled trials that reported recurrence as an outcome measure and had a mean follow-up of at least 6 months. Fifty-one studies comparing bare sclera excision, conjunctival or limbal autograft, intraoperative mitomycin C, postoperative mitomycin C, and amniotic membrane transplantation for primary and recurrent pterygia fit these inclusion criteria.Results: Four studies demonstrated that the conjunctival or limbal autograft procedure is more efficacious than amniotic membrane placement. Use of conjunctival or limbal autografts or mitomycin C during or after pterygium excision reduced recurrence compared with bare sclera excision alone in most studies of primary or recurrent pterygium. The outcomes of conjunctival or limbal autograft were similar to outcomes for intraoperative mitomycin C in the few studies that directly compared the 2 techniques. There is evidence that increased concentration and duration of exposure to intraoperative mitomycin C is associated with increased efficacy. Of the adjuvants studied, only mitomycin C was associated with vision-threatening complications, including scleral thinning, ulceration, and delayed conjunctival epithelialization; there is some evidence of increasing complications with increased concentration and duration of exposure. There is conflicting evidence as to whether increasing age is protective against recurrence, but the morphologic features of the pterygium were shown to affect the recurrence rate.Conclusions: Evidence indicates that bare sclera excision of pterygium results in a significantly higher recurrence rate than excision accompanied by use of certain adjuvants. Conjunctival or limbal autograft was superior to amniotic membrane graft surgery in reducing the rate of pterygium recurrence. Among other adjuvants, there is evidence that mitomycin C and conjunctival or limbal autografts reduce the recurrence rate after surgical excision of a pterygium. Furthermore, the data indicate that using a combination of conjunctival or limbal autograft with mitomycin C further reduces the recurrence rate after pterygium excision compared with conjunctival or limbal autograft or mitomycin C alone. Additional studies are necessary to determine the long-term effects, optimal route of administration, and dose and duration of treatment for mitomycin C. Factors such as availability of resources, primary or recurrent status of pterygium, age of patient, and surgeon or patient preference may influence the surgeon's choice of adjuvant because there are insufficient data to recommend a specific adjuvant as superior.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. Ophthalmology 2013; 120:201-208 (C) 2013 by the American Academy of Ophthalmology.