OBJECTIVE: To observe the clinical efficacy of pterygium excision combined with autologous corneal limbal stem cell transplantation in the treatment of pterygium. METHODS: Seventy-two cases (72 eyes) of pterygium were treated with pterygium excision combined with autologous corneal limbal stem cell transplantation under the surgical microscope, and the postoperative follow-up ranged from 6 to 12 months to observe the survival of implants and recurrence of pterygium. Results: All the implants survived in situ after surgery, 70 cases (70 eyes) were cured, with a cure rate of 97.2%, and 2 cases (2 eyes) were recurred, with a recurrence rate of 2.8%. Conclusion: Pterygium excision combined with autologous corneal limbal stem cell transplantation is easy to obtain, simple and easy to perform, and can significantly reduce the recurrence rate of pterygium after surgery, which is a good and effective method to treat pterygium. Pterygium is a common disease in ophthalmology, and the main treatment method is surgery, but the recurrence rate is high after simple excision, 20%-30% in China [1], especially after recurrent pterygium, and multiple operations can lead to lid adhesions. In recent years, stem cell transplantation has provided a new perspective for the treatment of pterygium as the research on corneal margin stem cells continues to advance. In our hospital, 72 cases (72 eyes) of pterygium were treated with pterygium excision combined with autologous corneal limbal stem cell transplantation from August 2011 to August 2012, and the results were satisfactory after follow-up observation. 1, Object and method 1, 1 general data 72 cases (72 eyes) of pterygium in this group, all patients with pterygium on the nasal side, including 37 cases (37 eyes) of men and 35 cases (35 eyes) of women; age 44-72 years old, average 57 years old; 68 cases (68 eyes) of primary cases, 4 cases (4 eyes) of recurrent cases; all cases of pterygium invaded more than 2 mm inside the corneal margin, no other All of them invaded more than 2 mm inside the corneal edge and had no other ocular diseases. 1, 2 Surgical method (1) Preoperative preparation: 0, 3% tobramycin eye drops were started 3 days before surgery, 4 times/day, and the conjunctival sac was flushed before surgery. (2) Excision of pterygium: All patients in this group were operated under the surgical microscope. 0,4% oxybocaine hydrochloride was ordered locally for surface anesthesia and then the ophthalmology was routinely disinfected and the lid was opened with a lid opener. 2% lidocaine was used for subconjunctival infiltration anesthesia on the surface of the pterygium at about 0,5 ml. A superficial corneal incision was made from about 0,5 mm outside the edge of the pterygium head to reach the anterior elastic layer. The head of the pterygium is grasped, and the pterygium is carefully separated from the corneal tissue to the corneal edge, and the bulbar conjunctiva is cut along the corneal edge to bluntly separate the pterygium tissue from the sclera, and the pterygium and degenerative tissue are completely removed in front of the lacrimal caruncle (avoid damaging the internal rectus muscle when removing the pterygium). (3) Corneal margin stem cell transplantation: A small amount of 2% lidocaine solution is injected under local anesthesia under the bulbar conjunctiva above the same eye, and a bulbar conjunctival graft without subconjunctival tissue of the same size as the pterygium defect area is cut, with the anterior border reaching approximately 0.5mm inside the corneal margin. the patient is asked to gaze to the temporal side, and the conjunctival graft is moved to the scleral trauma, with the corneal margin side anastomosing with the corneal margin side, and the graft is sutured to the bulbar conjunctiva with 10-0 nylon thread. The conjunctiva was fixed to the superficial sclera with interrupted sutures of 10-0 nylon thread. (4) Postoperative treatment: apply erythromycin eye ointment in the conjunctival capsule after surgery, apply pressure bandage to one eye, change the medication on the 2nd postoperative day, open spot eyes, alternate local drops of 0, 3% tobramycin eye drops and recombinant human epidermal growth factor derivative eye drops 4 times a day, and change to 0, 3% tobramycin dexamethasone eye drops 4 times a day after corneal epithelial repair, decreasing 1 time every 5 days for 20 days, remove 1 week after surgery Conjunctival suture was removed 1 week after surgery. (5) Postoperative observation: The corneal and conjunctival implants were observed under the slit lamp microscope 3 days after surgery, followed up once a week afterwards, and changed to once a month after 4 times, for a total of 12 months, to observe whether there was any recurrence of pterygium. 2.Results Efficacy criteria: Cure: corneal wound healing, smooth and transparent or only residual corneal opacity, graft viability, no congestion and hyperplasia of conjunctiva. Recurrence: corneal trauma with neovascularization and fibrous hyperplasia growing into the corneal edge more than 1,0mm, and long-term congestion and hypertrophy of the transplanted conjunctival flap. In this group, the implant and new epithelium were edematous within 1 week, and the patient had foreign body sensation, photophobia and tearing. The corneal trauma was repaired 1 week after surgery, the edema of the implants subsided, healing was good, and the symptoms of corneal irritation disappeared. After 6-12 months of postoperative follow-up, 70 cases (70 eyes) were cured and 2 cases (2 eyes) were recurred, with a recurrence rate of 2,8%. 3, Discussion Pterygium is a common and frequent disease in ophthalmology, which is an ocular surface disease characterized by abnormal proliferation of subconjunctival fibrovascularity. Recent studies have shown that the occurrence of pterygium is related to the destruction of stem cells at the corneal margin caused by various factors such as long-term chronic inflammatory stimulation, physical and chemical factors and immune factors [2]. This leads to the destruction of stem cell barrier function, causing the proliferation of subconjunctival fibrous tissue into the cornea, and the damaged stem cells may also release vascular growth factors, accelerating the formation of pterygium. Surgical excision is currently the most common method of treating pterygium. There are various traditional surgical procedures, including pterygium excision alone, pterygium head transfer, pterygium excision combined with amniotic membrane transplantation, etc., but the recurrence rate is high after surgery. The main causes of pterygium recurrence are: (1) Residual corneal surface and subconjunctival tissue, and neovascularization of the scleral surface into the corneal trabeculae are the root causes of pterygium recurrence [3]. (2) Because of their cell renewal and tissue regeneration capacity, stem cells at the corneal margin are not only a source of corneal epithelial regeneration but also a fence and barrier between the conjunctiva and cornea, and the occurrence and recurrence of pterygium is associated with the dysfunction or lack of stem cells in the presence of corneal epithelium [4]. Therefore, complete excision of pterygium tissue combined with autologous corneal limbal stem cell transplantation can significantly reduce the recurrence rate of pterygium. Corneal limbal stem cells are specialized cells located in the basal epithelial layer of the corneal limbus and have a direct role in the regeneration of the corneal epithelium, as well as a role in preventing the growth of conjunctival epithelium, and blood vessels into the cornea. Under normal conditions, the proliferation pressure of the corneal margin inhibits the growth of conjunctival epithelial cells and blood vessels into the cornea. When a lack of corneal margin stem cells is formed locally after conventional pterygium excision, autologous corneal margin stem cell transplantation can provide normal stem cells to the corneal margin of the lesion area, so that the corneal margin at the pterygium excision site can be reconstructed, and the cornea can be restored to normal through stem cell proliferation, differentiation and cell migration to pave the corneal trauma. It also restores the physiological function of the corneal margin, inhibits local tissue proliferation, and effectively prevents the invasion of conjunctival epithelium and neovascularization, thus preventing the recurrence of pterygium. Autologous corneal margin stem cell transplantation plays an important role in reconstructing ocular surface function, restoring ocular surface structure, preventing recurrence and protecting the integrity of corneal epithelium [5]. Pterygium excision combined with autologous limbal stem cell transplantation has the advantages of rapid corneal wound healing, mild postoperative inflammatory reaction, good donor conjunctival and limbal tissue repair, and effective reduction of postoperative recurrence rate of pterygium, etc. Moreover, autologous limbal stem cells are easy to obtain, simple to perform, no rejection reaction, easy to survive, no serious surgical complications, easy to operate, and easy to promote. It is a good and effective way to treat pterygium.