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目的探讨翼状胬肉切除加角膜缘重建术后无菌性巩膜融解的原因及处理方法。方法1999年5月至2004年5月采用自体角膜缘干细胞联带球结膜移植重建角膜缘治疗原发性翼状胬肉234例,术中、术后不应用丝裂霉素C、β-放射线等附加的治疗,术后有4例(1.71%)患者术区巩膜出现融解坏死,取坏死组织涂片、进行微生物培养及病理检查,并对4例患者进行血清学检查。采用环孢霉素A眼液滴眼一个月,对结果进行了回顾性的分析。结果4例患者细菌及真菌培养均未见微生物生长,病理检查:4例均未见白细胞浸润。环孢霉素A滴眼每天6次,巩膜缺损区于1个月左右完全愈合。随访12个月至20个月4例术区外观无异常变化。结论手术因素等所致的免疫反应可能是自体角膜缘移植术后无菌性巩膜融解的主要因素;免疫抑制剂环孢霉素A可有效地控制巩膜融解。
Objective To investigate the causes and treatment of aseptic sclera after pterygium excision and limbal reconstruction. Methods From May 1999 to May 2004, 234 cases of primary pterygium were reconstructed by corneal limbal stem cells conjunctival conjunctiva transplantation. Mitomycin C, β-radiation and so on were not applied during and after operation In addition, four patients (1.71%) had postoperative melt and necrosis of the sclera, necrotic tissue smear, microbiological culture and pathological examination, and 4 patients were serologically examined. Cyclosporine A eye drops for a month, the results of a retrospective analysis. Results No bacterial growth and fungal growth were observed in all 4 patients. Pathological examination showed no leukocyte infiltration in all 4 cases. Cyclosporin A eye drops 6 times a day, scleral defect area completely healed in about 1 month. The follow-up of 12 months to 20 months in 4 cases no abnormal changes in appearance. Conclusion The immune response caused by surgical factors may be the main factor of aseptic scleral melt after autologous limbal transplantation. The immunosuppressant cyclosporin A can effectively control the scleral melt.