自体血治疗翼状胬肉术后巩膜溶解的临床疗效

The Clinical Efficacy of Autologous Blood in Treating Scleral Lysis after Pterygium Surgery

摘要: 目的：探讨翼状胬肉术后发生巩膜溶解的原因；评价自体血治疗翼状胬肉术后巩膜溶解的安全性及有效性。方法：对就诊张家口爱尔眼科门诊通过自体全血治疗的翼状胬肉术后发生巩膜溶解的患者7例(7眼)进行随访观察。结果：术后复查时，发现术眼结膜植片下方的巩膜缺血苍白、变薄，甚至部分患者病变部位露出棕色色素组织，通过间断多次在病变部位周边结膜下注入静脉自体全血1 ml，所有患者巩膜溶解得到控制，溶解部位的巩膜纤维逐渐修复，周围结膜逐渐向溶解巩膜区爬行，未出现其它任何并发症，且随访过程中未出现复发的情况以及不良反应。结论：翼状胬肉术后发生巩膜溶解因素众多，其中包括巩膜暴露过多、术中过度止血、术后长时间使用糖皮质激素眼药水等，自体全血注射可能为翼状胬肉术后巩膜溶解的治疗提供一种新的选择，但其确切疗效和安全性有待更大规模的对照研究证实。

Abstract: Objective: To explore the causes of scleral lysis after pterygium surgery; to evaluate the safety and efficacy of autologous blood in the treatment of scleral lysis after pterygium surgery. Method: A follow-up observation was conducted on 7 patients (7 eyes) who developed scleral lysis after pterygium surgery treated with autologous whole blood at Zhangjiakou Aier Eye Hospital. Result: During postoperative follow-up, it was found that the sclera beneath the conjunctival graft of the operative eye was ischemic, pale and thin. In some patients, brown pigmented tissue was even exposed at the lesion site. By intermittently injecting 1 ml of autologous venous whole blood under the conjunctiva around the lesion site multiple times, the scleral lysis of all patients was controlled. The scleral fibers at the dissolved site gradually repaired, and the surrounding conjunctiva gradually crept towards the dissolved scleral area. No other complications occurred, and no recurrence or adverse reactions were observed during the follow-up process. Conclusion: There are numerous factors causing scleral lysis after pterygium surgery, including excessive scleral exposure, excessive hemostasis during the operation, and long-term use of glucocorticoid eye drops after the operation. Autologous whole blood injection may offer a new option for the treatment of scleral lysis after pterygium surgery, but its exact efficacy and safety need to be confirmed by larger-scale controlled studies.