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Kodavoor SK, Soundarya B, Dandapani R. Comparison of inferior conjunctival autografting and conjunctival tissue grafting from pterygium itself in the cases of filtering blebs and glaucoma suspects-A retrospective analysis. Indian J Ophthalmol 2020; 68:2084-2087. [PMID: 32971613 PMCID: PMC7727990 DOI: 10.4103/ijo.ijo_2164_19] [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: 11/22/2019] [Revised: 03/21/2020] [Accepted: 04/04/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This study aims at comparing the effectiveness of inferior conjunctival autografting (CAG) and conjunctival tissue grafting from pterygium itself (CTG) in the cases of filtering blebs/glaucoma suspects. METHODS One hundered and five eyes of 97 patients who underwent pterygium excision with conjunctival autografting (CAG) in the period from 2010 to 2016 were included. Fifty one eyes had filtering blebs and 54 were glaucoma suspects. Fifty two eyes of 49 patients (Group 1) had undergone pterygium excision with inferior conjunctival autograft (CAG) and 53 eyes of 48 patients (Group 2) had undergone pterygium excision with conjunctival tissue graft (CTG) from the pterygium itself. The minimum follow up period was 6 months. RESULTS Both groups had 2 eyes with recurrence, which was not statistically significant. Among other complications, graft retraction was seen with a higher incidence in Group 2, which was statistically significant. CONCLUSION In situations where sparing of the superior conjunctiva is mandatory, both the techniques of inferior conjunctival autografting and conjunctival tissue graft from the pterygium itself are excellent alternate options with comparable outcomes and no additional risk of significant complications.
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Affiliation(s)
| | - B Soundarya
- Cornea, Refractive and Cataract Surgery, The Eye Foundation, Coimbatore, Tamil Nadu, India
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Outcomes of Vertical Split Conjunctival Autograft Using Fibrin Glue in Treatment of Primary Double-Headed Pterygia. J Ophthalmol 2018; 2018:9341846. [PMID: 30671262 PMCID: PMC6317119 DOI: 10.1155/2018/9341846] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/22/2018] [Accepted: 12/10/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the efficiency of pterygium excision with the vertical split conjunctival technique using fibrin glue in treatment of primary double-headed pterygia. Patients and Methods 15 eyes of 15 patients with primary double-headed pterygia that underwent vertical split conjunctival autograft pterygium surgery were retrospectively reviewed. Recurrence was defined as fibrovascular proliferation over the limbus onto the cornea. Results The patients' mean age was 36.92 ± 10.8 years. At 12-month follow-up, recurrence was not seen in any cases. Regarding postoperative cosmetic grading, grade 1 (the appearance of the operated site is not different from the normal appearance) was found in 12 eyes (80%) and grade 2 (some fine episcleral vessels in the excised area extending up to but not beyond the limbus and without fibrous tissue) was found in 3 eyes (20%). None of the cases showed conjunctival scarring or fibrosis at the conjunctival donor area. Preoperative Sim K astigmatism at the central 3 mm and BCVA were 3.05 ± 1.5 diopters (D) and 0.64 ± 0.26 logMAR, which improved significantly to 1.15 ± 0.84 D and 0.26 ± 0.18 logMAR at 12-month follow-up postoperatively, respectively. Conclusion Vertical split conjunctival autograft using fibrin glue is an effective technique with good cosmetic results and low to no recurrence for primary double-headed pterygia treatment. This trial is registered with NCT03507283.
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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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Our Conjunctivolimbal Autograft Technique Results in Patients with Primary and Recurrent Pterygium. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2018. [DOI: 10.21673/anadoluklin.359922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kodavoor SK, Tiwari NN, Ramamurthy D. Concomitant use of conjunctival tissue graft from the pterygium itself without rotation in pterygium surgery: A full circle in conjunctival autografting. Indian J Ophthalmol 2018; 66:506-510. [PMID: 29582809 PMCID: PMC5892051 DOI: 10.4103/ijo.ijo_890_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: The aim of this study is to describe a modified technique of using conjunctival tissue from the pterygium itself without any rotation of graft for the primary pterygium in eyes with glaucoma filtering bleb, glaucoma suspects, and in primary double-head pterygium using fibrin glue. Methods: In this retrospective, noncomparative, interventional case series, 98 eyes of 98 patients with primary pterygium operated between July 2011 to July 2016 were included. They underwent this technique from the pterygium tissue itself. There was no rotation of this graft, and it was adhered to the bare scleral defect with fibrin glue. Histopathological analysis of pterygium tissue was done to look for morphology and thickness of this thin conjunctival tissue obtained from pterygium tissue itself. The primary outcome measure was recurrence rate. Other outcome measures studied was graft retraction and graft edema. Results: The mean age was 52 ± 10.04 years. Mean follow-up was 14 ± 8.24 months. The only significant complication was recurrence rate of 4.08% (4 eyes out of 98). The most come secondary outcome was graft edema, 52.04% (51 eyes out of 98) which resolved without any intervention. Other outcome such as graft retraction, 32.65% was also recorded. Conclusion: Conjunctival tissue from the pterygium tissue itself without actual rotation appears to be a successful technique with lower recurrence rate for treating primary pterygium in eyes with glaucoma filtering bleb, glaucoma suspects, and in primary double-head pterygium.
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Affiliation(s)
- Shreesha Kumar Kodavoor
- Department of Cornea and Refractive Services, The Eye Foundation, Post Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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Bamdad S, Kooshki AS, Yasemi M. Surgical outcome of conjunctival rotational autograft-mitomycin C (MMC) versus free conjunctival autograft-MMC for pterygium removal: A randomized clinical trial. Electron Physician 2017; 9:5877-5884. [PMID: 29560137 PMCID: PMC5843411 DOI: 10.19082/5877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 08/17/2017] [Indexed: 11/25/2022] Open
Abstract
Background Pterygium is a common degenerative eye disease. Despite various surgical methods to treat pterygium, recurrence is the main complication. The main issue is finding a surgical method with the lowest recurrence. Objective to compare the complications, recurrence rate and the cosmetic effects of two surgical techniques, namely conjunctival rotation autograft (CRA) and conjunctival autograft (CA), in treating pterygium. Methods This randomized clinical trial was conducted at Khalili Hospital in Shiraz, Iran, from January to August 2015. Forty-five eyes from 45 patients were studied. The patients were randomly divided into two groups using the blocking method. The patients of one group were operated on by the CRA technique, while the other group was operated on by the CA method. The patients were checked for the recurrence of pterygium, and other complications at the end of the first, third, and sixth month. Finally, the data were analyzed using SPSS version 21. Results The mean age of the patients was 42.5 years. The recurrence of pterygium was not observed in any of the patients 6 months after the surgery. Following 6 months after the operation, graft retraction occurred during the first week for one patient (4.5%) in the CA group, and five patients (21.7%) in the CRA group. The prevalence rate of graft injection among the patients of the CA and CRA groups 6 months after the operation was 9.1% and 65.2%, respectively. There was a significant correlation between injection intensity and the dissatisfaction of the patients with the operation’s outcome (p=0.017). Conclusion CRA with mitomycin is considered as an effective method to reduce the recurrence of pterygium after operation. This technique can be used as an acceptable method for pterygium operation, especially for patients with insufficient conjunctiva. Clinical trial registration The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2016092119581N2. Funding The study was financially supported by Shiraz University of Medical Sciences (SUMS) (grants No. 8901).
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Affiliation(s)
- Shahram Bamdad
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Anis Shamsi Kooshki
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Yasemi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran.,Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Abstract
PURPOSE There are very few studies that describe the technique and results of double-headed pterygium removal and most of these have recurrence rates higher than those described for single pterygium removal. P.E.R.F.E.C.T for PTERYGIUM has a very low recurrence rate, and this study describes the recurrence rate and cosmesis when used on double-headed pterygia. METHODS A prospective intervention series was performed on 20 eyes with a follow-up of 1 year or more with examination for recurrence and cosmetic appearance. RESULTS There were no recurrences. Cosmetic appearance in 20 eyes was normal or excellent, and the conjunctival donor site was normal in appearance in 19 eyes. CONCLUSIONS P.E.R.F.E.C.T for PTERYGIUM provides excellent cosmetic results and no recurrences, and slit-lamp examination of the superior bulbar conjunctiva is normal in most cases after 2 graft retrievals from the same site.
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He M, Storr-Paulsen T, Wang AL, Ghezzi CE, Wang S, Fullana M, Karamichos D, Utheim TP, Islam R, Griffith M, Islam MM, Hodges RR, Wnek GE, Kaplan DL, Dartt DA. Artificial Polymeric Scaffolds as Extracellular Matrix Substitutes for Autologous Conjunctival Goblet Cell Expansion. Invest Ophthalmol Vis Sci 2017; 57:6134-6146. [PMID: 27832279 PMCID: PMC5104422 DOI: 10.1167/iovs.16-20081] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose We fabricated and investigated polymeric scaffolds that can substitute for the conjunctival extracellular matrix to provide a substrate for autologous expansion of human conjunctival goblet cells in culture. Methods We fabricated two hydrogels and two silk films: (1) recombinant human collagen (RHC) hydrogel, (2) recombinant human collagen 2-methacryloylxyethyl phosphorylcholine (RHC-MPC) hydrogel, (3) arginine-glycine-aspartic acid (RGD) modified silk, and (4) poly-D-lysine (PDL) coated silk, and four electrospun scaffolds: (1) collagen, (2) poly(acrylic acid) (PAA), (3) poly(caprolactone) (PCL), and (4) poly(vinyl alcohol) (PVA). Coverslips and polyethylene terephthalate (PET) were used for comparison. Human conjunctival explants were cultured on scaffolds for 9 to 15 days. Cell viability, outgrowth area, and the percentage of cells expressing markers for stratified squamous epithelial cells (cytokeratin 4) and goblet cells (cytokeratin 7) were determined. Results Most of cells grown on all scaffolds were viable except for PCL in which only 3.6 ± 2.2% of the cells were viable. No cells attached to PVA scaffold. The outgrowth was greatest on PDL-silk and PET. Outgrowth was smallest on PCL. All cells were CK7-positive on RHC-MPC while 84.7 ± 6.9% of cells expressed CK7 on PDL-silk. For PCL, 87.10 ± 3.17% of cells were CK7-positive compared to PET where 67.10 ± 12.08% of cells were CK7-positive cells. Conclusions Biopolymer substrates in the form of hydrogels and silk films provided for better adherence, proliferation, and differentiation than the electrospun scaffolds and could be used for conjunctival goblet cell expansion for eventual transplantation once undifferentiated and stratified squamous cells are included. Useful polymer scaffold design characteristics have emerged from this study.
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Affiliation(s)
- Min He
- Schepens Eye Research Institute/Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States 2Department of Ophthalmology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Thomas Storr-Paulsen
- Schepens Eye Research Institute/Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States 3Department of Ophthalmology, Aarhus University Hospital NBG, Aarhus, Denmark
| | - Annie L Wang
- Schepens Eye Research Institute/Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Chiara E Ghezzi
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, United States
| | - Siran Wang
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, United States
| | - Matthew Fullana
- Department of Macromolecular Science and Engineering, Case Western Reserve University, Cleveland, Ohio, United States
| | - Dimitrios Karamichos
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States 7Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Tor P Utheim
- Schepens Eye Research Institute/Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States 8Department of Oral Biology, University of Oslo, Norway 9Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Norway 10Faculty of Health Sciences, National Centre for Optics, Vision and Eye Care, University College of Southeast Norway, Norway
| | - Rakibul Islam
- Schepens Eye Research Institute/Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States 8Department of Oral Biology, University of Oslo, Norway
| | - May Griffith
- Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden 12Swedish Medical Nanoscience Center, Department of Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - M Mirazul Islam
- Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden 12Swedish Medical Nanoscience Center, Department of Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Robin R Hodges
- Schepens Eye Research Institute/Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Gary E Wnek
- Department of Macromolecular Science and Engineering, Case Western Reserve University, Cleveland, Ohio, United States
| | - David L Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, United States
| | - Darlene A Dartt
- Schepens Eye Research Institute/Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
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Park J, Son Y, Suh E. Effect of transverse conjunctival advancement flap surgery for primary pterygium. Can J Ophthalmol 2016; 51:401-407. [PMID: 27938948 DOI: 10.1016/j.jcjo.2016.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 04/29/2016] [Accepted: 05/19/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To introduce a new surgical technique, transverse conjunctival advancement flap, and to evaluate the efficacy and safety of the technique in primary pterygium surgery. DESIGN Retrospective, noncomparative, interventional case-series analysis. PARTICIPANTS Sixty-three eyes of 63 patients. METHODS The patients with primary pterygium were treated with transverse conjunctival advancement flap technique. After excision of the pterygium head and the perilimbal part of the pterygium body (within 2 mm from the limbus), the bare sclera was covered with the transverse conjunctival advancement flap using the conjunctiva of the remaining posterior part of the pterygium body. The patients were followed up for more than 6 months. RESULTS The mean age of patients was 64.9 ± 8.7 years (range 43-85 years), and the mean follow-up period was 9.8 ± 3.9 months (range 6-18 months). In all cases, surgery did not exceed 20 minutes. During the follow-up period, recurrence of the pterygium occurred in 1 (1.5%) of the 63 cases, with recurrence only in the conjunctiva. There was no occurrence of serious complications. CONCLUSIONS The transverse conjunctival advancement flap technique may be considered a safe and effective method, with a low rate of pterygium recurrence, after primary pterygium excision.
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Affiliation(s)
- Jongyeop Park
- Dongguk University Gyeongju Hospital, Gyeongju-si, South Korea
| | - Yengwoo Son
- Dongguk University Gyeongju Hospital, Gyeongju-si, South Korea
| | - Eoksoo Suh
- Dongguk University Gyeongju Hospital, Gyeongju-si, South Korea..
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Autologous Blood Versus Fibrin Glue in Pterygium Excision With Conjunctival Autograft Surgery. Cornea 2016; 36:452-456. [DOI: 10.1097/ico.0000000000001106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tsim NC, Young AL, Jhanji V, Ho M, Cheng LL. Combined conjunctival rotational autograft with 0.02% mitomycin C in primary pterygium surgery: a long-term follow-up study. Br J Ophthalmol 2015; 99:1396-400. [DOI: 10.1136/bjophthalmol-2014-305817] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 03/14/2015] [Indexed: 11/03/2022]
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Superior versus inferior conjunctival autografts combined with fibrin glue in the management of primary pterygia. Cornea 2014; 32:1582-6. [PMID: 24145626 DOI: 10.1097/ico.0b013e3182a9e712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the outcomes of superior versus inferior conjunctival autograft (CAU) in the prevention of recurrence after performing a pterygium surgery in patients with primary pterygia. METHODS This was a prospective randomized study of 60 eyes of 60 patients with primary pterygium. All the eyes underwent pterygium excision and were assigned randomly to receive either superior (30 eyes) or inferior (30 eyes) CAU. All grafts were attached with fibrin glue. The patients were followed up on postoperative day 1, day 7, 1 month, 3 months, and 6 months. RESULTS Outcome measures included rate of recurrence, mean surgical time, visual analog scale pain score, and amount of pain medication required in the first postoperative week. The mean surgical time, visual analog scale pain score, and amount of pain medication required in both groups were not statistically different. A follow-up of at least 6 months (mean 5.5 ± 1.1 months) was achieved in 49 eyes of 49 patients (24 eyes in the superior CAU group and 25 eyes in the inferior CAU group). One eye in the superior CAU group (4.2%) and 1 eye in the inferior CAU group (4.0%) developed pterygium recurrence. There was no statistically significant difference in the recurrence rates between the 2 groups. In the inferior CAU group, mild localized donor site scarring was noted in 2 patients (8.3%). CONCLUSIONS Pterygium excision with superior or inferior CAU secured with fibrin glue is safe and effective. There was no significant difference in surgical time, pain, and recurrence rates of pterygium after excision with superior or inferior CAU.
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Katırcıoglu YA, Altiparmak U, Engur Goktas S, Cakir B, Singar E, Ornek F. Comparison of Two Techniques for the Treatment of Recurrent Pterygium: Amniotic Membrane vs Conjunctival Autograft Combined with Mitomycin C. Semin Ophthalmol 2014; 30:321-7. [PMID: 24506693 DOI: 10.3109/08820538.2013.874468] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To compare the results of amniotic membrane transplantation (AMT) combined with mitomycin C (MMC) to the results of free conjunctival autograft (CA) combined with MMC for the treatment of patients with recurrent pterygium. METHODS In this prospective study, 60 eyes of 55 patients with recurrent pterygium were included and randomly assigned into group I (n = 30) who underwent AMT combined with MMC (AMT-MMC) and group II (n = 30) who underwent CA combined with MMC (CA-MMC). During a mean follow-up of 27.2 ± 20.8 months, recurrence of pterygium, change in uncorrected visual acuity and complications (including pain, corneal, conjunctival or scleral changes) were analyzed and were compared between groups. RESULTS Five eyes of 5 patients were lost to follow-up and were removed from analysis. The mean age (p = 0.274), the mean follow-up (p = 0.063), the number of prior pterygium excision surgeries (p = 0.641) and the mean preoperative visual acuity (p = 0.959) were similar in both groups. Recurrence was seen in 2 eyes (8%) in AMT-MMC group and 4 patients (13.3%) in CA-MMC group (p = 0.531). Postoperative visual acuity (p = 0.237), change in visual acuity (p = 0.525), severe pain (p = 0.531) and epithelial defect lasting more than 5 days (p = 0.510) were similar in both groups. CONCLUSIONS Amniotic membrane combined with MMC has similar recurrence rate to CA combined with MMC, in patients with recurrent pterygium. Similar outcomes and complication rates make AMT-MMC a promising method for the treatment of recurrent pterygium cases.
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Affiliation(s)
| | - Ugur Altiparmak
- a Ministry of Health, Ankara Training and Research Hospital , Ankara , Turkey
| | - Seniz Engur Goktas
- a Ministry of Health, Ankara Training and Research Hospital , Ankara , Turkey
| | - Burcin Cakir
- a Ministry of Health, Ankara Training and Research Hospital , Ankara , Turkey
| | - Evin Singar
- a Ministry of Health, Ankara Training and Research Hospital , Ankara , Turkey
| | - Firdevs Ornek
- a Ministry of Health, Ankara Training and Research Hospital , Ankara , Turkey
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Fava MA, Choi CJ, El Mollayess G, Melki SA. Sandwich fibrin glue technique for attachment of conjunctival autograft during pterygium surgery. Can J Ophthalmol 2013; 48:516-20. [DOI: 10.1016/j.jcjo.2013.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 05/19/2013] [Accepted: 07/16/2013] [Indexed: 11/16/2022]
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Young AL. The Use of Conjunctival Rotational Autograft in the Management of Pterygium. Asia Pac J Ophthalmol (Phila) 2013; 2:209-10. [PMID: 26106912 DOI: 10.1097/apo.0b013e31829d3ddb] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Alvin L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital & Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR
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Sune MP, Sune PG. Conjunctival Rotation Autograft for Pterygium: An Alternative to Conventional Conjunctival Autografting. Asia Pac J Ophthalmol (Phila) 2013; 2:227-31. [PMID: 26106916 DOI: 10.1097/apo.0b013e3182993f8c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine the safety and efficacy of conjunctival rotation autograft (CRA) as an alternative to conventional conjunctival autograft after pterygium excision and its complications and rate of recurrence. DESIGN A prospective non-comparative interventional case study. METHODS Conjunctival rotation autograft was performed under peribulbar block in 50 eyes with primary pterygium as well as recurrent pterygium of grade 1, 2 and 3 according to a morphological grading system. Patients were followed up for 12 months for complications like graft retraction, injection, recurrence, etc. RESULTS A total of 55 CRAs were done in 50 eyes of 47 subjects in the study wherein grafts were attached by using the 10-0 nylon sutures in primary and recurrent pterygia. Mean follow up period was 11.67 months (Range 9-12 months). The most commonly found complications were graft injection in 16 (29.09%) cases and graft pigmentation in 5 (9.0%) cases. Injection was not associated with pterygium grade and was found to be statistically insignificant (P = 0.27). Recurrence was found only in 1 (1.8%) case in grade T3 recurrent pterygium. CONCLUSIONS Conjunctival rotation autograft appears to be a successful and safe alternative to conjunctival autograft, with a relatively low rate of pterygium recurrence in this uncontrolled series. We advocate the use of CRA for cases of pterygium in which a conventional autograft is contraindicated or difficult. In addition, the procedure can be used as a primary surgical option in primary and recurrent pterygia.
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Affiliation(s)
- Mona P Sune
- From the Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed University), Sawangi ,Wardha, India
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Abstract
We describe a technique of rotational lamellar scleral flap for surgical repair in cases of posttrabeculectomy aqueous leak in patients with button holing or necrosis of the trabeculectomy flap. A rotational scleral flap is marked out from the sclera adjacent to the trabeculectomy site followed by a lamellar dissection to fashion the flap. Relaxing cuts are made at the base of the flap so as to ensure that the rotation flap adequately covers the site of aqueous leak. This flap is then secured to the underlying sclera and the cornea at the limbus.
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Park SY, Han KE, Seo KR. Recurrence after Modified Mini-Flap Technique for Pterygium Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.10.1419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sun Young Park
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Eun Han
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Ryul Seo
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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Comparison of conjunctival autograft transplantation and amniotic membrane transplantation for pterygium: a meta-analysis. Graefes Arch Clin Exp Ophthalmol 2011; 250:375-81. [PMID: 21935607 DOI: 10.1007/s00417-011-1820-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 08/17/2011] [Accepted: 09/02/2011] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Conjunctival autograft transplantation (CAT) and amniotic membrane transplantation (AMT) are two widely used techniques for pterygium treatment. However, previous studies comparing the outcomes of CAT and AMT have generally had small sample sizes and conflicting results. The aim of this report was to evaluate and comment on peer-reviewed literature for evidence of effectiveness and safety of CAT and AMT for management of pterygium. METHODS Studies comparing outcomes of CAT and AMT for pterygium treatment were identified by searching PubMed, Embase, Web of Knowledge, and a search of all references in relevant papers. Two reviewers confirmed study eligibility and extracted data independently, and data were pooled using standard meta-analysis techniques. RESULTS Five eligible studies reporting outcomes in 538 eyes were included. The pooled hazard ratio (HR) estimate for recurrence of CAT compared to AMT was 0.30 (95% confidence interval (CI) [0.16, 0.59], p < 0.001) and 0.22 (95%CI [0.02, 2.37], p = 0.214), respectively, for primary and recurrent pterygium. For unacceptable appearance, the pooled HR estimate was 0.33 (95% CI [0.16, 0.66], p = 0.002). There were no statistically significant differences in adverse events (odds ratio (OR) = 0.96, 95% CI [0.46, 1.97], p = 0.901). CONCLUSIONS Available trials indicate that CAT has lower recurrence risk compared to AMT for primary pterygium treatment, as well as lower risk of unacceptable appearance risk.
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Young AL, Tam PMK, Leung GYS, Cheng LL, Lam PTH, Lam DSC. Prospective Study on the Safety and Efficacy of Combined Conjunctival Rotational Autograft With Intraoperative 0.02% Mitomycin C in Primary Pterygium Excision. Cornea 2009; 28:166-9. [DOI: 10.1097/ico.0b013e318187544d] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hong SM, Ko SJ, Kim SD. Effect of Inferior Conjunctival Transposition Flap Surgery for Primary Pterygium. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.12.1774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seong Min Hong
- Department of Ophthalmology, Wonkwang University College of Medicine, Iksan, Korea
| | - Sang Jun Ko
- Department of Ophthalmology, Wonkwang University College of Medicine, Iksan, Korea
| | - Sang Duck Kim
- Department of Ophthalmology, Wonkwang University College of Medicine, Iksan, Korea
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Affiliation(s)
- Amit Todani
- Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA
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24
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Özdemir M. CONJUNCTIVAL Z-PLASTY FOR PTERYGIUM: COMPARISON WITH CONJUNCTIVAL AUTOGRAFTING. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2008. [DOI: 10.29333/ejgm/82583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Human amniotic membrane transplantation with fibrin glue in management of primary pterygia: a new tuck-in technique. Cornea 2008; 27:94-9. [PMID: 18245974 DOI: 10.1097/ico.0b013e318158b47f] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To report the use of fibrin glue for attaching the human amniotic membrane graft with a tuck-in technique after primary pterygium excision. METHODS Twelve patients with primary pterygium (grade 2 or 3) underwent pterygium excision. The bare sclera was covered with an oversized human amniotic membrane graft by using fibrin glue for graft adherence. The edges of the graft were tucked underneath the adjacent free margin of conjunctiva on 3 sides. Various parameters such as operative time, patient's postoperative comfort, graft adherence, time of graft epithelialization, and recurrence of pterygium were assessed. RESULTS The amniotic membrane graft adhered successfully in 11 patients. Average surgical time was 15.5 minutes (range, 13-21 minutes). The postoperative period was generally comfortable. Epithelialization of the graft was rapid, occurring within 7 days in 11 eyes. In 1 patient, the graft was found dislodged partially on the first postoperative day. Eleven eyes showed no recurrence at the end of 1-year follow-up. CONCLUSIONS Use of fibrin glue for attaching human amniotic membrane graft in primary pterygium surgery is effective. It not only reduces the surgical time but also minimizes postoperative discomfort and complications.
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Wu WK, Wong VWY, Chi SCC, Lam DSC. Surgical management of double-head pterygium by using a novel technique: conjunctival rotational autograft combined with conjunctival autograft. Cornea 2008; 26:1056-9. [PMID: 17893533 DOI: 10.1097/ico.0b013e31813349ec] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe a novel technique for the surgical management of double-head pterygium and to evaluate its safety and efficacy. METHODS A prospective noncomparative interventional case series was conducted. Patients with primary double-head pterygium underwent pterygium excision, followed by conjunctival rotational autograft (CRA) combined with conjunctival autograft (CA). CRA was harvested from the larger pterygium and placed over the bare scleral defect of the smaller pterygium with 180-degree rotation. The bare scleral defect of the larger pterygium was covered with CA harvested from the superior bulbar conjunctiva. Patients were followed up for 1 year, and the outcomes and recurrence rates were noted. RESULTS Twenty patients were recruited into the study, of which 7 (35%) were men and 13 (65%) were women. The mean age was 63.8 years. No intraoperative complication was encountered. Postoperatively, there was significant improvement in best-corrected visual acuity (P = 0.005) and reduction in magnitude of astigmatism (P = 0.016). At 1 year after operation, there were 7 cases of recurrence (35%), but 4 were 1 mm. The main postoperative complication was persistent CRA injection in 9 cases. CONCLUSIONS CRA combined with CA is a safe alternative in the management of double-head pterygium. Further modifications of the surgical techniques are warranted to decrease prolonged hyperemia of the CRA.
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Affiliation(s)
- Wai-Kwan Wu
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
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Abstract
PURPOSE OF REVIEW Pterygium is a common ocular disorder in many parts of the world. At present, there is a wide variety of surgical methods but very few clinical guidelines on the optimal treatment of primary or recurrent pterygium. The purpose of this review is to summarize the more recent and relevant studies on pterygium treatment. RECENT FINDINGS The primary aim is to excise the pterygium and prevent its recurrence. As bare sclera excision is associated with a high recurrence rate, pterygium excision is often combined with conjunctival autograft, mitomycin C, beta-irradiation or other adjunctive therapies to reduce recurrence rates. There is currently, however, no consensus regarding the ideal treatment for the disease. Comparability between studies is also hampered by the various definitions of pterygium recurrence. SUMMARY This article reviews the current concepts and techniques used for the treatment of pterygium. Conjunctival autografting and mitomycin C application are the most commonly used methods for preventing recurrences. The use of mitomycin C and beta-irradiation should be used judiciously because of the potential long-term risk of sight-threatening complications. Additional clinical trials should be performed to evaluate the relative efficacies and long-term safety of the various treatment modalities.
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Müller S, Stahn J, Schmitz K, Behrens-Baumann W. [Recurrence rates after pterygium excision with sliding conjunctival flap versus free conjunctival autograft]. Ophthalmologe 2007; 104:480-3. [PMID: 17525850 DOI: 10.1007/s00347-007-1539-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND After simple excision without additional surgical measures, pterygiums demonstrate high recurrence rates. According to the literature, recurrences may occur in up to 83% after simple excision compared to 5-21% after excision combined with conjunctival autografts. An alternative to the free conjunctival graft is the sliding conjunctival graft. METHODS The data of 50 patients operated over a period of 8 years were evaluated retrospectively. The long-term results after pterygium excision with free conjunctival graft vs sliding conjunctival flap were compared with data extracted from the literature. RESULTS The average follow-up was 23 months. During this period, 18.5% of 27 operated eyes with free conjunctival grafts developed a recurrence of pterygium. After excision with sliding conjunctival grafts only 6.9% of 29 operated and examined eyes developed recurrences. CONCLUSION In the present study pterygium excision combined with sliding conjunctival graft was a simplified surgical technique with a lower recurrence rate compared to the free conjunctival graft.
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Affiliation(s)
- S Müller
- Augenklinik der Otto-von-Guericke-Universität, 39120, Magdeburg.
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Küçükerdönmez C, Akova YA, Altinörs DD. Comparison of Conjunctival Autograft With Amniotic Membrane Transplantation for Pterygium Surgery. Cornea 2007; 26:407-13. [PMID: 17457187 DOI: 10.1097/ico.0b013e318033b3d4] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the clinical results of conjunctival autograft and amniotic membrane transplantation (AMT) for primary and recurrent pterygium excision. In an effort to determine whether AMT yields acceptable cosmetic results as conjunctival autografting in pterygium surgery, we compared the final cosmetic outcomes of these 2 techniques. METHODS We performed a prospective, randomized clinical study of 78 eyes (78 patients) divided into 2 groups. Forty eyes (28 with primary and 12 with recurrent pterygia) received conjunctival limbal autograft (group 1), and 38 eyes (27 with primary and 11 with recurrent pterygia) received AMT (group 2) after extensive removal of pterygium. Mean follow-up time was 16.6 +/- 3.52 months in group 1 and 13.4 +/- 2.08 months in group 2. The results were evaluated by clinical examination and photographing and final appearances were graded from 1 to 4. Grade 4 represented true recurrence, whereas grade 3 indicated unacceptable cosmetic appearance. RESULTS Recurrence rates of primary, recurrent, and all pterygia in group 1 and group 2 were 3.6%, 16.7%, and 7.5% and 3.7%, 18.2%, and 7.9%, respectively. There was no significant difference in recurrence rates between the 2 groups (P = 1.00 for all). The rates of final appearance as grade 3 were 10.0% in group 1 and 21.1% in group 2, and the difference was statistically significant (P = 0.048). No major complications occurred during the follow-up period. CONCLUSIONS Although better results in the final appearance were achieved using conjunctival autografting than with AMT, AMT can be a useful alternative in pterygium surgery, especially in those patients who may have a limited amount of conjunctiva for future surgeries.
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Affiliation(s)
- Cem Küçükerdönmez
- Başkent University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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Uçakhan OO, Kanpolat A. Combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C in the treatment of primary pterygium. Clin Exp Ophthalmol 2006; 34:219-25. [PMID: 16671901 DOI: 10.1111/j.1442-9071.2006.01197.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To introduce a new technique of conjunctival reconstruction after primary pterygium excision, and to evaluate the efficacy of combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C application in preventing recurrence of primary pterygium. METHODS In a prospective, non-comparative case series, 43 eyes of 41 consecutive patients with primary pterygium were studied. In all patient eyes, after excision of pterygia, 0.02% mitomycin C was applied topically for 2 min over the exposed scleral surface and "symmetrical conjunctival flap transposition" was performed to reconstruct the conjunctival defect. The main outcome measures were pterygium recurrence or any complications related with surgery or mitomycin C. RESULTS The mean age of the patients was 47.5 +/- 12.4 years (range 30-70 years). Among the 38 patients who were not lost to follow up, three patient eyes (7.5%) had grade 1, 24 eyes (60.0%) had grade 2 and 13 eyes (32.5%) had grade 3 pterygium. The mean follow up was 12.2 +/- 5.7 months (range 7-28 months). No recurrence or sight-threatening complications were encountered in any patient eye throughout the follow-up period. CONCLUSION Combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C application may be an effective surgical alternative in preventing recurrence of primary pterygium. Although the procedure seems to be free from severe complications, surgeons and patients should be well aware of the risk of late radiomimetic complications of mitomycin C. Comparative, randomized trials with more number of patients and longer follow up are required to further establish the safety and efficacy of this treatment strategy.
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Affiliation(s)
- Omür O Uçakhan
- Department of Ophthalmology, Ankara University School of Medicine, Cankaya 06680, Ankara, Turkey.
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Folliot S, Vabres B, Weber M, Péchereau A. Greffe de membrane amniotique avec greffe conjonctivo-limbique dans le traitement des ptérygions récidivants, invasifs ou intéressant l’axe optique. J Fr Ophtalmol 2006; 29:169-75. [PMID: 16523159 DOI: 10.1016/s0181-5512(06)73766-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate amniotic membrane transplantation with limbic-conjunctival autograft during recurrent pterygium surgery in cases with a risk of stromal defect or with optic axis involvement, in order to limit the corneal defect in pterygium and preserve vision with moderate astigmatism. MATERIALS AND METHODS Retrospective study of 50 cases. Three clinical aspects were encountered: A, recurrent pterygium after simple surgery (a corrected stromal defect)--six cases; B, primary pterygium at risk of stromal defect - five cases; C, primary pterygium with optic axis involvement--four cases. Each patient underwent ablative surgery followed by ocular surface rebuilding with limbic-conjunctival autograft combined with amniotic membrane graft on the corneal defect. Visual acuity and astigmatism were measured and compared before and after surgery. RESULTS The mean follow-up was 13 months. At the end of the follow-up, the recurrence rate was 27% (four cases: two in A, two in B, and none in C). Mean visual acuity was improved from 0.7 to 0.8 postoperatively (p=0.041). Astigmatism changed slightly from 1.47 to 1.98 dioptres (p=0.155). DISCUSSION For recurrent pterygium, with stromal defect or optic axis involvement, amniotic membrane transplantation and limbic-conjunctival autograft seems not to influence the recurrence rate. However, by limiting initial keratectomy, this surgical procedure only slightly modifies visual acuity and astigmatism in the cases where the two parameters are slightly affected. Failure can be easily managed with further surgery such as lamellar keratoplasty. CONCLUSION Amniotic membrane transplantation and limbic-conjunctival autograft for recurrent pterygium or with optic axis involvement can be useful to integrate in the therapeutic arsenal of pterygium surgery.
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Affiliation(s)
- S Folliot
- Service d'Ophtalmologie, CHU, Nantes
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Ang LPK, Tan DTH, Cajucom-Uy H, Beuerman RW. Autologous cultivated conjunctival transplantation for pterygium surgery. Am J Ophthalmol 2005; 139:611-9. [PMID: 15808155 DOI: 10.1016/j.ajo.2004.10.056] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2004] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the safety and efficacy of autologous cultivated conjunctival transplantation for the treatment of primary pterygium. DESIGN Prospective nonrandomized clinical trial. METHODS Forty patients with primary pterygium were recruited. Excision of the pterygium was followed by reconstruction using a serum-free derived autologous cultivated conjunctival equivalent in 22 patients (group A) and conventional denuded amniotic membrane transplantation in 18 patients (group B). In group A patients, conjunctival epithelial equivalents were constructed by the ex vivo expansion of conjunctival epithelial cells on human amniotic membranes (HAM). The main outcome measures were conjunctival epithelialization, recurrence, survival analysis, and incidence of complications. RESULTS The mean follow-up was 14.1 +/- 3.9 months (range, 12 to 25 months). Complete epithelialization was achieved within five days after surgery in group A patients compared with approximately three weeks for group B patients. The proportion of patients that had true recurrences was 22.7% in group A and 25.0% in group B. The mean time to recurrence was 4.8 +/- 1.6 months in group A and 5.0 +/- 2.9 months in group B. No ocular complications were noted in group A, while one eye (6.0%) in group B developed scleral necrosis associated with a persistent epithelial defect. CONCLUSIONS Transplantation of an autologous cultivated conjunctival epithelial sheet facilitated early postoperative epithelialization and recovery, and may aid in preventing serious complications associated with simple denuded HAM transplantation, such as scleral necrosis and secondary infection. This may provide a novel method for conjunctival epithelial replacement in the treatment of ocular surface disorders.
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Ma DHK, See LC, Hwang YS, Wang SF. Comparison of Amniotic Membrane Graft Alone or Combined With Intraoperative Mitomycin C to Prevent Recurrence After Excision of Recurrent Pterygia. Cornea 2005; 24:141-50. [PMID: 15725881 DOI: 10.1097/01.ico.0000141237.71837.d8] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Without effective adjunctive therapy, the recurrence rate after excision of recurrent pterygia is high. In an effort to determine a way to better reduce the recurrence of pterygia, we compared the efficacy and safety of amniotic membrane graft (AMG) alone and AMG combined with intraoperative mitomycin C after excision of recurrent pterygia. METHODS Patients with recurrent pterygia were randomly assigned to receive excision of pterygia followed by AMG alone or AMG combined with intraoperative 0.025% mitomycin C for 3 minutes (AMG-mitomycin C). Patients who could be followed up for more than 12 months were entered for data analysis. Conjunctival (potential) and corneal (true) recurrence of pterygia and other complications were recorded. RESULTS The group receiving AMG alone was made up of 48 eyes in 48 patients, and the group receiving AMG-mitomycin C consisted of 47 eyes in 46 patients. No significant difference was found in age distribution, sex distribution, or duration of follow-up between the 2 groups. Regarding the recurrence rates of each group, 6 conjunctival (12.5%) and 6 corneal (12.5%) recurrences developed in the AMG group, and 4 conjunctival (8.5%) and 6 corneal (12.8%) recurrences developed in the AMG-mitomycin C group. No significant difference was found in the conjunctival and corneal recurrence rate between the 2 groups (P=0.623 and 0.966, respectively; log rank test), and no major complications developed in either group. CONCLUSIONS AMG alone can be considered an effective alternative adjunctive treatment of recurrent pterygia. The addition of intraoperative mitomycin C did not further reduce the recurrence rate.
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Affiliation(s)
- David Hui-Kang Ma
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Tananuvat N, Martin T. The Results of Amniotic Membrane Transplantation for Primary Pterygium Compared with Conjunctival Autograft. Cornea 2004; 23:458-63. [PMID: 15220729 DOI: 10.1097/01.ico.0000116522.57227.97] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To study the efficacy and safety of amniotic membrane transplantation as an adjunctive therapy after surgical excision of primary pterygium and to compare the clinical outcome with that of conjunctival autograft. METHODS Eighty-six eyes of 78 patients with primary pterygium were operated on by a single surgeon (N.T.). All patients were randomized to undergo amniotic membrane or conjunctival autograft transplantation as an adjuvant therapy after pterygium excision. Forty-four eyes in 39 patients were treated with amniotic membrane transplantation (AM group), and 42 eyes of 41 patients were treated with conjunctival autograft (CG group). Patients were followed up at 1 week, 1, 3, 6, and 12 months postoperation. The main outcome measurement was a recurrence rate after surgery. RESULTS The mean follow-up was 14.40 +/- 5.4 months in the AM group and 12.35 +/- 3.13 months in the CG group. There were 18 recurrences (40.9%) in the AM group and two (4.76%) in the CG group, which was significantly different among both groups (P < 0.007). The cumulative proportion that were recurrence-free at 12 months was 0.6 +/- 0.15 for the AM group and 0.95 +/- 0.07 for the CG group (P = 0.0003, Log-rank test). The cumulative nonrecurrence rate at 6 and 12 months in all patients stratified by age and sex was not significantly different (P = 0.28 and P = 0.9, Log-rank test). No major complications were observed in either group. CONCLUSION The surgical results of primary pterygium excision followed by amniotic membrane and conjunctival autograft transplantation were compared. It was found that amniotic membrane transplantation for pterygium surgery has an unacceptably high recurrence rate.
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Affiliation(s)
- Napaporn Tananuvat
- Department of Ophthalmology, Chiang Mai University, Chiang Mai, Thailand.
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Syam P. Autograft for pterygia: Author reply. Ophthalmology 2004. [DOI: 10.1016/j.ophtha.2003.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kaya M, Tunç M. Vertical Conjunctival Bridge Flaps in Pterygium Surgery. Ophthalmic Surg Lasers Imaging Retina 2003. [DOI: 10.3928/1542-8877-20030701-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
OBJECTIVE Superior conjunctival graft is commonly used in pterygium surgery, which may adversely affect the outcome of future filtration surgery. We retrospectively studied the success rate of inferior conjunctival autografting for primary pterygia in our unit. DESIGN A noncomparative, retrospective, interventional case series. PARTICIPANTS Thirty eyes of 27 patients treated between August 1996 and February 2001 with primary pterygia. INTERVENTION Excision of pterygium followed by conjunctival autograft harvested from the inferior bulbar conjunctiva. Surgeries were performed by an experienced surgeon (CL) in 23 patients and by trainees in the remaining four cases. MAIN OUTCOME MEASURES Recurrence of the pterygium and complications. RESULTS Mean follow-up was 27 months (range, 8-53). Recurrence occurred in one eye (3.3%). This was a white female in her early fifties, with recurrence detected 3 months after the surgery. Conjunctival scarring at the donor site was observed in 11 eyes (36.66%). There was no symblepharon formation. There was no restriction of up gaze. Hemorrhage under the conjunctival graft developed in three eyes, corneal dellen near the limbus developed in four eyes, and epithelial inclusion cysts at the recipient site developed in two eyes. CONCLUSIONS Inferior conjunctival autografting is an effective technique with a low recurrence rate. This is a useful technique in cases in which it is not possible or desirable to use the superior conjunctiva as a donor source.
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Abstract
The treatment of pterygium is still quite controversial, with various treatments being advocated in the scientific literature. Unfortunately, there are very few well-conducted controlled clinical trials of treatments. However, years of anecdotal and noncontrolled studies have confirmed that some methods, such as bare scleral closure, are no longer acceptable in the treatment of pterygium and that other methods are likely to be more useful. In the future it will be important to develop a grading system, and surgeons will need to be conservative in the treatment of pterygium until such time as a single treatment provides a lower recurrence rate and complication rate.
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Affiliation(s)
- Lawrence W Hirst
- University of Queensland, Divison of Ophthalmology, Princess Alexandra Hospital, Ipswich Road, Woolloongabba 7, Queensland 4102, Australia
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40
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Dadeya S. Response to efficacy and safety of recurrent pterygium surgery using human processed pericardium. Cornea 2003; 22:188-9. [PMID: 12605063 DOI: 10.1097/00003226-200303000-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Alp BN, Yanyali A, Ay GM, Keskin O. Conjunctival rotation autograft for primary pterygium. Ophthalmologica 2002; 216:333-6. [PMID: 12424398 DOI: 10.1159/000066188] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the safety and effectiveness of conjunctival rotation autograft technique in preventing the recurrence of primary pterygium. METHODS In this prospective study, 24 eyes of 24 consecutive patients with primary pterygium were evaluated. Conjunctival rotation autograft technique, which involved the removal of the underlying fibrovascular pterygium tissue and replacement of the original epithelium over the bare sclera with a 180 degrees rotation was performed in all eyes. RESULTS Patients were 34-70 years of age (mean, 52.8; SD = 10.5). During the mean follow-up of 15.9 months (range, 12-23 months; SD: 4.0), 4 recurrences (16.6%) were observed. Neither intraoperative nor postoperative complications were encountered except for recurrences and 3 suture openings, which were re-sutured postoperatively without further complications. CONCLUSION Conjunctival rotation autograft technique appears to be effective and safe in preventing the recurrence of primary pterygium. A prospective randomised trial comparing conjunctival rotation autografting with other adjunctive procedures in addition to simple pterygium excision is required to determine its effectiveness.
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Affiliation(s)
- Banu N Alp
- Department of Ophthalmology, Kocaeli University, School of Medicine, Kocaeli, Turkey
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John T. Mini-autograft for pterygium surgery. Eye (Lond) 2002; 16:678-80. [PMID: 12194106 DOI: 10.1038/sj.eye.6700127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Ti SE, Tseng SCG. Management of primary and recurrent pterygium using amniotic membrane transplantation. Curr Opin Ophthalmol 2002; 13:204-12. [PMID: 12165701 DOI: 10.1097/00055735-200208000-00003] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This review discusses the relative merits of the various techniques used in pterygium surgery with particular reference to the growing interest in the use of amniotic membrane transplantation (AMT) because it is safe, effective, and may be employed in conjunction with other techniques, such as limbal transplantation. The efficacy of AMT is comparable to the established method of conjunctival autograft transplantation (CG) and it is especially indicated when there exists a very large conjunctival defect to cover as in primary double-headed pterygium, or in the context of preserving superior bulbar conjunctiva for future glaucoma surgeries. The authors explain how current management principles (eg, use of anti-inflammatory agents, adequate removal of fibrovascular tissue) are based on known differences in pathogenesis and clinical behavior between primary and recurrent pterygium.
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Affiliation(s)
- Seng-Ei Ti
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA.
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Dadeya S, Malik KPS, Gulliani BP. Pterygium Surgery: Conjunctival Rotation Autograft Versus Conjunctival Autograft. Ophthalmic Surg Lasers Imaging Retina 2002. [DOI: 10.3928/1542-8877-20020701-03] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
The aim of this study was the comparison of recurrence rates of pterygia following different surgical methods. Twenty-one patients were operated by the bare sclera technique, with the application of mitomycin C (0.25 mg/ml for 2 min). Twenty-seven patients were operated by limbal stem cell transplantation. The third group contained 13 patients who were operated by amniotic membrane transplantation. Five recurrences of pterygia were noted in the mitomycin C group and 2 each in the limbal stem cell transplantation group and the amniotic membrane group. The mean time to recurrence was 5.4 +/- 4.12 months in the mitomycin C group versus 10.5 +/- 3.5 months in the group of patients with limbal transplantation. In the third group, both recurrences were evident 4 months after the operation.
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Affiliation(s)
- R Iveković
- University Department of Ophthalmology, Clinical Hospital 'Sestre milosrdnice', Zagreb, Croatia.
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Solomon A, Pires RT, Tseng SC. Amniotic membrane transplantation after extensive removal of primary and recurrent pterygia. Ophthalmology 2001; 108:449-60. [PMID: 11237898 DOI: 10.1016/s0161-6420(00)00567-4] [Citation(s) in RCA: 211] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To evaluate the postoperative outcome and the recurrence rate after extensive removal of primary and recurrent pterygia combined with amniotic membrane transplantation. DESIGN A noncomparative interventional case series. PARTICIPANTS Fifty-four eyes in 54 subjects with either primary (n = 33) or recurrent (n = 21) pterygia operated on by one surgeon (SCGT). INTERVENTION All subjects were operated on for pterygia with an extensive excision of the lesion followed by amniotic membrane transplantation and intraoperative injection of a depot corticosteroid. MAIN OUTCOME MEASURES Cumulative rates of conjunctival (grade 3) and corneal (grade 4) recurrence and incidence of complications. RESULTS The mean follow-up was 12.8 +/- 4.3 months for primary and 14.3 +/- 4.9 months for recurrent pterygia. The true recurrence rate (grade 4) was 3.0%, 9.5%, and 5.6% for primary, recurrent, and all pterygia, respectively. The cumulative proportion of recurrence-free eyes at 12 months was 0.90 +/- 0.06 for primary and 0.69 +/- 0.11 for recurrent pterygia (P = 0.047, log-rank test). Removal of the semilunar fold was associated with longer survival times (P = 0.063) and decreased failure rate (P = 0.046). A similar success rate was achieved in double-head pterygia (1 recurrence in 11 eyes). CONCLUSIONS Amniotic membrane transplantation is an effective and safe procedure for pterygium surgery, with a relatively low recurrence rate for both primary and recurrent pterygia. It can be a useful alternative to conjunctival autograft when a large conjunctival defect has to be covered, such as in primary double-head pterygia and in large recurrent pterygia.
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Affiliation(s)
- A Solomon
- Ocular Surface and Tear Center, Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, FL 33136, USA
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Abstract
The past decade has witnessed several major advances in the field of ocular surface reconstruction. It is now established that the limbal and corneal epithelia belong to the same clonogenic lineage and that conjunctival transdifferentiation does not occur. These facts have engendered the increasing use of limbal transplantation in several ocular conditions involving limbal compromise. Many reports on this procedure have been published in the past year. They add to the growing body of evidence that limbal transplantation is efficacious in replenishing the stem cell pool, promoting improved vision and enhancing ocular comfort. Recent clinical studies on limbal autograft transplantation also underscore the importance of preoperative impression cytology in donor eyes, highlight the fact that transplantation in inflamed eyes is to be avoided, and indicate that the procedure is likely to provide better outcomes if performed several months after ocular surface burns. The appreciation of the utility of amniotic membrane transplantation in ocular surface reconstruction has provided a surgical tool to use in tandem with limbal transplantation. Questions such as why limbal autografts fail, the long-term results of LAT, and whether limbal inclusion is mandatory during conjunctival transplantation after pterygium excision have not been answered fully. Studies on long-term outcomes with limbal allograft transplantation and those reporting on experience with newer techniques such as epithelial transplantation using tissue culture-cultivated epithelium are likely to provide better perspectives on the best way to reconstruct the ocular surface in stem cell-deficient eyes.
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Affiliation(s)
- S Basti
- St. Francis Hospital, Evanston, Illinois, USA
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Tan DT, Tang WY, Liu YP, Goh HS, Smith DR. Apoptosis and apoptosis related gene expression in normal conjunctiva and pterygium. Br J Ophthalmol 2000; 84:212-6. [PMID: 10655200 PMCID: PMC1723383 DOI: 10.1136/bjo.84.2.212] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pterygium is a relatively common eye disease in the tropics whose aetiology and pathogenesis remain uncertain. As such, interest has focused on understanding the underlying mechanism of pterygia development. METHODS 15 specimens of pterygia from 15 eyes were examined, together with normal conjunctival tissue from the same eyes for the pattern of gene expression of genes associated with the induction or repression of apoptosis (p53, bcl-2, and bax). In addition, the samples directly for apoptotic cells were examined by the terminal deoxynucleotide transferase (TdT) mediated nick end labelling (TUNEL) methodology. RESULTS In pterygia specimens apoptotic cells were found mainly confined to the basal layer of cells of the epithelial layer, situated immediately adjacent to the fibrovascular support layer. These cells were shown to express significant levels of p53 and bax, as well as the apoptosis inhibiting protein bcl-2. In contrast, normal conjunctival specimens displayed no bcl-2 expression and apoptotic cells were seen throughout the entire width of the epithelial layer, coupled with high levels of bax expression. CONCLUSION These results support a model whereby pterygia development is a result of disruption of the normal process of apoptosis occurring in the conjunctiva.
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Affiliation(s)
- D T Tan
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751
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49
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Abstract
The procedure of transplanting healthy conjunctiva onto eyes with damaged ocular surface epithelium was first described by Thoft in 1977. Today, conjunctival autografting is widely used in pterygium surgery and has been shown to be both safe and effective in reducing pterygium recurrence. Several randomized, controlled, clinical trials have been reported in the literature, and conjunctival autografting is now recognized to have an efficacy equal to that of such adjunct therapies as beta-irradiation and mitomycin C, and yet it is safer than these treatments. Recent modifications of the conjunctival autograft include the conjunctival rotation autograft and the inferior conjunctival transposition flap, both of which have been reported to be associated with low rates of recurrence. With the discovery of the role of limbal stem cells in the maintenance and stability of the corneal surface, recent forms of ocular surface transplantation that have supplanted Thoft's conjunctival transplantation procedure include limbal autograft transplantation and limbal allograft transplantation. In addition, the adjunct use of human amniotic membrane in these ocular surface transplantation procedures has improved success and survival rates in the management of ocular surface disease, which still presents significant challenges to clinicians today.
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Affiliation(s)
- D Tan
- Singapore National Eye Center, Singapore
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50
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Abstract
Pterygium is an active, invasive, inflammatory process, a key feature of which is focal limbal failure. In a two-stage process, "conjunctivalization" of the cornea occurs with tissue characterized by extensive chronic-inflammation, cellular proliferation, connective tissue remodeling, and angiogenesis. An understanding of this process has resulted in efforts aimed at limbal reconstruction, which is considered the gold standard for surgical care. Although good results have been obtained with other treatment methods, a long-term approach to follow-up with at least 5-year survival figures is desirable. Sophisticated analyses of the tear film and surface epithelium in patients with pterygium may help explain symptoms. The efficacy, at least in the short term, of nonsteroidal anti-inflammatory drugs in the treatment of inflamed pterygia has been confirmed. Corneal topographic analysis has shown that surgery reduces induced astigmatism and also causes subtle changes that may explain postsurgical improvements in vision.
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Affiliation(s)
- M T Coroneo
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia
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