翼状胬肉切除术后角膜溃疡46例临床分析

doi:10.3760/cma.j.cn115909-20210418-00158

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Abstract Objective: To analyze the clinical features of corneal ulcer after pterygium surgery, and to explore therapeutic regimens. Methods: A retrospective analysis was conducted on 46 cases (46 eyes) that were diagnosed with corneal ulcer secondary to pterygium surgery in Shandong Eye Hospital from January 2004 to December 2020. Detailed records of the patient's preoperative systemic and local medical history, type of operation and postoperative complications management, and an assessment of the clinical characteristics of the corneal ulcer were analyzed. Different treatments were chosen based on the size of the corneal ulcer, depth of infiltration, limbal stem cell damage, symblepharon, etc. The prognosis of the above treatment regimens was explored. Data were analyzed by a Wilcoxon test and Chi-square test. Results: Retrospectively, 26 cases underwent the traditional pterygium excision, while 17 cases underwent pterygium excision combined with autoallergic limbus corneal stem cell transplants. Only 1 case underwent traditional the pterygium excision combined with mitomycin C. The pathogen results show that 26 cases (57%) had negative results. Twenty cases (43%) had infectious corneal ulcer and most ulcers were located at the attachment of the pterygium. Thirty-two cases involved the corneal and scleral limbus and 10 cases were complicated by severe scleral ischemia. Three patients were cured by systemic therapy, 36 patients underwent keratoplasty and 7 patients underwent other methods including amnion transplants, keratectomy, and conjunctival flap covering. Twenty patients with uninfected corneal ulcer underwent autoallergic limbus corneal stem cell transplantation and 11 cases of infected corneal ulcer were covered with conjunctiva. Best corrected visual acuity after ulcer healing was significantly higher than before (Z=-5.091, P<0.001). Conclusions: Corneal ulcer secondary to pterygium excision usually occurs at the attachment of the pterygium. It can be accompanied by symblepharon and scleral ischemia. Thoroughly clearing local lesions, ensuring corneal integrity and restoring limbal stem cell function are seen as the most effective treatments for corneal ulcer after pterygium excision.

Key words： pterygium corneal ulcer scleral ischemia stem cell transplantation keratoplasty

Received: 18 April 2021

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Corresponding Authors: Suxia Li, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan 250021, China; State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250021, China (Email: lsuxiasusu@163.com)

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https://www.cjoovs.com/EN/10.3760/cma.j.cn115909-20210418-00158 OR https://www.cjoovs.com/EN/Y2021/V23/I8/589

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