A Survey of Surgical Techniques in Pterygium, Thailand 2016

Evaluating the application of argon laser on pterygium surgery: Report of 30 patients

BACKGROUND

The recurrence rate plays a key role in using various treatments of pterygium. This study assessed the effectiveness of argon laser therapy before the excision of pterygium on the recurrence rate.

MATERIALS AND METHODS

The eyes (n = 60) of patients (n = 30) were divided into two groups based on the treatment. All eyes had undergone pterygium excision with the bare sclera technique. Three weeks before surgery, an argon laser was applied to 30 eyes. Patients have been followed up for 1 year, and the progression of pterygium has been evaluated at days 1, 7, 14, and 30, and then, every 2 months until month 6 and then every 3 months until month 12. Recurrence was defined as more than 1 mm growth of pterygium from the limbus.

RESULTS

In the group with adjuvant argon laser therapy, the mean size of pterygium was 3.7 ± 0.47 mm before surgery and 2.3 ± 0.98 after 12 months (P = 0.001). These were 3.8 ± 0.43 mm and 2.4 ± 1 mm in the other group (P = 0.001). The recurrence of the pterygium was 76% (23/30) in the group treated with an argon laser and 90% (27/30) in another group (P = 0.16). There was no correlation between pterygium sizes before surgery and the pterygium recurrence rate in both eyes (P = 0.272 [right] and 0.916 [left]).

CONCLUSION

Argon laser therapy on pterygium before surgery cannot decrease its recurrence rate, but its application gives a good vision and clarifies the surgery's target area.

Efficacy and Safety of Amniotic Membrane Transplantation Combined with Closure of Tenon Capsule and Bulbar Conjunctival Space in the Treatment of Primary Pterygium

Objective

The aim of the study is to evaluate the safety and effectiveness of amniotic membrane transplantation combined with the closure of the tenon capsule and bulbar conjunctival space.

Methods

This study retrospectively included 100 patients with primary pterygium who received closed bulbar conjunctiva and tenon capsule space combined with amniotic membrane transplantation in our hospital from January 2020 to June 2021 as the experimental group and 100 patients with routine treatment in the same period as the control group. The postoperative efficacy evaluation and postoperative complications of the two groups were compared, so as to comprehensively evaluate the safety and effectiveness of this method.

Results

The results showed that the postoperative complications of the two groups were significantly improved by Fisher's exact test (χ² = 14.510, P = 0.006 < 0.05). The comparison results showed that the treatment group showed significant advantages in six indexes compared with the observation group and the difference between the two groups was statistically significant (P < 0.05) of in the NRS score, Prabhasawat score, inspection of the ocular surface comprehensive analyzer, corneal fluorescein staining, conjunctival fluorescein staining in the operation area, breakup time of tear film examination of the two groups at 3, 7 and 14 days, and 1, 6 and 12 months after the operation.

Conclusions

Amniotic membrane transplantation combined with the closure of the tenon capsule and bulbar conjunctival space is safer than conventional surgery in the treatment of primary pterygium. It has a shorter recovery time, higher safety, and a positive curative effect. It can be considered to popularize this operation in clinic.

Effect of Pterygium Removal Combined with Conjunctival Autograft on Corneal Parameters in Swept-Source Imaging

Background: Both pterygium ingrowth and excision determine alterations in corneal topography. The aim of this study was to evaluate the influence of pterygium removal combined with conjunctival autografts in addition to the use of human fibrin tissue glue on changes in corneal parameters as measured by 3-D swept-source anterior segment optical coherence tomography (AS-OCT) imaging. Methods: Sixteen eyes (16 patients) with pterygium that qualified for surgical treatment were enrolled in this study. Eye examination, slit lamp, and 3-D AS-OCT (CASIA 2) assessment were performed before the surgery and 7 days, 1 month, and 6 months after pterygium excision. Topographic parameters of both anterior and posterior surfaces of the cornea were analysed at each follow-up visit. Results: The gradual decrease in total astigmatism power from preoperative median 2.75 (6.15) D to 1.2 (1.1) D at 6-month follow-up (p = 0.034) was noted from the day 7 visit. Values were strongly influenced by variations of anterior cornea astigmatism. In contrast, a gradual total HOA reduction at the 1-month (from median 0.79 (1.3) D to 0.44 (0.27) D; p = 0.038) and at 6-month visits (0.25 (0.09); p = 0.001) was observed. Similarly, values were strongly influenced by variations of the anterior. Additionally, total average keratometry values increased from preoperative 44.05 (2.25) D to 44.6 (1.9) (p = 0.043) 1 month after the surgery. Conclusions: Significant steepening of the anterior cornea and a reduction in both astigmatism and HOA were observed after pterygium excision. The anterior corneal surface was an essential component of the total postoperative corneal topography values. Three-dimensional swept-source AS-OCT imaging seems to be a valuable tool for monitoring both the progression of the disease and postoperative effects in pterygium eyes.

Comparing Adjuvant Beta Radiation, Mitomycin C, and Conjunctival Autograft in Primary Pterygium Treatment, a Three-year Follow-up Study

Purpose:

To compare the recurrence rate of primary pterygium surgery after the adjuvant use of Beta radiation, Mitomycin C, and conjunctival autograft.

Methods:

180 eyes of 180 patients were included in the study. All cases had primary pterygium excision following the use of adjuvant therapy of Beta radiation or Mitomycin C (0.02% for 5 minutes) or conjunctival autograft. The study was conducted at Fayoum University Hospital, Fayoum, Egypt, and Misr University Hospital. The patients were randomly divided into three groups, with each group comprising 60 patients. Group (A) included patients treated with Beta radiation following Pterygium excision, group (B) patients had primary pterygium excision with the application of 0.02% Mitomycin C for 5 minutes, and group (C) patients had conjunctival autograft to cover the bare area after pterygium excision. Patients were followed up for three years postoperatively.

Results:

group A had the highest recurrence rate (33.3%) followed by group B (13.3%), and finally group C presented a recurrence rate of 6.7%. Group B showed the highest rate of intra-ocular postoperative complications, while no intra-ocular complications were recorded in group C. Common complications in groups A and B were scleral melting, keratitis, and Dellen formation.

Conclusion:

Using conjunctival autograft after primary pterygium excision gives the best results regarding the rate of recurrence and postoperative complications. Meanwhile, B-radiation or Mitomycin C did not prove to be as good.