翼状片の再発防止のための手術法

Surgical approach in pterygium to minimize recurrences

　翼状片切除に，強膜露出を併用した術式による10人の術者の77眼に対する手術の再発率は，0から100％（平均45％）で，1カ月以内に21％，3カ月以内に51％が再発した．この事実から，再発は翼状片組織のとり残しが原因と考えられ，以下の手術手技が勧められる．

（1）翼状片の剥離は結膜下，強膜上ともになるべく鈍的に行う．翼状片の切断は剪刀ではさんだ後，なるべく深部まで切除する．

（2）翼状片の除去は，涙丘方向のみではなく，上方に広がる結膜下肥厚組織をも十分に切除する．このため，術者は患者の側方から手術をする．

（3）強膜露出法に輪部焼灼や輪部溝作成を併用する．

（4）再発翼状片などで，露出部強膜端の結膜を十分に薄く剥離できない場合には，露出部強膜上に結膜移植や，側方の輪部結膜の移動移植術などを併用する．

We evaluated the incidence of recurrence after pterygium surgery in 77 eyes in our institution over a 5-year period. Surgery was performed by one of the 10 surgeons. Excision of pterygium and baring the sclera was performed as the basic technique.

The surgical result varied widely among the sur-geons, ranging from 100 to 0%. At an overall eva-luation, pterygium recurred in 21% of the operated eyes within one month and in 51% within 3 months.

Analysis of our cases indicated that the early recurrence was mainly due to the unexcised ptery-gium tissue at the end of surgery. In order tominimize recurrences, it is advocated that the ptery-gium be separated, as a whole, from the conjunctiva and the sclera without cutting and that it be excised completely, together with the adjacent tissues ante-rior and posterior to the lesion.