再発翼状片に対する初回手術の影響

Influence of initial surgery on recurrence of pterygium

要約　目的：再発翼状片の初回手術による影響の検討。対象と方法：再発翼状片28例29眼（21眼は再手術施行）を対象とし，初回術式と再発部位，再発までの日数，ステロイド点眼の種類と期間を検討した。再手術症例では術式，直筋を巻き込む血管線維性組織による高度癒着の有無，ステロイド点眼の種類と期間・ステロイド内服，再再発につき検討した。結果：再発はすべて結膜弁辺縁から開始しており，再発まで平均3.7か月，初回術後デキサメタゾンないしベタメタゾン点眼期間は平均1.8か月であった。再手術21眼中17眼に直筋を巻き込む血管線維性組織による高度癒着があった。結論：翼状片初回手術は直筋周囲への侵襲の回避，術後の十分な消炎，結膜弁辺縁に注意した経過観察が再発予防に重要である。

Abstract.　Purpose：To report the influence of initial surgery on recurrence of pterygium. Cases and Method：This study was made on 29 eyes of 28 cases who were referred to us for recurrence of pterygium. A second surgery was performed by us on 21 eyes. We reviewed the method of initial surgery,site of recurrence,duration between initial surgery and recurrence,and type of medication. Results：Pterygium recurred at the edge of conjunctival flap in all the cases. Duration between initial surgery and recurrence averaged 3.7 months. Corticosteroid eye drops were used for an average of 1.8 months after initial surgery. There was firm fibrovascular adhesion in the subconjunctival space involving the rectus muscle in 17 out of 21 eyes. Conclusion：In order to prevent recurrence of pterygium,it is imperative to avoid injury to the rectus muscle,suppression of inflammation after surgery,and follow-up with due attention to the edge of conjunctival flap.