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Meena A, Agrawal A, Parmar G, Gurnani B. Subconjunctival dexamethasone-assisted conjunctival autograft harvesting versus normal saline during pterygium surgery - A randomized clinical trial. Indian J Ophthalmol 2024; 72:217-222. [PMID: 38099381 PMCID: PMC10941926 DOI: 10.4103/ijo.ijo_969_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE To evaluate the effect of subconjunctival dexamethasone compared to normal saline on conjunctival autograft harvesting in patients undergoing pterygium surgery. METHODS Fifty-two eyes of 52 patients who underwent pterygium excision combined with autologous conjunctival graft (CAG) using releasable suture were included in this prospective interventional study. The patients were randomized into two groups of 26 patients each. Group A consisted of patients in whom CAG was harvested using subconjunctival 0.5 ml of 0.4% dexamethasone sodium phosphate and in group B patients, normal saline was used. The patients were assessed for postoperative pain, foreign body sensation, and watering as the subjective signs of inflammation and conjunctival inflammation and lid edema as the objective signs of inflammation at 12 and 24 h postsurgery. RESULTS The mean age of group A and B patients was 47.69 + 13.09 and 46.00 + 10.76 years, respectively. The male:female ratio was 1.6:1 in group A and 1.1:1 in group B. The mean surgical time in group A was 243.96 ± 52.13 s and in group B was 258.08 ± 43.99 s. Postoperative pain, foreign body sensation, and watering were significantly lower in group A patients than in group B patients at both 12 and 24 h postoperatively (group A: 4.65 ± 1.33, 4.88 ± 1.73, and 3.85 ± 1.43, respectively, at 12 h; 1.89 ± 1.03, 1.69 ± 1.09, and 1.69 ± 0.97, respectively, at 24 h and group B: 6.42 ± 0.95, 6.65 ± 0.98, and 6.27 ± 1.40, respectively, at 12 h; 3.27 ± 1.43, 3.12 ± 1.25, 2.58 ± 1.14, respectively, at 24 h) ( P < 0.001). Conjunctival inflammation was significantly lower in group A at 12 h ( P < 0.05) and 24 h ( P < 0.05) after surgery compared to group B. Lid edema failed to show any significant ( P = 0.17) difference with respect to severity in both the groups at 12 and 24 h ( P = 0.699). CONCLUSION Subconjunctival dexamethasone decreased patient discomfort following pterygium surgery. The dexamethasone group had reduced conjunctival inflammatory signs without any notable complications.
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Affiliation(s)
- Ashok Meena
- Department of Cornea and Refractive Services, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Ashish Agrawal
- Department of Cornea and Refractive Services, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Gautam Parmar
- Department of Cornea and Refractive Services, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Bharat Gurnani
- Department of Cornea and Refractive Services, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Chitrakoot, Madhya Pradesh, India
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Huang JJ, Locatelli EVT, Chocron A, Camacho MR, Dubovy S, Karp CL, Galor A. Conjunctival Nevus. CURRENT OPHTHALMOLOGY REPORTS 2023; 11:104-112. [PMID: 38390435 PMCID: PMC10883671 DOI: 10.1007/s40135-023-00315-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 02/24/2024]
Abstract
Purpose of Review To provide an up-to-date review of the epidemiology, presentation, diagnosis, and treatment options for conjunctival nevi (CN). Recent Findings Around 17.2%-42% of all conjunctival tumors have been found to be CN, which most frequently present in White individuals between the first to early third decade of life, with equal distribution between males and females. CN commonly occur in the interpalpebral bulbar conjunctiva with pigmentation ranging from amelanotic to dark. Diagnosis is typically made through slit lamp examination, visualized by a well circumscribed, variably elevated, variably pigmented, solitary lesion with clear cysts distributed throughout the pigment. In ambiguous cases, anterior segment optical coherence tomography (AS-OCT) can highlight the presence of sub-clinical cysts, whose presence points to a diagnosis of nevus. However, excisional biopsy with histopathology examination is the gold standard for identifying CN. Summary CN are benign, variably pigmented lesions. They are the most common of the conjunctival melanocytic tumors. Due to the extremely low risk of transformation to malignant melanoma (MM), CN are usually managed with routine observation and photo documentation.
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Affiliation(s)
- Jaxon J Huang
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
- Surgical Services, Miami Veterans Administration Medical Center, Miami, FL, USA
- Research Service, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Elyana V T Locatelli
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
- Surgical Services, Miami Veterans Administration Medical Center, Miami, FL, USA
- Research Service, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Alberto Chocron
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
- Surgical Services, Miami Veterans Administration Medical Center, Miami, FL, USA
- Research Service, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Matthew R Camacho
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
| | - Sander Dubovy
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
| | - Carol L Karp
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
- Surgical Services, Miami Veterans Administration Medical Center, Miami, FL, USA
- Research Service, Miami Veterans Administration Medical Center, Miami, FL, USA
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Geng X, Wang Y, Cui H, Li C, Cheng B, Cui B, Liu R, Zhang J, Zhu L, Li J, Shen J, Li Z. Carboxymethyl chitosan regulates macrophages polarization to inhibit early subconjunctival inflammation in conjunctival injury. Int J Biol Macromol 2023:125159. [PMID: 37268068 DOI: 10.1016/j.ijbiomac.2023.125159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 06/04/2023]
Abstract
Persistent subconjunctival inflammation leads to subconjunctival fibrosis and eventual visual impairment. There is an unmet need for how to effectively inhibit subconjunctival inflammation. Herein, the effect of carboxymethyl chitosan (CMCS) on subconjunctival inflammation was investigated and the mechanism was involved. The evaluation of cytocompatibility demonstrated that CMCS had good biocompatibility. The in vitro results showed that CMCS inhibited secretions of pro-inflammatory cytokines (IL-6, TNF-α, IL-8 and IFN-γ) and chemokines (MCP-1), and downregulated TLR4/MyD88/NF-κB pathway in M1. The in vivo results displayed that CMCS alleviated conjunctival edema and congestion, and improved conjunctival epithelial reconstruction significantly. Both in vitro and in vivo results demonstrated that CMCS inhibited the infiltration of macrophages and reduced the expressions of iNOS, IL-6, IL-8 and TNF-α in the conjunctiva. Given that CMCS indicated the activities of inhibiting M1 polarization, NF-κB pathway, and subconjunctival inflammation, which may be employed as a potent treatment for subconjunctival inflammation.
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Affiliation(s)
- Xingchen Geng
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - Yiwei Wang
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - Haohao Cui
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - Chengcheng Li
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - Boyuan Cheng
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - Bingbing Cui
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - Ruixing Liu
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - Junjie Zhang
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - Lei Zhu
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - Jingguo Li
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China.
| | - Jianliang Shen
- School of Ophthalmology and Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou 325027, China.
| | - Zhanrong Li
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China.
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Desai NR, Adams B. Cryopreserved Amniotic Membrane Using the TissueTuck Technique: A Sutureless Approach for Pterygium Surgery. Cornea 2023; 42:181-185. [PMID: 36130320 PMCID: PMC9797198 DOI: 10.1097/ico.0000000000003111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 06/02/2022] [Accepted: 06/11/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical outcomes of the TissueTuck technique in the management of pterygium. METHODS This was a single-center, retrospective review of patients with primary or recurrent pterygium that underwent surgical excision followed by application of cryopreserved amniotic membrane (AM) using the TissueTuck technique. All patients underwent surgery between January 2012 and May 2019. Patient profile, surgical time, complications, and rates of pterygium recurrence were analyzed. RESULTS A total of 582 eyes of 453 patients (328 female patients; 65.1 ± 13.9 years) were included for analysis and initially presented with primary (92%) pterygium. The average duration of pterygium excision surgery was 14.7 ± 5.2 minutes (median: 14, range: 4-39 minutes) with mitomycin C administration in 257 (45%) eyes. At the last follow-up of 30.2 ± 22.2 months (median: 24.5, range: 3-94 months), BCVA significantly improved from logMAR 0.23 at baseline to logMAR 0.19 ( P < 0.0001). Recurrence rate was 2.3% but only 0.7% (2/274) in those cases with primary, single-headed pterygium without mitomycin C treatment. Other postoperative complications in that cohort included granuloma (7.9%), scarring (3.8%), and diplopia in extreme lateral gaze (2.5%). The AM remained secured to the ocular surface throughout the postoperative period. CONCLUSIONS The TissueTuck surgical technique with cryopreserved AM can be performed in minimal time and result in a low recurrence and complication rate after pterygium surgery.
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Affiliation(s)
| | - Bryan Adams
- The Eye Institute of West Florida, Largo, FL
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5
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Palewski M, Budnik A, Konopińska J. Evaluating the Efficacy and Safety of Different Pterygium Surgeries: A Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11357. [PMID: 36141628 PMCID: PMC9517485 DOI: 10.3390/ijerph191811357] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/23/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
The search for the "gold standard" in the surgical treatment of pterygium has been ongoing for over two decades. Despite the development of various surgical techniques, recurrence rates range from 6.7% to 88% depending on the method used. This review discusses the latest and most commonly used methods for the surgical removal of pterygium, primarily focusing on efficacy and safety. Moreover, this review includes articles that either evaluated or compared surgical methods and clinical trials for primary and recurrent pterygium. Limited data are available on combined methods as well as on the efficacy of adjuvant treatment. The use of adjuvant intraoperative mitomycin C (MMC) and conjunctival autografting (CAU) are the two most highly recommended options, as they have the lowest rates of postoperative recurrence.
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Affiliation(s)
| | | | - Joanna Konopińska
- Department of Ophthalmology, Medical University of Białystok, 15-089 Bialystok, Poland
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Evaluation of the Efficacy of Different Pterygium Surgeries in Polish Caucasian Population. J Ophthalmol 2022; 2022:1641350. [PMID: 35462617 PMCID: PMC9033351 DOI: 10.1155/2022/1641350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/08/2022] [Indexed: 11/18/2022] Open
Abstract
The aim of the study was to compare the efficacy of the two most commonly used surgical methods for pterygium removal in the Polish population, conjunctival autograft versus amniotic membrane transplantation, and to evaluate the postoperative recurrence rate. A retrospective analysis of the medical records was conducted, including 65 patients who underwent surgery for primary or recurrent pterygium at an ophthalmology clinic in Bialystok, Poland, between 2016 and 2020. Surgical success (no regrowth) was achieved in almost half of the amniotic membrane patients (44%) and in most of the conjunctival autograft patients (79%), with statistical significance. The odds of successful surgery were 79% lower for subjects with amniotic membranes than for those with conjunctival autografts (OR with 95% CI = 0.21 (0.05; 0.94);
). Our study confirms that the conjunctival autograft surgeries present more favorable success rates in Polish Caucasian population when compared to procedures involving amniotic membranes.
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Akbari M, Alizadeh Y, Moghadam R, Dourandeesh M, Moravej Z. Comparison of pterygium recurrence with and without using postsurgical topical cyclosporin a 0.05%: A randomized clinical trial. J Curr Ophthalmol 2022; 34:208-215. [PMID: 36147279 PMCID: PMC9486997 DOI: 10.4103/joco.joco_285_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose: To evaluate the efficacy of 3-month administration of topical cyclosporin A (CsA) 0.05% on postoperative recurrence after pterygium surgery. Methods: In this randomized clinical trial, 78 patients undergoing pterygium surgery (using the rotational conjunctival flap technique with mitomycin C [MMC]) were enrolled and randomly allocated into the control (n = 39) and case (CsA) (n = 39) groups in a single-blind method. The patients were examined on postoperative days 1, 3, and 7 and months 1, 3, and 6, and their best-corrected visual acuity, intraocular pressure, clinical inflammation, postoperative complications, and recurrence were compared. Results: The mean age of patients was 53.22 ± 9.99 years; most (57.7%) of them were men. The two groups were not different in terms of demographics, pterygium size, or pterygium grade. The clinical inflammation at the first and third postoperative months was not different between the groups (P = 0.108 and 0.780, respectively). No serious complications were detected; complication rates were not different between the groups (P = 0.99). The recurrence rate was 5.1% in the case group and 7.7%% in the control group (P = 0.99). Conclusion: The present study showed no priority for 3-month administration of CsA 0.05% drops on postoperative outcomes, including prevention of pterygium recurrence, complications, and inflammation after the rotational conjunctival autograft technique with MMC.
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8
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Patel ED, Rhee MK. Surgical Techniques and Adjuvants for the Management of Pterygium. Eye Contact Lens 2022; 48:3-13. [PMID: 34686641 DOI: 10.1097/icl.0000000000000849] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To provide an updated review of surgical techniques and adjuvants for the management of pterygium. METHODS A literature search was conducted in PubMed for studies published since January 2011. "Pterygium surgery" and the MeSH term "Pterygium/surgery" was used. The results were filtered for randomized controlled trials in English, yielding 60 citations. RESULTS One study compared topical anesthetic agents. One study compared methods of corneal polishing of the corneoscleral bed after pterygium excision. Numerous studies evaluated the use of conjunctival autograft versus amniotic membrane, superior versus inferior conjunctival autograft, and conjunctival versus limbal-conjunctival autograft. Many studies evaluated graft fixation methods. Several studies evaluated the adjuvant use of mitomycin C, 5-fluorouracil, and bevacizumab. A few studies evaluated the adjuvant use of steroids. Eleven studies evaluated various methods of postoperative management. CONCLUSIONS Current evidence supports pterygium excision with conjunctival autograft fixation using fibrin glue, followed by patching until the first postoperative visit. Surgical adjuvants and postoperative use of artificial tears and topical cyclosporine 0.05% may further reduce recurrence. Postoperative use of topical steroids is highly variable because there is no consensus regarding the optimal dose, frequency, and duration of treatment.
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Affiliation(s)
- Ekta D Patel
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY
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Yu J, Feng J, Jin T, Tian L, Zhu L, Cao K, Li S, Jie Y. The Effect of a Novel Strategy in Treating Primary Pterygium: A Prospective Randomized Clinical Study. Am J Ophthalmol 2021; 225:108-116. [PMID: 33453159 DOI: 10.1016/j.ajo.2021.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We sought to compare the efficacy and safety of conjunctival autograft (CAG), amniotic membrane transplantation (AMT) with postoperative interferon alfa-2b (IFN alfa-2b), and modified conjunctival autograft plus amniotic membrane transplantation (mCAG plus AMT) with postoperative IFN alfa-2b for primary pterygium. DESIGN Randomized controlled clinical trial. METHODS Eyes with nasal and primary pterygia were randomized in a 1:1:1 ratio to receive CAG, AMT with IFN alfa-2b, or mCAG plus AMT with IFN alfa-2b. Subjects were followed up for 12 months. Primary outcomes included recurrence rate and complications. Secondary outcomes included corneal epithelium status, ocular surface symptom score, and visual acuity change. RESULTS Eighty-five subjects (30 in the CAG group, 25 in the AMT group, and 30 in the CAG+AMT group) completed the 12-month follow-up. No complication or grade 4 recurrence was found. There was no significant difference among the 3 groups in recurrence grade, corneal epithelium status, and visual acuity change. Compared with mCAG+AMT, CAG has a negative effect (β = -0.62, P = .001), and AMT has a negative effect (β = -2.02, P < .001) on postoperative symptom scores. Compared with AMT, CAG has a positive effect (β = 1.28, P < .001) on postoperative symptom scores. CONCLUSIONS All 3 strategies had good safety and clinical efficacy in the study. Compared with conjunctival autograft, the 2 surgeries using no autograft or limited autograft was less traumatic and gave more flexibility for future ocular surface condition changes.
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Affiliation(s)
- Jing Yu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Jun Feng
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Tao Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Lei Tian
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Lei Zhu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Siyuan Li
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Ying Jie
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China.
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Susiyanti M, Panjaitan M, Wangge G, Gondhowiardjo TD. A randomized clinical trial of freeze-dried amniotic membrane transplantation and conjunctival-limbal graft for pterygium excision and evaluation of conjunctival inflammation marker in tears. MEDICAL JOURNAL OF INDONESIA 2020. [DOI: 10.13181/mji.oa.203818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Minimizing inflammation on the ocular surface after pterygium surgery is essential to prevent recurrence. Currently, limited data are available for the comparison between freeze-dried amniotic membrane (FD-AM) and conjunctival–limbal graft (CLG). Therefore, this study aimed to assess conjunctival inflammation and the interleukin (IL)-6 levels in tears after pterygium excision between both techniques.
METHODS This prospective, single-blinded, randomized clinical trial included 26 eyes of 26 patients with primary or recurrent pterygium and who were indicated for pterygium surgery at Cipto Mangunkusumo Hospital, Indonesia from October 2017 until February 2018. The patients were scheduled for pterygium excision with FD-AM or CLG based on block randomization. Conjunctival inflammation and the level of IL-6 in tears were measured on day-7 and -28 after surgery.
RESULTS The 26 eyes (13 in each group) were subjected to a complete 1-month follow-up period. Day-7 after the surgery, severe inflammation occurred in 4/13 (31%) eyes having FD-AM and 8/13 eyes (62%) having CLG (p = 0.59). The IL-6 tear level increased similarly in FD-AM (22.85 pg/ml) and CLG (23.51 pg/ml) in (p = 0.78). No severe adverse events occurred.
CONCLUSIONS Pterygium excision using FD-AM yield a milder inflammation than CLG on day-7 and -28 after surgery. The tear IL-6 levels similarly increased on day-7.
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Chun YH, Paik JS, Oh JH, Kim HS, Na KS. Association between pterygium, sun exposure, and serum 25-hydroxyvitamin in a nationally representative sample of Korean adults. Lipids Health Dis 2018; 17:260. [PMID: 30453963 PMCID: PMC6245817 DOI: 10.1186/s12944-018-0902-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/29/2018] [Indexed: 12/18/2022] Open
Abstract
Purpose Ultraviolet-B (UVB) light exposure is the major risk factor for developing a pterygium, and serum 25-hydroxyvitamin D (25(OH)D) level is an objective measure of UVB light exposure. In this study, we investigated the association between pterygium, sun exposure, and serum 25(OH)D. Methods This population-based, cross-sectional study comprised 12,258 adults (aged ≥19 years) participating in the fifth annual Korea National Health and Nutrition Examination Survey from 2010 to 2012. The enrolled subjects underwent interviews, clinical examinations, and laboratory investigations. The serum 25(OH)D levels were measured, and pterygium was examined by using a slit lamp. We used three adjusted logistic regression models and selected covariates as potential confounders. Results The overall prevalence of pterygium was 7.09, and 53.1% of these subjects were women. The prevalence of pterygium was higher in elderly subjects and those who lived at low latitudes. In multivariate analysis with adjustment for confounding factors, subjects with a serum 25(OH)D level > 30 ng/mL, 25–30 ng/mL, and 15–20 ng/mL had an odds ratio (OR) (95% confidence interval [CI]) of 1.565 (1.035–2.366), 1.545 (1.086–2.198), 1.8 (1.358–2.386), and 1.535 (1.216–1.938), respectively, compared to those with a serum 25(OH)D level < 15 ng/mL. Subjects with a daily sun exposure > 5 h had an OR (95% CI) of 1.761 (1.395–2.223) compared to subjects with a daily sun exposure < 2 h. Conclusion The present study provides epidemiological evidence of an association of daily sun exposure and serum 25(OH)D levels with pterygium in a representative Korean population.
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Affiliation(s)
- Yoon Hong Chun
- Department of Pediatrics, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Ji-Sun Paik
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ju Heun Oh
- Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyun-Seung Kim
- Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyung-Sun Na
- Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Abstract
The main treatment for pterygium is surgical removal. However, pterygium surgery is concerned with high rates of postoperative recurrence. Predicting factors of recurrence are not fully understood, yet, but they probably depend on a multitude of patient-related, clinical, and/or surgical factors. Several adjuvant treatments have been proposed to reduce postoperative pterygium recurrence, including different antimetabolites, antiangiogenetic factors, and radiation therapy. The purpose of this review is to collect the current evidence regarding application and limits of different therapeutic approaches for preventing postoperative recurrence of pterygium, giving insights and perspectives for better management of this disease. In the light of the current evidence, pterygium surgery cannot disregard wound coverage with conjunctival autografting or rotational flap combined with adjuvant treatments. The rotational flap technique is associated with shorter surgical time rates and prevents graft displacement and necrosis, given its vascular pedicle. Amniotic membrane may still be reserved in case of great conjunctival defects or insufficient conjunctiva. Repeated subconjunctival antivascular endothelial growth factor injections can be considered as an effective and safe adjuvant treatment. Moreover, management of postoperative pain is crucial. Innovative treatment strategies will probably target different molecular pathways, considering recent findings regarding pterygium pathogenesis, to improve better understanding and develop universally shared guidelines. Great importance shall be dedicated to the identification of novel molecular biomarkers and favoring factors of recurrence, in order to achieve a customized surgical treatment for each patient and obtain maximal reduction of postoperative recurrence.
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Affiliation(s)
- Raffaele Nuzzi
- S.C.U. Ophthalmology Unit, "City of Health and Science" University Hospital, Department of Surgical Sciences, University of Turin, Turin, Italy,
| | - Federico Tridico
- S.C.U. Ophthalmology Unit, "City of Health and Science" University Hospital, Department of Surgical Sciences, University of Turin, Turin, Italy,
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Malla T, Jiang J, Hu K. Clinical outcome of combined conjunctival autograft transplantation and amniotic membrane transplantation in pterygium surgery. Int J Ophthalmol 2018; 11:395-400. [PMID: 29600172 DOI: 10.18240/ijo.2018.03.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/12/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To compare long-term outcome of primary and recurrent pterygium surgery with three different techniques: combined conjunctival autograft and overlay amniotic membrane transplantation (CAT with AMT), conjunctival autograft transplantation (CAT) alone and amniotic membrane transplantation (AMT) alone. METHODS In this retrospective study, 142 eyes of 142 pterygium patients (104 primary, 38 recurrent) who underwent CAT (group A), AMT (group B) or CAT with AMT (group C) respectively following surgical excision were reviewed and compared based on the recurrences and post-operative complications. RESULTS The number of recurrence post-surgery were 17 (9 from primary, 8 from recurrent; the same description below), 18 (10, 8) and 2 (1, 1) in groups A, B, and C respectively; dry eyes were 22 (16, 6), 27 (18, 9) and 7 (3, 4); conjunctival inflammations were 30 (17, 13), 27 (16, 11) and 11 (6, 5). Patients in group C (either primary or recurrent or both) mainly showed significantly better results than those in group A or B (P<0.05) regarding above-mentioned clinical effects. CONCLUSION Combined CAT and overly AMT have significantly lower rates of recurrence and postoperative complications for primary and recurrent pterygium surgery than CAT or AMT alone.
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Affiliation(s)
- Tejsu Malla
- Department of Ophthalmology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China.,Department of Ophthalmology, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Jing Jiang
- Department of Ophthalmology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China.,Nanjing Ningyi Eye Center, Nanjing 210008, Jiangsu Province, China
| | - Kai Hu
- Department of Ophthalmology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China.,Department of Ophthalmology, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu Province, China.,Nanjing Ningyi Eye Center, Nanjing 210008, Jiangsu Province, China
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14
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Zeng W, Liu Z, Dai H, Yan M, Luo H, Ke M, Cai X. Anti-fibrotic, anti-VEGF or radiotherapy treatments as adjuvants for pterygium excision: a systematic review and network meta-analysis. BMC Ophthalmol 2017; 17:211. [PMID: 29178848 PMCID: PMC5702200 DOI: 10.1186/s12886-017-0601-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/09/2017] [Indexed: 12/03/2022] Open
Abstract
Background Anti-fibrotic, anti-VEGF (vascular endothelial growth factor) medications, or radiotherapy, as adjuvant for pterygium surgical procedure, has been suggested for reducing recurrence, but difficulties may be experienced in deciding which treatment to use. The purpose of this study was to compare the efficacies of these different adjuvants for preventing recurrence following pterygium surgery. Methods We conducted a systematic review to identify randomized controlled trials of patients with primary or recurrent pterygium who received anti-fibrotic, anti-VEGF medication, or radiotherapy as adjuvants in combination with surgical procedure. The surgical procedure contained bare sclera technique or petrygium excision combination with tissue grafting. The primary outcome of this study was recurrence. Direct-comparison and Bayesian network meta-analyses were performed to assess direct and indirect evidence of efficacy. Results We obtained data from 34 randomized controlled trials, representing a total of 2483 patients. Adjuvants included bevacizumab, 5-FU (5-fluorouracil), MMC (mitomycin C), and β-RT (beta-radiotherapy). Compared with placebo, we found distinguishable improvement in recurrence with bevacizumab (odds ratio [OR] 0.38, 95% confidence interval [CI] 0.18–0.80), MMC (0.12, 95% CI 0.06–0.21), and β-RT (0.17, 95% CI 0.04–0.69), but not with 5-FU (0.41, 95% CI 0.12–1.39). MMC significantly reduced recurrence when compared to bevacizumab (0.31, 95% CI 0.13–0.77) and 5-FU (0.28, 95% CI 0.08–0.99). The probability of having the most recurrences after excision was lowest for MMC, followed by bevacizumab and β-RT. Similar results were found in subgroup analyses, including for primary pterygium, and the patients receiving bare sclera technique or conjunctival autograft. Conclusions Adjuvants such as MMC, bevacizumab, and β-RT could effectively prevent recurrence following pterygium excision. However, their efficacy and acceptability require further clarification in future randomized controlled trials. Electronic supplementary material The online version of this article (10.1186/s12886-017-0601-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wen Zeng
- Department of Ophthalmology, Zhongnan hospital of Wuhan University, No 169 Donghu road, Wuchang District, Wuhan, Hubei, 430071, People's Republic of China
| | - Zengming Liu
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Hanjun Dai
- Department of Ophthalmology, Zhongnan hospital of Wuhan University, No 169 Donghu road, Wuchang District, Wuhan, Hubei, 430071, People's Republic of China
| | - Ming Yan
- Department of Ophthalmology, Zhongnan hospital of Wuhan University, No 169 Donghu road, Wuchang District, Wuhan, Hubei, 430071, People's Republic of China
| | - Hong Luo
- Department of Ophthalmology, Zhongnan hospital of Wuhan University, No 169 Donghu road, Wuchang District, Wuhan, Hubei, 430071, People's Republic of China
| | - Min Ke
- Department of Ophthalmology, Zhongnan hospital of Wuhan University, No 169 Donghu road, Wuchang District, Wuhan, Hubei, 430071, People's Republic of China
| | - Xiaojun Cai
- Department of Ophthalmology, Zhongnan hospital of Wuhan University, No 169 Donghu road, Wuchang District, Wuhan, Hubei, 430071, People's Republic of China.
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15
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Kim DJ, Lee JK, Chuck RS, Park CY. Low recurrence rate of anchored conjunctival rotation flap technique in pterygium surgery. BMC Ophthalmol 2017; 17:187. [PMID: 29017515 PMCID: PMC5634825 DOI: 10.1186/s12886-017-0587-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 10/03/2017] [Indexed: 12/04/2022] Open
Abstract
Background To report the recurrence rate for an anchored conjunctival rotation flap technique in primary pterygium surgery. Methods Primary pterygium surgeries performed using anchored conjunctival rotation flap techniques (110 eyes in 110 patients) with a minimum follow-up of 12 months were reviewed. In this technique, a conjunctival flap is rotated to cover the bare sclera and suture-fixated with either 8–0 polyglactin (41 eyes) or 10–0 nylon (69 eyes). The recurrence rate was determined, and the two suture materials utilized were compared. Results The recurrence rate was 2.71% (3 cases in 110 eyes) when an anchored conjunctival rotation flap technique was used and patients were monitored for 26.40 ± 17.09 months. Interestingly, the recurrences were only observed in polyglactin-sutured eyes. No recurrence was detected in nylon-sutured eyes. No other complications were observed in either group. Conclusions The anchored conjunctival rotation flap technique for pterygium surgery has a relatively low recurrence rate. Nylon suture-fixation of the flap was found to be superior to polyglactin suture-fixation in preventing recurrence. Electronic supplementary material The online version of this article (10.1186/s12886-017-0587-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dong Ju Kim
- Department of Ophthalmology, Dongguk University, Ilsan Hospital, 814, Siksadong, Ilsan-dong-gu, Goyang, Kyunggido, 410-773, South Korea
| | - Jimmy K Lee
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Roy S Chuck
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Choul Yong Park
- Department of Ophthalmology, Dongguk University, Ilsan Hospital, 814, Siksadong, Ilsan-dong-gu, Goyang, Kyunggido, 410-773, South Korea.
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16
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Clearfield E, Hawkins BS, Kuo IC. Conjunctival Autograft Versus Amniotic Membrane Transplantation for Treatment of Pterygium: Findings From a Cochrane Systematic Review. Am J Ophthalmol 2017; 182:8-17. [PMID: 28734814 DOI: 10.1016/j.ajo.2017.07.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 07/07/2017] [Accepted: 07/09/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To summarize key findings from a systematic review of the effectiveness and risks of conjunctival autograft (CAG) compared with amniotic membrane transplant (AMT) for pterygium. DESIGN Cochrane systematic review. METHODS We included only randomized controlled trials (RCTs) in which CAG and AMT had been compared for primary or recurrent pterygia. The primary outcome was recurrence of pterygium ≥1 mm onto the cornea by 3 and 6 months post surgery. We adhered to Cochrane methods for trial selection, data extraction, risk of bias evaluation, and data synthesis. RESULTS Twenty RCTs with 1866 participants (1947 eyes) were included. Pterygium recurrence 6 months after surgery ranged from 3.3% to 16.7% in the CAG group and 6.4% to 42.3% in the AMT group based on data from 1021 eyes in 10 RCTs. Estimated risk ratios from meta-analysis indicated that CAG-treated eyes had a 47% lower risk of recurrence 6 months after surgery compared with the AMT group (RR, 0.53, 95% confidence interval [CI], 0.33-0.85). For 96 eyes with recurrent pterygium, the risk of recurrence 6 months after CAG was reduced by 55% compared with AMT (risk ratio [RR], 0.45, 95% CI, 0.21-0.99). Three-month recurrence rates were similar for CAG and AMT based on data from 538 eyes (6 RCTs). CONCLUSIONS CAG was more effective than AMT to prevent pterygium recurrence by 6 months post surgery, especially in recurrent pterygia. CAG-treated eyes had half the recurrence rates of AMT-treated eyes. Future RCTs should assess changes in patient-reported outcomes (symptoms, cosmesis) and visual acuity, and evaluate effects of surgical variations.
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17
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Akbari M, Soltani-Moghadam R, Elmi R, Kazemnejad E. Comparison of free conjunctival autograft versus amniotic membrane transplantation for pterygium surgery. J Curr Ophthalmol 2017; 29:282-286. [PMID: 29270475 PMCID: PMC5735234 DOI: 10.1016/j.joco.2017.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/09/2017] [Accepted: 08/01/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose To compare the recurrence rate and surgical outcomes of amniotic membrane transplantation (AMT) and free conjunctival autograft (CAT) for pterygium surgery. Methods In this prospective study, 60 patients with primary pterygium were randomly assigned to two groups of CAT or AMT and were compared in terms of recurrence rate, mean healing time of corneal epithelial defects, the mean level of inflammation, and complications. Results The mean ± SD age of patients was 48.98 ± 9.8 years (range, 27–71 years). 73.3% were men, and 26.7% were women. The groups did not differ with respect to demographic characteristics (P > 0.05). Patients were followed for an average of 12.6 ± 1.3 months. The recurrence rates were 6.7% and 3.3% in the AMT and CAT groups, respectively (P > 0.05). Comparison of mean inflammation score showed higher inflammation in the AMT group in the first, third, and sixth postoperative month (P < 0.05). Mean healing times of corneal epithelial defects were 2.5 ± 0.572 and 2.67 ± 0.479 days in the CAT and AMT groups, respectively (P = 0.173). Conclusions No significant complication was observed during or after both surgical methods. No statistically significant difference was seen in visual acuity changes and epithelial healing in CAT and AMT groups, but more inflammation and recurrence rate were seen in AMT group.
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Affiliation(s)
- Mitra Akbari
- Eye Research Center, Department of Ophthalmology, Guilan University of Medical Sciences, Rasht, Iran.,Eye Research Center, Amir-Al-Momenin Hospital, Rasht, Guilan, Iran
| | - Reza Soltani-Moghadam
- Eye Research Center, Department of Ophthalmology, Guilan University of Medical Sciences, Rasht, Iran.,Eye Research Center, Amir-Al-Momenin Hospital, Rasht, Guilan, Iran
| | - Ramin Elmi
- Legal Medicine Organization, Rasht, Guilan, Iran
| | - Ehsan Kazemnejad
- Eye Research Center, Department of Ophthalmology, Guilan University of Medical Sciences, Rasht, Iran.,Eye Research Center, Amir-Al-Momenin Hospital, Rasht, Guilan, Iran
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18
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Liu HY, Chen YF, Chen TC, Yeh PT, Hu FR, Chen WL. Surgical result of pterygium extended removal followed by fibrin glue-assisted amniotic membrane transplantation. J Formos Med Assoc 2017; 116:10-17. [DOI: 10.1016/j.jfma.2015.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 10/29/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022] Open
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19
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da Costa Paula C, Julio G, Campos P, Pujol P, Asaad M. Effects of Mitomycin C in Early Conjunctival Inflammation after Pterygium Surgery. Curr Eye Res 2016; 42:696-700. [PMID: 27854142 DOI: 10.1080/02713683.2016.1236965] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to compare inflammatory events and graft characteristics 1 month and 6 months after conjunctival limbal autograft (CLAU) with and without intraoperative mitomycin C (MMC). METHODS This study included 69 eyes of 69 patient's eyes with pterygium. Clinical data concerning patient demography, preoperative examination including pterygium morphology, recurrence clinical assessment, and complications after CLAU with (MMC+) and without (MMC-) intraoperative MMC were all registered at 1 month and 6 months after surgery. RESULTS Thirty-five eyes were included in MMC+ and 34 in MMC-. Preoperative data were similar in both groups (Student's t test and Fisher's exact test; p > 0.05). Thirty-four (49.6%) eyes in the whole sample showed at least one inflammatory complication at 1 month after surgery. MMC- group showed a significantly higher number of cases with complications (p < 0.001; Chi2 test) (MMC+ 28.5%; MMC- 70.5%). No patients presented clinical recurrence at 1 month after surgery. The examination revealed a higher incidence of clinical hyperemia surrounding the surgical site and graft contraction on the host site on the MMC- group, both with statistical signification (p < 0.001; Chi2 test). Although the hemorrhages were less frequent in the MMC- group, there were no significant differences between the two groups (p > 0.05; Chi2 test). Pyogenic granuloma developed at the surgical site in three eyes (4.37%), two of those granulomas were at the MMC- group (p > 0.05). Tendency for recurrences was significantly different between both groups (p = 0.0001; Fisher's exact test) at the end of 6 months. Thirteen (38%) eyes showed recurrence in MMC- and no cases were displayed in MMC+. Presence of at least 1 inflammatory event was only seen in 16 (23%) cases, all of them in MMC-. Specifically, 15 (44%) eyes showed hyperemia and one (3%) eye presented conjunctival hemorrhages. No new cases of pyogenic granuloma or graft contraction were seen at this time point in both groups. Hyperemia was the only specific event with significant differences between MMC- and MMC+ (p = 0.0001; Fisher's exact test) at 6 months after surgery. CONCLUSION The eyes receiving intraoperative MMC after CLAU seem to present less hyperemia and graft contraction after surgery than those that did not receive MMC as an adjuvant factor. Intraoperative MMC could be associated with a lower recurrence rates.
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Affiliation(s)
| | - Gemma Julio
- b Optics and Optometry Department , Universitat Politècnica de Cataluña UPC , Terrassa , Spain.,c Centro de Oftalmología Barraquer , Barcelona , Terrassa , Spain
| | - Pamela Campos
- d Department of Ophthalmology , Hospital de Terrassa, Consorci Sanitari de Terrassa , Terrassa , Spain
| | - Pere Pujol
- d Department of Ophthalmology , Hospital de Terrassa, Consorci Sanitari de Terrassa , Terrassa , Spain
| | - Mouafk Asaad
- d Department of Ophthalmology , Hospital de Terrassa, Consorci Sanitari de Terrassa , Terrassa , Spain
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20
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Limbal conjunctival versus amniotic membrane in the intraoperative application of mitomycin C for recurrent pterygium: a randomized controlled trial. Graefes Arch Clin Exp Ophthalmol 2016; 255:375-385. [PMID: 27761704 DOI: 10.1007/s00417-016-3509-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/25/2016] [Accepted: 10/03/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE This study compared the outcomes of a limbal conjunctival autograft (LCAG) with those of an amniotic membrane graft (AMG) followed by intraoperative 0.02 % mitomycin C (MMC) to treat recurrent pterygium. METHODS In this randomized controlled trial, ninety-six eyes with recurrent pterygium were enrolled and randomly allocated into two groups using a computer-generated random number table. Pterygium removal was followed by intraoperative 0.02 % MMC for 3 min and then either LCAG or AMG transplantation. The major outcomes were recurrence rate, conjunctival inflammation grade, healing time of the corneal epithelial defect, eye-movement amplitude (EMA), uncorrected distance visual acuity (UDVA), and complications. RESULTS A follow-up of 12 months was conducted for 93 eyes of 82 patients. Grade D (recurrence) presented in one eye of the LCAG group and five eyes of the AMG group, with no between-group difference (p = 0.196). However, Grades A, B, and C presented in 46, zero and zero eyes of the LCAG group respectively, and in 37, two and two eyes of the AMG group respectively, with the surgical bed generally showing a better appearance in the LCAG group than in the AMG group (p = 0.008). Compared with baseline values, the postoperative EMA improved significantly in both groups (p < 0.001 for the LCAG group; p = 0.001 for the AMG group), as did UDVA (p = 0.005 for the LCAG group; p = 0.012 for the AMG group). No between-group differences were found in terms of the healing time for epithelial defect, conjunctival inflammation grade, or the frequency of complications such as punctate epithelial keratitis, episcleral melting, corneal pannus, and delayed corneal epithelium healing. CONCLUSIONS LCAG transplantation with intraoperative 0.02 % MMC is as efficacious in treating recurrent pterygium as AMG transplantation with MMC. The former procedure results in an attractive cosmetic appearance but might result in limbal damage in some eyes. The surgeon's familiarity with these procedures should determine the method of treatment.
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21
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Safety and efficacy of human amniotic membrane in primary pterygium surgery. Cell Tissue Bank 2016; 17:407-12. [PMID: 27068054 DOI: 10.1007/s10561-016-9554-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/07/2016] [Indexed: 10/22/2022]
Abstract
Grafts made from human amniotic membrane are used to prevent recurrence of pterygium after excision. The success of the procedure can be affected by the quality of preparation and preservation of the grafts. We prospectively evaluated the safety and efficacy of cryopreserved amniotic membrane prepared at the research tissue bank of the Biotechnology Research Center in Tripoli, Libya, and used as adjunct therapy in primary pterygium excision. Twenty-six patients (15 males and 11 females) aged 21-78 years and indicated for primary pterygium excision were transplanted at the Tripoli Eye Hospital with the amniotic membrane grafts. Sixteen patients (62 %) were available for all three follow-up visits scheduled at 1, 3 and 6 months post-surgery. By the third visit, two patients (12.5 %) developed granuloma and three (18.8 %) had pterygium recurrence. The grafts were used after cryopreservation for ≤180 days or >180 days, but statistical analysis showed that the complications were not associated with the length of storage. Moreover, the high rate of complications in this study was not caused by use of cryopreserved AM. In conclusion, locally produced cryopreserved AM is safe as an adjunct therapy for treatment of primary pterygium excision.
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22
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Abstract
BACKGROUND A pterygium is a fleshy, wing-shaped growth from the conjunctiva, crossing over the limbus onto the cornea. Prevalence ranges widely around the world. Evidence suggests that ultraviolet light is a major contributor in the formation of pterygia. Pterygia impair vision, limit eye movements, and can cause eye irritation, foreign body sensation, and dryness. In some susceptible patients, the pterygium can grow over the entire corneal surface, blocking the visual axis.Surgery is the only effective treatment for pterygium, though recurrences are common. With simple excision techniques (that is, excising the pterygium and leaving bare sclera), the risk of recurrence has been reported to be upwards of 80%. Pterygium excision combined with a tissue graft has a lower risk of recurrence. In conjunctival autograft surgery, conjunctival tissue from another part of the person's eye along with limbal tissue is resected in one piece and used to cover the area from which the pterygium was excised. Another type of tissue graft surgery for pterygium is amniotic membrane graft, whereby a piece of donor amniotic membrane is fixed to the remaining limbus and bare sclera area after the pterygium has been excised. OBJECTIVES The objective of this review was to assess the safety and effectiveness of conjunctival autograft (with or without adjunctive therapy) compared with amniotic membrane graft (with or without adjunctive therapy) for pterygium. We also planned to determine whether use of MMC yielded better surgical results and to assess the direct and indirect comparative costs of these procedures. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (Issue 10, 2015), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to November 2015), EMBASE (January 1980 to November 2015), PubMed (1948 to November 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to November 2015), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) (last searched 21 November 2014), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 23 November 2015. SELECTION CRITERIA We included in this review randomized controlled trials that had compared conjunctival autograft surgery (with or without adjunctive therapy) with amniotic membrane graft surgery (with or without adjunctive therapy) in people with primary or recurrent pterygium. DATA COLLECTION AND ANALYSIS Two review authors independently screened search results and assessed full-text reports from among the potentially eligible trials. Two review authors independently extracted data from the included trials and assessed the trial characteristics and risk of bias. The primary outcome was the risk of recurrence of pterygium at 3 months and 6 months after surgery. We combined results from individual studies in meta-analyses using random-effects models. Risk of recurrence of pterygium was reported using risk ratios to compare conjunctival autograft with amniotic membrane transplant. MAIN RESULTS We identified 20 studies that had analyzed a total of 1947 eyes of 1866 participants (individual studies ranged from 8 to 346 participants who were randomized). The studies were conducted in eight different countries: one in Brazil, three in China, three in Cuba, one in Egypt, two in Iran, two in Thailand, seven in Turkey, and one in Venezuela. Overall risk of bias was unclear, as many studies did not provide information on randomization methods or masking to prevent performance and detection bias.The risk ratio for recurrence of pterygium using conjunctival autograft versus amniotic membrane transplant was 0.87 (95% confidence interval (CI) 0.43 to 1.77) and 0.53 (95% CI 0.33 to 0.85) at 3 months and 6 months, respectively. These estimates include participants with primary and recurrent pterygia. We performed a subgroup analysis to compare participants with primary pterygia with participants with recurrent pterygia. For participants with primary pterygia, the risk ratio was 0.92 (95% CI 0.37 to 2.30) and 0.58 (95% CI 0.27 to 1.27) at 3 months and 6 months, respectively. We were only able to estimate the recurrence of pterygia at 6 months for participants with recurrent pterygia, and the risk ratio comparing conjunctival autograft with amniotic membrane transplant was 0.45 (95% CI 0.21 to 0.99). One included study was a doctoral thesis and did not use allocation concealment. When this study was excluded in a sensitivity analysis, the risk ratio for pterygium recurrence at 6 months' follow-up was 0.43 (95% CI 0.30 to 0.62) for participants with primary and recurrent pterygium. One of the secondary outcomes, the proportion of participants with clinical improvement, was analyzed in only one study. This study reported clinical outcome as the risk of non-recurrence, which was seen in 93.8% of participants in the conjunctival limbal autograft group and 93.3% in the amniotic membrane transplant group at 3 months after surgery.We did not analyze data on the need for repeat surgery, vision-related quality of life, and direct and indirect costs of surgery due to an insufficient number of studies reporting these outcomes.Thirteen studies reported adverse events associated with conjunctival autograft surgery and amniotic membrane transplant surgery. Adverse events that occurred in more than one study were granuloma and pyogenic granuloma and increased intraocular pressure. None of the included studies reported that participants had developed induced astigmatism. AUTHORS' CONCLUSIONS In association with pterygium excision, conjunctival autograft is associated with a lower risk of recurrence at six months' after surgery than amniotic membrane transplant. Participants with recurrent pterygia in particular have a lower risk of recurrence when they receive conjunctival autograft surgery compared with amniotic membrane transplant. There are few studies comparing the two techniques with respect to visual acuity outcomes, and we identified no studies that reported on vision-related quality of life or direct or indirect costs. Comparison of these two procedures in such outcome measures bears further investigation. There were an insufficient number of studies that used adjunctive mitomycin C to estimate the effects on pterygium recurrence following conjunctival autograft or amniotic membrane transplant.
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Affiliation(s)
- Elizabeth Clearfield
- Johns Hopkins Bloomberg School of Public HealthDepartment of Epidemiology615 N. Wolfe StreetRoom 6014BaltimoreMarylandUSA21205
| | - Valliammai Muthappan
- Wilmer Eye Institute, Johns Hopkins University School of MedicineDepartment of Ophthalmology600 North Wolfe StreetBaltimoreMarylandUSA21287
| | - Xue Wang
- Johns Hopkins Bloomberg School of Public HealthDepartment of Epidemiology615 N. Wolfe StreetRoom 6014BaltimoreMarylandUSA21205
| | - Irene C Kuo
- Wilmer Eye Institute, Johns Hopkins University School of MedicineDepartment of Ophthalmology600 North Wolfe StreetBaltimoreMarylandUSA21287
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Cardenas-Cantu E, Valenzuela J, Zavala J, Valdez-Garcýa JE. Basis of Pterygium Development. ACTA ACUST UNITED AC 2016. [DOI: 10.5005/highlights-44-6-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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24
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Hernández-Bogantes E, Amescua G, Navas A, Garfias Y, Ramirez-Miranda A, Lichtinger A, Graue-Hernández EO. Minor ipsilateral simple limbal epithelial transplantation (mini-SLET) for pterygium treatment. Br J Ophthalmol 2015; 99:1598-600. [PMID: 26130669 PMCID: PMC4680150 DOI: 10.1136/bjophthalmol-2015-306857] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/06/2015] [Indexed: 01/11/2023]
Abstract
We describe a novel surgical technique for pterygium removal taking advantage of the properties of amniotic membrane and limbal epithelial stem cells. A total of 10 eyes underwent pterygium excision with amniotic membrane coverage of the bare sclera and placement of pieces of limbal epithelium in a linear fashion in the affected limbal area covered by a second amniotic membrane using fibrin glue. After up to 8 months of follow-up, there were no signs of early recurrence or sight-threatening complications. The minor ipsilateral simple limbal epithelial transplantation technique for the treatment of pterygium requires less tissue than the conventional conjunctival autograft, leaving healthy conjunctiva if needed for another procedure in the future and offers the advantages of epithelial stem cells, which in the long term may reduce the rate of recurrence significantly.
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Affiliation(s)
- Erick Hernández-Bogantes
- Department of Cornea and Refractive Surgery, Instituto de Oftalmologia, Fundacion Conde de Valenciana, México, D.F, México
| | - Guillermo Amescua
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alejandro Navas
- Department of Cornea and Refractive Surgery, Instituto de Oftalmologia, Fundacion Conde de Valenciana, México, D.F, México
| | - Yonathan Garfias
- Research Unit, Instituto de Oftalmología, Fundación Conde de Valenciana, México, D.F, México Department of Biochemistry, Faculty of Medicine, UNAM, México, D.F, México
| | - Arturo Ramirez-Miranda
- Department of Cornea and Refractive Surgery, Instituto de Oftalmologia, Fundacion Conde de Valenciana, México, D.F, México
| | - Alejandro Lichtinger
- Department of Cornea and Refractive Surgery, Instituto de Oftalmologia, Fundacion Conde de Valenciana, México, D.F, México
| | - Enrique O Graue-Hernández
- Department of Cornea and Refractive Surgery, Instituto de Oftalmologia, Fundacion Conde de Valenciana, México, D.F, México
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Ghanavati SZ, Shousha MA, Betancurt C, Perez VL. Combined conjunctival autograft and overlay amniotic membrane transplantation; a novel surgical treatment for pterygium. J Ophthalmic Vis Res 2015; 9:399-403. [PMID: 25667744 PMCID: PMC4307667 DOI: 10.4103/2008-322x.143386] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 10/01/2013] [Indexed: 12/22/2022] Open
Abstract
The authors report the long-term results of combined conjunctival autograft and overlay amniotic membrane transplantation (AMT) for treatment of pterygium as a new surgical technique. Nineteen patients including 12 male and 7 female subjects with pterygium (primary, 14 cases; recurrent, 5 cases) underwent combined conjunctival autograft and overlay AMT and were followed from 10 to 26 months. Mean age was 44.21±12.49 (range, 29.0-73.0) years. In one patient with grade T3 primary pterygium, the lesion recurred (5.2%, recurrence rate). No intra-and postoperative complication developed. This procedure seems a safe and effective surgical technique for pterygium treatment. Protection of the ocular surface during the early postoperative period reduces the friction-induced inflammation and might be helpful to prevent the recurrence.
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Affiliation(s)
- Siamak Zarei Ghanavati
- Department of Ophthalmology, Khatam-al-Anbia Eye Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohamed Abou Shousha
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Carolina Betancurt
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Victor L Perez
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
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Abstract
Pterygium pathogenesis is mainly related to UV light exposure. However, the exact mechanisms by which it is formed have not been elucidated. Clinical advances in surgical treatment use conjunctival autografts and amniotic membranes in combination with adjuvant therapies, including mitomycin C, β-radiation, and 5-fluoroacil, to reduce recurrence. Several studies aim to unveil the molecular mechanisms underlying pterygium growth and proliferation. They demonstrate the role of different factors, such as viruses, oxidative stress, DNA methylation, apoptotic and oncogenic proteins, loss of heterozygosity, microsatellite instability, inflammatory mediators, extracellular matrix modulators, lymphangiogenesis, cell epithelial-mesenchymal transition, and alterations in cholesterol metabolism in pterygium development. Understanding the molecular basis of pterygium provides new potential therapeutic targets for its prevention and elimination. This review focuses on providing a broad overview of what is currently known regarding molecular mechanisms of pterygium pathogenesis.
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Affiliation(s)
- Eduardo Cárdenas-Cantú
- a Ophthalmology Research Chair, School of Medicine and Health Sciences, Tecnologico de Monterrey , Monterrey , Mexico and
| | - Judith Zavala
- a Ophthalmology Research Chair, School of Medicine and Health Sciences, Tecnologico de Monterrey , Monterrey , Mexico and
| | - Jorge Valenzuela
- a Ophthalmology Research Chair, School of Medicine and Health Sciences, Tecnologico de Monterrey , Monterrey , Mexico and
| | - Jorge E Valdez-García
- a Ophthalmology Research Chair, School of Medicine and Health Sciences, Tecnologico de Monterrey , Monterrey , Mexico and.,b Ophthalmology Institute, Tec Salud, Tecnologico de Monterrey , Monterrey , Mexico
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27
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Sheppard JD, Mansur A, Comstock TL, Hovanesian JA. An update on the surgical management of pterygium and the role of loteprednol etabonate ointment. Clin Ophthalmol 2014; 8:1105-18. [PMID: 24966664 PMCID: PMC4063821 DOI: 10.2147/opth.s55259] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Pterygium, a sun-related eye disease, presents as wing-shaped ocular surface lesions that extend from the bulbar conjunctiva onto the cornea, most commonly on the nasal side. Pterygia show characteristic histological features that suggest that inflammation plays a prominent role in their initial pathogenesis and recurrence. Appropriate surgery is the key to successful treatment of pterygia, but there is also a rationale for the use of anti-inflammatory agents to reduce the rate of recurrence following surgery. Multiple surgical techniques have been developed over the last two millennia, but these initially had little success, due to high rates of recurrence. Current management strategies, associated with lower recurrence rates, include bare sclera excision and various types of grafts using tissue glues. Adjunctive therapies include mitomycin C and 5-fluorouracil, as well as the topical ocular steroid loteprednol etabonate, which has been shown to have a lower risk of elevated intraocular pressure than have the other topical ocular steroids. Here, the surgical management of pterygium is presented from a historical perspective, and current management techniques, including the appropriate use of various adjunctive therapies, are reviewed, along with an illustrative case presentation and a discussion of the conjunctival forceps designed to facilitate surgical management. Despite thousands of years of experience with this condition, there remains a need for a more thorough understanding of pterygium and interventions to reduce both its incidence and postsurgical recurrence. Until that time, the immediate goal is to optimize surgical practices to ensure the best possible outcomes. Loteprednol etabonate, especially the ointment formulation, appears to be a safe and effective component of the perioperative regimen for this complex ocular condition, although confirmatory prospective studies are needed.
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Yalniz-Akkaya Z, Ustun H, Ozkan Uney G, Burcu A, Ornek F. Subconjunctival amniotic membrane free graft in rabbit eyes: effects on fibrovascular reaction. J Fr Ophtalmol 2014; 37:358-64. [PMID: 24704043 DOI: 10.1016/j.jfo.2013.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 09/19/2013] [Accepted: 09/25/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of our study is to investigate the effect of subconjunctival amniotic membrane free graft on subconjunctival fibrovascular reaction. METHODS Twelve healthy male white New Zealand rabbits were used for the study. The rabbits were divided randomly into two groups: Study Group (n=6) and Control Group (n=6). In the Study Group, a 4mm limbal incision was made and a 4×4mm subconjunctival pocket was created with blunt dissection. A 4×4mm single layer of free amniotic membrane was placed in the pocket in an epithelium-up fashion without suturing. The limbal opening was secured with 10-0 nylon sutures on both sides. In the Control Group, a 4mm limbal incision was made, a 4×4mm subconjunctival pocket was created with blunt dissection, and the limbal opening was closed with 10-0 nylon sutures on both sides. After the first month, sclero-conjunctival blocks were obtained from the operated area and sections were stained with hematoxylin and eosin, Masson trichrome, and Ki67, SMA and CD34 antibodies. RESULTS The number of fibroblasts, lymphocytes and macrophages was significantly higher in the Study Group than in the Control Group. The number of Ki67- and SMA-positive cells, and CD34-positive vessels was also significantly higher in the Study Group. Amniotic membrane appeared to form folds in all the specimens. CONCLUSION The higher fibrovascular reaction shown by our histopathological examination indicates that free human amniotic membrane grafting without suturing is not useful in decreasing the subconjunctival fibrovascular reaction at the first postoperative month in rabbit eyes.
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Affiliation(s)
- Z Yalniz-Akkaya
- Ankara training and research hospital, department of ophthalmology, Sukriye Mah, Ulucanlar Cad, No. 89, Altindag, Ankara, Turkey.
| | - H Ustun
- Kafkas university, school of medicine, department of pathology, Bülbül Mahallesi Kombine Yolu Üzeri Merkez Kars, 36000 Kars, Turkey
| | - G Ozkan Uney
- Ankara training and research hospital, department of ophthalmology, Sukriye Mah, Ulucanlar Cad, No. 89, Altindag, Ankara, Turkey
| | - A Burcu
- Ankara training and research hospital, department of ophthalmology, Sukriye Mah, Ulucanlar Cad, No. 89, Altindag, Ankara, Turkey
| | - F Ornek
- Ankara training and research hospital, department of ophthalmology, Sukriye Mah, Ulucanlar Cad, No. 89, Altindag, Ankara, Turkey
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Janson BJ, Sikder S. Surgical Management of Pterygium. Ocul Surf 2014; 12:112-9. [DOI: 10.1016/j.jtos.2014.01.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 01/10/2014] [Accepted: 01/01/2014] [Indexed: 10/25/2022]
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A comparison of anchored conjunctival rotation flap and conjunctival autograft techniques in pterygium surgery. Cornea 2013; 32:1578-81. [PMID: 24097183 DOI: 10.1097/ico.0b013e3182a73a48] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To compare conjunctival autograft and anchored conjunctival rotation flap techniques, in terms of recurrence and complication rates, after performing a primary pterygium surgery. METHODS Sixty patients who underwent pterygium surgery, which was performed on 1 eye (M:F = 25:35), either using conjunctival autograft (25 eyes) or anchored conjunctival rotation flap (35 eyes) techniques, were followed up postoperatively for a minimum period of 18 months. The anchored conjunctival rotation flap surgery was conducted by designing a conjunctival flap with a similar shape as that of the autograft, but with the preservation of the inferior limbal anchoring point (1 mm) by the incomplete cutting of the limbal area. After rotation of the flap around the anchoring point, the flap was tightened with sutures to cover the bare scleral area. Early postoperative complications, such as flap or graft edema and granuloma formation, were assessed. The recurrence rate of pterygium was evaluated, and a comparison was made between the 2 surgical techniques. RESULTS The recurrence rate was 8.0% in the conjunctival autograft group and 8.6% in the anchored conjunctival rotational flap group (P = 0.659). However, the occurrence of flap or graft edema was lower for anchored conjunctival rotational flap surgery (14.3% vs. 72.0%, P < 0.001). No granuloma formation was observed in either group. CONCLUSIONS The anchored conjunctival rotational flap surgery showed similar pterygium recurrence rates and a lower incidence of flap edema, while enabling simple recognition of flap orientation, compared with the conjunctival autograft technique.
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Effects of intraoperative steroid injection on the outcome of pterygium surgery. Eye (Lond) 2013; 27:906-14. [PMID: 23887766 DOI: 10.1038/eye.2013.142] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 03/20/2013] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the effects of intraoperative triamcinolone injection on the outcome of pterygium surgery. METHODS This prospective study included 54 eyes with primary nasal pterygia that underwent pterygium surgery with a bare-sclera technique and intraoperative mitomycin C application. Patients were randomized into two groups; the steroid group that received subconjunctival injection of 12 mg triamcinolone acetonide at the end of surgery, and the control group that did not receive such steroid injection. Main outcome measures included presence of conjunctival inflammation at 1 month postoperatively as well as recurrence of pterygium. RESULTS Twelve-month follow-up was completed in 48 eyes (23 in the steroid group and 25 in the control group). At 1 month postoperatively, different grades of conjunctival inflammation were present in 11 (47.8%) of the steroid group and in 14 (56%) of the control group (P=0.39). For eyes with moderate or severe postoperative inflammation, subconjunctival triamcinolone was injected; these included 6 (26.1%) and 9 (36%) in the steroid and control groups, respectively (P=0.54). During follow-up, surgical area showed fine episcleral vessels without fibrous tissue in 1 (4.3%) of the steroid group and 3 (12.0%) of the control group (P=0.33), which all regressed after triamcinolone injection. Conjunctival recurrence of pterygium was seen in 2 (8.7%) of the steroid group and in 1 (4.0%) of the control group (P=0.47). No eye developed corneal recurrence in either group. CONCLUSIONS In pterygium surgery with a bare-sclera technique and mitomycin C application, intraoperative triamcinolone injection did not significantly reduce postoperative conjunctival inflammation or pterygium recurrence.
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Huang Y, He H, Sheha H, Tseng SC. Ocular Demodicosis as a Risk Factor of Pterygium Recurrence. Ophthalmology 2013; 120:1341-7. [DOI: 10.1016/j.ophtha.2013.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 12/20/2012] [Accepted: 01/02/2013] [Indexed: 02/06/2023] Open
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A Combined Approach of Amniotic Membrane and Oral Mucosa Transplantation for Fornix Reconstruction in Severe Symblepharon. Cornea 2013; 32:155-60. [DOI: 10.1097/ico.0b013e318247983d] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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