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Sen S, Jain A, Upadhyay P, Imchen MT, Nath T, Kakkar A. Comparison of Keratometric Change Following Various Conjunctival Autografting Techniques in Pterygium Surgery. Cureus 2023; 15:e49662. [PMID: 38161826 PMCID: PMC10756329 DOI: 10.7759/cureus.49662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
Aim To compare the postoperative keratometric changes and duration of surgery for different techniques of conjunctival autografting in pterygium surgery. Methods Patients with primary pterygium attending the outpatient department and having appropriate indications for surgery were enrolled. Preoperative ophthalmic examination included visual acuity assessment, refraction, keratometry, slit lamp, and fundus evaluation. Pterygium excision surgery with conjunctival autografting was performed on all patients using one of the four different techniques, namely, sutures, fibrin glue, and the autologous blood and bridge techniques. Duration of surgery was recorded for all patients. Postoperatively, all patients were followed up on Day 1, Day 7, and Months 1, 3, and 6. Duration of surgery, keratometric changes, and recurrence rates were analyzed in all four groups. Results Sixty-eight eyes of 66 patients completed the study protocol. There was a significant reduction in astigmatism after the autologous blood graft technique (P value 0.0055) and the glue technique (P value < 0.0001). The success rate of the autologous and glue technique was 90%. The glue technique was found to be more time efficient (mean duration 20.40 minutes) than other techniques. Conclusion After pterygium excision, conjunctival auto grafting using either autologous blood or glue plays a significant role in reducing pterygium-induced astigmatism and recurrence rates with the added advantage of a shorter operative time.
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Affiliation(s)
- Snigdha Sen
- Department of Ophthalmology, Sarojini Naidu Medical College, Agra, IND
| | - Anu Jain
- Department of Ophthalmology, Sarojini Naidu Medical College, Agra, IND
| | - Prerna Upadhyay
- Department of Ophthalmology, Government Medical College, Autonomous State Medical College, Firozabad, IND
| | | | - Tirupati Nath
- Department of Ophthalmology, Sarojini Naidu Medical College, Agra, IND
| | - Akash Kakkar
- Department of Ophthalmology, Sarojini Naidu Medical College, Agra, IND
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Abolfathzadeh N, Ghiasian L, Samavat B, Hadi Y, Arbab M. Recurrent pterygium: A review. J Curr Ophthalmol 2021; 33:367-378. [PMID: 35128181 PMCID: PMC8772501 DOI: 10.4103/joco.joco_153_20] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/18/2021] [Accepted: 04/18/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: To summarize the recent evidence regarding different aspects of pterygium recurrence. Methods: Human-based studies from PubMed, Scopus, and Google Scholar were identified using the following keywords: conjunctival disease, pterygium, recurrent pterygium, pterygium recurrence, pterygium management/surgery, conjunctival autograft (CAU), amniotic membrane graft/transplant, and adjuvant therapy (January 2009 to February 2021). We reviewed risk factors associated with the recurrence of pterygium, timing of recurrence, medical treatments to prevent from recurrence, and nonsurgical and surgical alternatives for management of recurrence. Results: Dry eye disease, black race, and young age are considered definite risk factors for recurrence. However, fleshy appearance of the pterygium and preoperative size remain controversial. Surgical techniques such as excessive suturing, insufficient conjunctival graft size, thick conjunctival graft with remained Tenon tissue, and postoperative graft retraction are considered possible risk factors for recurrence. Using fibrin glue instead of sutures can further reduce recurrence rates. Although recurrence could occur even after many years, most recurrences happen in the first 3–6 months after surgery. Multiple kinds of adjuvant medications are used before, during, or after the operation including mitomycin C (MMC), 5-fluorouracil (5-FU), corticosteroids, and anti-vascular endothelial growth factors (anti-VEGFs). Multiple weekly subconjunctival 5-FU injections are shown to be safe and effective in halting the progression of recurrent pterygium. Although topical bevacizumab is found to inhibit the growth of impending recurrent pterygium, the effect is mostly temporary. CAU is superior to amniotic membrane transplantation in the treatment for recurrent pterygia. Conclusions: There is yet to be a panacea in treating recurrent pterygium. Currently, there is not a globally accepted recommendation for treating recurrent pterygium with anti-VEGFs or 5-FU as a nonsurgical treatment. We strongly recommend using MMC as an adjunct to surgery in recurrent cases, with consideration of its specific complications. CAU is the most effective surgical treatment for recurrent pterygium, and other new surgical therapies need further investigation.
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Early postoperative outcomes of pterygium surgery: Sutures versus autogenous serum in-situ fixation of limbal conjunctival autograft. Life Sci 2019; 221:93-98. [PMID: 30742868 DOI: 10.1016/j.lfs.2019.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/29/2019] [Accepted: 02/08/2019] [Indexed: 01/10/2023]
Abstract
Limbal Conjunctival Autograft Transplantation (LCAT) is considered to be the most effective treatment option for pterygium with the least recurrence rate and rapid restoration of normal epithelial morphology. Of the many available methods for securing Limbal Conjunctival Autograft (LCAG), sutures and autogenous serum in-situ are cost-effective and offers better outcomes. AIM To compare the outcome of surgeries between the two groups: Group I - LCAG secured with autogenous serum in-situ versus Group II - LCAG secured with sutures. MAIN METHODS A prospective randomized control trial conducted on 60 patients who were equally divided into two groups. Post-operative follow-up visits were scheduled at 1st week, 3rd week and 6th week. They were examined for pain, foreign body sensation, subconjunctival hemorrhage, tearing, hyperemia, graft edema, graft displacement, graft retraction, recurrence and/or any other complications and were graded depending on the severity. Mean surgical time was compared between the two groups. KEY FINDINGS Average duration of surgery was significantly less in Group I than in Group II. Postoperatively, symptoms like pain, foreign body sensation, tearing and hyperemia were less common in Group I, furthermore subconjunctival hemorrhage and graft edema were more in Group II. SIGNIFICANCE Though both the procedures are safe and effective, the use of autogenous serum in-situ significantly shortens the duration of surgery and is accompanied by lesser postoperative discomfort and inflammation. However, long-term studies are needed to assess the risk of recurrence. Graft displacement remains a severe, but infrequent complication.
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Ghoz N, Elalfy M, Said D, Dua H. Healing of autologous conjunctival grafts in pterygium surgery. Acta Ophthalmol 2018; 96:e979-e988. [PMID: 30156059 DOI: 10.1111/aos.13794] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/24/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To temporally study the healing of conjunctival autografts in consecutive patients following pterygium surgery. METHODS A case-cohort observational study. Thirty-two eyes of 28 patients who underwent pterygium surgery were included. All eyes had pterygium excision with conjunctival autografts. Twenty-seven eyes of 24 patients underwent excision of primary pterygium while five eyes of four patients had surgery for recurrent pterygium. All grafts were attached using fibrin glue. Mitomycin-C 0.04% was used intraoperatively in 25 eyes. All eyes were followed up at 1, 2, 4, 8, 12 weeks and 6 months postoperatively. Photographs were taken at each visit to monitor graft vessels, re-perfusion and healing. Main outcome measures were graft loss; re-perfusion of grafts and appearance and resolution of oedema, transudation and haemorrhage; approximation of graft edges to host bed and changes at donor site. RESULTS No graft tissue was lost. In all eyes, healing of autografts started with graft swelling due to oedema and transudation followed by re-perfusion injury, which manifested as swelling, variable vessels calibre, patchy or diffuse haemorrhage occurring within first week and resolving by fourth postoperative week. Graft vessels anastomose with vessels in surrounding conjunctiva and underlying episclera to re-establish blood circulation. Retraction of graft edges from surrounding conjunctiva was uncommon with rapid epithelialization of exposed (epi)sclera. CONCLUSION Conjunctival autografts in pterygium surgery follow a consistent healing pattern dominated by re-perfusion injury in early postoperative days. This produces dramatic changes in the autograft for which patients should be counselled before surgery. Conjunctival autografts are not at risk of falling off, losing epithelial cover or undergoing necrosis.
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Affiliation(s)
- Noha Ghoz
- Academic Section of Ophthalmology; Division of Clinical Neuroscience; University of Nottingham; Nottingham UK
- Department of Ophthalmology; Nottingham University Hospitals; NHS Trust; Nottingham UK
| | - Mohamed Elalfy
- Academic Section of Ophthalmology; Division of Clinical Neuroscience; University of Nottingham; Nottingham UK
- Department of Ophthalmology; Nottingham University Hospitals; NHS Trust; Nottingham UK
| | - Dalia Said
- Academic Section of Ophthalmology; Division of Clinical Neuroscience; University of Nottingham; Nottingham UK
- Department of Ophthalmology; Nottingham University Hospitals; NHS Trust; Nottingham UK
| | - Harminder Dua
- Academic Section of Ophthalmology; Division of Clinical Neuroscience; University of Nottingham; Nottingham UK
- Department of Ophthalmology; Nottingham University Hospitals; NHS Trust; Nottingham UK
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Lan A, Xiao F, Wang Y, Luo Z, Cao Q. Efficacy of fibrin glue versus sutures for attaching conjunctival autografts in pterygium surgery: a systematic review with meta-analysis and trial sequential analysis of evidence. Oncotarget 2018; 8:41487-41497. [PMID: 28489563 PMCID: PMC5522296 DOI: 10.18632/oncotarget.17195] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/05/2017] [Indexed: 11/25/2022] Open
Abstract
Previous meta-analyses have been conducted to compare the efficacy of fibrin glue (FG) versus sutures in pterygium surgery; however, additional clinical trials have since been published. Therefore, we conducted an updated meta-analysis to further explore the association between FG application in pterygium surgery, and the recurrence rate, complication rate, and surgical duration. An electronic literature search for eligible studies published before July 29, 2016 was conducted across multiple databases. Odds ratios (ORs), standardized mean difference (SMD), and 95% confidence intervals (CI) were calculated. Publication bias of the included articles was evaluated by funnel plots. Differences in recurrence rate and complication rate between the FG and suture groups were evaluated in terms of OR with 95% CI, and SMD with 95% CI were used to estimate the difference in surgical duration. Trial sequential analysis (TSA) was used to determine whether the currently available evidence was sufficient and conclusive. Twenty-four studies were included in this study. The pooled ORs for recurrence rate and complication rate were 0.35 and 1.121, respectively. The pooled SMD for surgical duration was −4.142. The TSA results indicated that evidence of the effect was sufficient in the recurrence group and surgical duration group. Although there was no difference in complication rate between FG and sutures, the apparent advantages of FG over sutures are shorter surgical duration and greater reduction in the recurrence rate of pterygium.
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Affiliation(s)
- Aihua Lan
- First Clinical Academy, Guangxi Medical University, Nanning, Guangxi, China
| | - Feifan Xiao
- First Clinical Academy, Guangxi Medical University, Nanning, Guangxi, China
| | - Yun Wang
- Department of Ophthalmology, Ningbo Eye Hospital, Ningbo, Zhejiang, China
| | - Zhen Luo
- Department of Ophthalmology, Liuzhou Worker's Hospital, Liuzhou, Guangxi, China
| | - Qixin Cao
- Department of Ophthalmology, Huzhou Hospital of Traditional Chinese Medicine, Huzhou, Zhejiang, China
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Kodavoor SK, Ramamurthy D, Solomon R. Outcomes of pterygium surgery-glue versus autologous blood versus sutures for graft fixation-an analysis. Oman J Ophthalmol 2018; 11:227-231. [PMID: 30505112 PMCID: PMC6219338 DOI: 10.4103/ojo.ojo_4_2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIM: The aim of this study is to compare the surgical outcomes of pterygium excision with conjunctival autograft using sutures, fibrin glue (tisseel), and autologous blood for the management of primary pterygium. PATIENTS AND METHODS: A retrospective study done in 681 eyes with primary nasal pterygium. Excision of the pterygium was performed followed by closure of the bare sclera with conjunctival autograft using interrupted 10-0 monofilament nylon sutures in 173 eyes (Group 1), fibrin glue (tisseel-baxter healthcare corporation, westlake village, ca-91362 USA) in 351 eyes (Group 2), and autologous blood in 157 eyes (Group 3). Patients were followed up for a period of 5–52 months. During follow-up, graft-related complications such as recurrence, graft loss, graft retraction, granuloma if any were noted and compared among the three groups. RESULTS: A total of 681 eyes who had primary nasal pterygium were included in this study. Pterygium excision with conjunctival autograft was performed using 10-0 monofilament nylon interrupted sutures in 173 eyes (25.4%), tisseel fibrin glue in 351 eyes (51.54%), and autologous blood in 157 (23.05%) eyes. The mean duration of follow-up was 5–52 months. The overall recurrence rate was 2.9% (20 eyes). In Group 1, recurrence was seen in 5 eyes (2.89%), in Group 2, it was seen in 7 eyes (1.99%) and in Group 3, 8 eyes (5.10%). However, the recurrence rate was not significant (P = 0.160). The rate of graft retraction in the 3 study groups were 12 eyes (6.94%), 10 eyes (2.85%), and 56 eyes (35.67%) with a significant P < 0.001. Granuloma was seen in 2 eyes (1.16%), in Group 1, and in 1 eye (0.64%) in Group 3. Graft loss was seen in 3 eyes (1.73%), 4 eyes (1.14%), 6 eyes (3.82%) in Group 1, 2, and 3, respectively. CONCLUSION: The outcomes of the three most commonly performed surgical technique of conjunctival autograft fixation has shown us that all three techniques are equally comparable and can be offered to our patients with equally good results.
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Affiliation(s)
| | | | - Raline Solomon
- Department of Cornea, The Eye Foundation Hospital, Coimbatore, Tamil Nadu, India
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Recurrence Rate and Graft Stability With Fibrin Glue Compared With Suture and Autologous Blood Coagulum for Conjunctival Autograft Adherence in Pterygium Surgery: A Meta-Analysis. Cornea 2017; 36:1285-1294. [DOI: 10.1097/ico.0000000000001270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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8
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Surgical techniques and adjuvants for the management of primary and recurrent pterygia. J Cataract Refract Surg 2017; 43:405-419. [DOI: 10.1016/j.jcrs.2017.03.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 08/03/2016] [Indexed: 01/31/2023]
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Bondalapati S, Ambati B. Minimally Invasive Pterygium Surgery: Sutureless Excision with Amniotic Membrane and Hydrogel Sealant. Case Rep Ophthalmol 2016; 7:79-84. [PMID: 26933434 PMCID: PMC4772609 DOI: 10.1159/000444076] [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] [Indexed: 11/19/2022] Open
Abstract
Purpose To describe a novel technique for sutureless pterygium surgery using ReSure® tissue sealant. Methods In this retrospective observational case series, we describe a modified procedure for pterygium excision followed by amniotic membrane transplant (AMT) adhered to the corneal and conjunctival defects using ReSure tissue sealant. Results Nine eyes of seven patients (age range: 28–80 years, 4 females and 3 males) underwent pterygium removal with AMT followed by adherence of tissue to the conjunctival edges with ReSure. No issues with transplant dislocation or failure and no intra- or postoperative complications were noted. No recurrences were noted during the follow-up period. Conclusion ReSure may be considered as a potential sealant to adhere AMT to defective corneal and conjunctival tissues in sutureless pterygium surgery.
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Affiliation(s)
- Sailaja Bondalapati
- Medical student Research Fellow, University of Utah, Salt Lake City, Utah, USA
| | - Balamurali Ambati
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
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Boucher S, Conlon R, Teja S, Teichman JC, Yeung S, Ziai S, Baig K. Fibrin glue versus autologous blood for conjunctival autograft fixation in pterygium surgery. Can J Ophthalmol 2015; 50:269-72. [DOI: 10.1016/j.jcjo.2015.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/15/2015] [Indexed: 01/10/2023]
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12
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Nugent RB, Lee GA. Ophthalmic use of blood-derived products. Surv Ophthalmol 2015; 60:406-34. [PMID: 26077627 DOI: 10.1016/j.survophthal.2015.03.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 03/23/2015] [Accepted: 03/25/2015] [Indexed: 12/23/2022]
Abstract
There is a wide spectrum of blood-derived products that have been used in many different medical and surgical specialties with success. Blood-derived products for clinical use can be extracted from autologous or allogeneic specimens of blood, but recombinant products are also commonly used. A number of blood derivatives have been used for a wide range of ocular conditions, from the ocular surface to the retina. With stringent preparation guidelines, the potential risk of transmission of blood-borne diseases is minimized. We review blood-derived products and how they are improving the management of ocular disease.
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Affiliation(s)
| | - Graham A Lee
- City Eye Centre, Brisbane, Queensland, Australia; Department of Ophthalmology, University of Queensland, Brisbane, Queensland, Australia.
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Toker E, Eraslan M. Recurrence After Primary Pterygium Excision: Amniotic Membrane Transplantation with Fibrin Glue Versus Conjunctival Autograft with Fibrin Glue. Curr Eye Res 2015; 41:1-8. [PMID: 25849961 DOI: 10.3109/02713683.2014.999947] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim of the present study was to compare the surgical results and recurrence rates of primary pterygium excision with conjunctival autografts versus amniotic membrane grafts fixated with fibrin glue. MATERIALS AND METHODS In this prospective study, 73 eyes of 65 patients who had undergone conjunctival autograft group (CAG) (n:37) or amniotic membrane group (AMG) (n:36) after pterygium excision were evaluated. Fibrin glue was used for the fixation of grafts in both groups. The patients were followed up for 12 months. Postoperative complications were recorded. The rate of recurrence was defined as the primary outcome measure. RESULTS In the CAG, partial dehiscence of the graft was observed on the nasal edge on postoperative day 1 in two (5.4%) eyes that healed with secondary re-epithelialization at week 1. Twelve (32.4%) eyes showed a yellowish-orange or hemorrhagic edema of the graft on postoperative day 7 that spontaneously resolved in 1 to 3 weeks. In the AMG, partial dehiscence and folding of the amniotic membrane occurred in two (5.5%) eyes. Two eyes (5.4 %) in the CAG developed corneal recurrence and five eyes (13.8%) in the amniotic membrane graft group developed recurrence; one limbal (2.7%), four corneal recurrences (11.1%) (p = 0.25). CONCLUSION Fibrin glue is a safe and effective method for attaching conjunctival or amniotic membrane grafts for wound closure following pterygium surgery. Although the results were not statistically significant, amniotic membrane grafting using fibrin glue seems to have a higher pterygium recurrence rate compared with conjunctival autografting.
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Affiliation(s)
- Ebru Toker
- a Department of Ophthalmology , Marmara University Medical School , Istanbul , Turkey
| | - Muhsin Eraslan
- a Department of Ophthalmology , Marmara University Medical School , Istanbul , Turkey
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Yeung SN, Rubenstein D, Price AJ, Elbaz U, Zhang AQ, Côté E, Slomovic AR. Sequential pterygium excision with conjunctival autograft in the management of primary double-headed pterygia. Can J Ophthalmol 2014; 48:521-3. [PMID: 24314415 DOI: 10.1016/j.jcjo.2013.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 05/12/2013] [Accepted: 05/23/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy of sequential pterygium excision with conjunctival autograft (PECA) in the management of double-headed pterygia. METHODS All patients who underwent a sequential PECA procedure for double-headed pterygia from 2004 to 2009 were included in this retrospective, noncomparative, interventional case series. The recurrence rate and visual outcomes after this procedure were determined. RESULTS Nine eyes of 8 patients with doubled-headed pterygia undergoing sequential PECA were identified. Of 18 PECA procedures, 1 recurrence (5.56%) was found. The single recurrence was observed nasally in the right eye (first site operated) of a female patient 55 months after the second PECA procedure. None of the operated eyes lost any lines of corrected distance visual acuity, and 22% gained at least 1 line of corrected distance visual acuity. CONCLUSIONS In this series, harvesting the conjunctival autograft from the same site several months later does not appear to increase the rate of recurrence. Sequential PECA is a safe and effective method of addressing double-headed pterygia.
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Affiliation(s)
- Sonia N Yeung
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, B.C.; Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Toronto, Ont.
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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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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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Cagatay HH, Gokce G, Ekinci M, Koban Y, Daraman O, Ceylan E. Long-term comparison of fibrin tissue glue and vicryl suture in conjunctival autografting for pterygium surgery. Postgrad Med 2014; 126:97-103. [PMID: 24393756 DOI: 10.3810/pgm.2014.01.2729] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Pterygium is a common clinical entity that usually causes visual impairment, astigmatism and cosmetic problems. Although many surgical techniques to treat pterygium have been proposed, no single method, with minimal patient complications, has yet been accepted and established. Excision combined with conjunctival autograft is the most often used procedure for the treatment of primary pterygium, and the technique is associated with minimized recurrence rates in patients. The purpose of our study was to compare visual and refractive outcomes, complications, and recurrence rates with the use of fibrin glue versus 8.0 vicryl suture in pterygium surgery performed with conjunctival autograft. MATERIALS AND METHODS Our retrospective, comparative study included 106 eyes of 106 patients operated on for primary pterygium, between the years 2011 and 2012, and followed for ≥ 12 months. Patients were divided into 2 treatment groups: Group 1, vicryl suture use (n = 53), and Group 2, fibrin tissue glue (n = 53). Patient follow-up periods were 21.15 ± 5.3 months for Group 1 and 22.06 ± 5.2 months for Group 2. RESULTS Demographics and preoperative/follow-up clinical characteristics of patients revealed no significant differences between the 2 patient groups. Additionally, no significant differences were found between the patient groups in visual acuity level changes and refractive values. Although the rates of recurrence (7.5% in Group 1 and 1.9% in Group 2; P = 0.36) and graft dehiscence (Group 1, 7.5% compared with Group 2, 3.8%; P = 0.67) were slightly higher for patients in the suture group, differences did not reach significance. CONCLUSIONS Our study results suggest that conjunctival autografting with fibrin glue has favorable visual and refractive results for patients, and is associated with lower complication rates, compared with use of the traditional 8.0 vicryl suturing technique. We suggest that fibrin tissue glue provides adequate adhesion and that graft loss will not be a problem if protective shields are used in patients postoperatively. The appropriate surgery technique should be selected by considering the advantages and disadvantages of each procedure.
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Affiliation(s)
- Halil Huseyin Cagatay
- Assistant Professor, Kafkas University, Faculty of Medicine, Department of Ophthalmology, Kars, Turkey
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Salagar KM, Biradar KG. Conjunctival autograft in primary and recurrent pterygium: a study. J Clin Diagn Res 2013; 7:2825-7. [PMID: 24551648 DOI: 10.7860/jcdr/2013/7383.3767] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 10/08/2013] [Indexed: 11/24/2022]
Abstract
AIM Investigate the efficiency of limbal conjunctival autograft in primary and recurrent pterygium. (2) To report the incidence of recurrence after primary and recurrent pterygium surgery using limbal conjunctival autograft. MATERIAL AND METHODS It is a prospective study conducted at Department of Ophthalmology, Basaveshwar Teaching and General Hospital, Gulbarga Karnataka, India for a period of 1 year (2007 to 2008) 100 patients were operated of which 6 were recurrent pterygium and the remaining were fleshy pterygium. All patients were in age group 20 to 60 and above. RESULTS In this study 7% cases were in age group 20 to 30 years, 22% 31 to 40 years, 30% 41 to 50 years, 24% 51 to 60 years and 17% 60 and above. (2) Depending on occupation high incidence is seen in outdoor patients i.e., 80%, indoor 20%. (3) Depending on location, 50% nasal, 30% temporal, bilateral 20%. (4) Laterality - Right eye 52%, left eye 38%, bilateral 10%. (5) Recurrence - More common in younger patients < 40 age 6 patients developed recurrence. CONCLUSION Autogenous conjunctival grafting is a safe, uncomplicated, quick procedure and does not involve loss of tissue and prevents recurrence of pterygium. It also reduces the risk of granuloma formation, scleral thinning and necrosis.
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Affiliation(s)
- Kavita Mallikarjun Salagar
- Assistant Professor, Department of Ophthalmology, Basaveshwar Teaching and General Hospital , Gulbarga, Karnataka, India
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The influence of pterygium morphology on fibrin glue conjunctival autografting pterygium surgery. Int Ophthalmol 2013; 34:75-9. [DOI: 10.1007/s10792-013-9799-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/18/2013] [Indexed: 10/26/2022]
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Shehadeh-Mashor R, Srinivasan S, Boimer C, Lee K, Tomkins O, Slomovic AR. Management of recurrent pterygium with intraoperative mitomycin C and conjunctival autograft with fibrin glue. Am J Ophthalmol 2011; 152:730-2. [PMID: 21742307 DOI: 10.1016/j.ajo.2011.04.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 04/27/2011] [Accepted: 04/29/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of using fibrin glue in cases of recurrent pterygium treated with pterygium excision and conjunctival autograft combined with mitomycin C. DESIGN Retrospective, interventional case series. METHODS The charts of 28 patients with recurrent pterygium who had undergone pterygium excision and conjunctival autograft using fibrin glue to secure the graft combined with intraoperative mitomycin C at a corneal service in a university teaching hospital were reviewed. Inclusion criteria were recurrent pterygium that had undergone at least 1 previous surgical excision and patients who had completed a regular postoperative follow-up of at least 12 months. Outcome measures included mean best-corrected visual acuity (BCVA) and intraoperative and postoperative complications. RESULTS The mean age of the cohort was 49.7 years. There were no intraoperative complications. Early postoperative total graft dehiscence developed in 1 eye that underwent repositioning with glue and sutures. One eye had mild graft dehiscence and required no surgical intervention. One eye had a conjunctival cyst on the graft that did not require intervention. No significant change was observed in BCVA. At a mean follow-up of 26.5 months, there was 1 case of recurrence. CONCLUSIONS Pterygium excision and conjunctival autograft using fibrin glue to secure the graft combined with intraoperative mitomycin C seems to be a safe and effective surgical option for treating recurrent pterygium. However, a larger cohort with longer follow-up may be required to assess the recurrence rate of this method.
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Mahdy RA, Wagieh MM. Safety and efficacy of fibrin glue versus vicryl sutures in recurrent pterygium with amniotic membrane grafting. Ophthalmic Res 2011; 47:23-6. [PMID: 21691139 DOI: 10.1159/000328629] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 04/08/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE The study aimed to compare surgical outcomes with likely toxic side effects when using pterygium excision and amniotic membrane grafting with fibrin glue versus Vicryl sutures. METHOD This is a prospective randomized study. Patients were classified into two groups: group 1 consisted of 20 patients with Vicryl-sutured grafts, and group 2 consisted of 20 patients with fibrin-glued grafts that were prepared from autologous blood. Results including surgery time, patient discomfort, complications and recurrence rates within 1, 6 and 12 months were analyzed. RESULTS The study demonstrated that there was a statistically significant decrease in surgery time in the fibrin glue group (the procedure took 17 min) relative to the sutured group (28 min; p < 0.05). Additionally, both postoperative pain and discomfort were noted significantly less often in the fibrin glue group. Complications were also decreased in the fibrin glue group. CONCLUSION The study revealed that the use of fibrin glue in pterygium surgery with amniotic membrane grafting was safer, less toxic and less time-consuming, and resulted in fewer complications than graft surgery with sutures.
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Affiliation(s)
- Reda A Mahdy
- Department of Ophthalmology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
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Comparison of Fibrin Glue versus Suture for Conjunctival Autografting in Pterygium Surgery: A Meta-Analysis. Ophthalmology 2011; 118:1049-54. [DOI: 10.1016/j.ophtha.2010.10.033] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 10/21/2010] [Accepted: 10/21/2010] [Indexed: 11/23/2022] Open
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Marques M, Brown SA, Cordeiro NDS, Rodrigues-Pereira P, Cobrado ML, Morales-Helguera A, Queirós L, Luís A, Freitas R, Gonçalves-Rodrigues A, Amarante J. Effects of coagulase-negative staphylococci and fibrin on breast capsule formation in a rabbit model. Aesthet Surg J 2011; 31:420-8. [PMID: 21551433 DOI: 10.1177/1090820x11404400] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The etiology and ideal clinical treatment of capsular contracture (CC) remain unresolved. Bacteria, especially coagulase-negative staphylococci, have been previously shown to accelerate the onset of CC. The role of fibrin in capsule formation has also been controversial. OBJECTIVE The authors investigate whether fibrin and coagulase-negative staphylococci (CoNS) modulate the histological, microbiological, and clinical outcomes of breast implant capsule formation in a rabbit model and evaluate contamination during the surgical procedure. METHODS Thirty-one New Zealand white female rabbits were each implanted with one tissue expander and two breast implants. The rabbits received (1) untreated implants and expanders (control; n = 10), (2) two implants sprayed with 2 mL of fibrin and one expander sprayed with 0.5 mL of fibrin (fibrin; n = 11), or (3) two implants inoculated with 100 µL of a CoNS suspension (10(8)CFU/mL-0.5 density on the McFarland scale) and one expander inoculated with a CoNS suspension of 2.5 × 10(7) CFU/mL (CoNS; n = 10). Pressure/volume curves and histological and microbiological evaluations were performed. Operating room air samples and contact skin samples were collected for microbiological evaluation. The rabbits were euthanized at four weeks. RESULTS In the fibrin group, significantly decreased intracapsular pressures, thinner capsules, loose/dense (<25%) connective tissue, and negative/mild angiogenesis were observed. In the CoNS group, increased capsular thicknesses and polymorph-type inflammatory cells were the most common findings. Similar bacteria in capsules, implants, and skin were cultured from all the study groups. One Baker grade IV contracture was observed in an implant infected with Micrococcus spp. CONCLUSIONS Fibrin was associated with reduced capsule formation in this preclinical animal model, which makes fibrin an attractive potential therapeutic agent in women undergoing breast augmentation procedures. Clinical strategies for preventing bacterial contamination during surgery are crucial, as low pathogenic agents may promote CC.
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Affiliation(s)
- Marisa Marques
- Hospital de Sao Joao, Servico de Cirurgia Plastica, Porto, Portugal.
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The role of radiotherapy in the treatment of pterygium: A review of the literature including more than 6000 treated lesions. Cancer Radiother 2011; 15:140-7. [DOI: 10.1016/j.canrad.2010.03.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 03/11/2010] [Accepted: 03/23/2010] [Indexed: 11/20/2022]
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Recurrence rate using fibrin glue-assisted ipsilateral conjunctival autograft in pterygium surgery: 2-year follow-up. Cornea 2011; 29:1211-4. [PMID: 20697275 DOI: 10.1097/ico.0b013e3181d5d96d] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS To determine the recurrence rate after pterygium excision with ipsilateral conjunctival autograft using fibrin glue. METHODS One hundred eleven eyes of 92 patients operated for primary pterygium were retrospectively evaluated for recurrence rate and intraoperative and postoperative complications. Pterygia were preoperatively divided in atrophic/grade 1 (n = 2; 1.80%), intermediate/grade 2 (n = 85; 76.58%), or fleshy/grade 3 (n = 24; 21.62%) types. All patients were operated using an ipsilateral conjunctival autograft fixed with fibrin glue. Only patients with 2-year follow-up were included in this study. RESULTS Two years after surgery, the mean recurrence rate was 4.50% (n = 5). No intraoperative complications were noted. Postsurgical complications were graft pseudoedema (n = 45; 40.54%), graft retraction (n = 3; 2.70%), and donor site granuloma (n = 1; 0.90%). CONCLUSION Fibrin glue-assisted ipsilateral conjunctival autograft seems to be safe and efficacious and associated with a low rate of recurrence.
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Ropivacaine for topical anesthesia in pterygium surgery with fibrin glue for conjunctival autograft. Cornea 2011; 29:375-6. [PMID: 20164749 DOI: 10.1097/ico.0b013e3181ba7061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate efficacy of ropivacaine 1% for topical anesthesia in pterygium surgery with conjunctival autograft using fibrin glue for attaching the graft to the bare sclera. METHODS Thirty-seven patients affected by primary pterygium underwent surgical excision under topical anesthesia with ropivacaine 1%. We performed a surgical approach with dissection of the pterygium, scraping of corneal bed with a motorized burr, meticulous excision of underlying Tenon's capsule, preparation of a free autologous conjunctival graft in the superior sector, excision of the graft, and position of the same to cover the scleral bed exposed in the nasal area with respect to limbus and stromal orientation fixing the graft with fibrin glue. RESULTS It was possible to perform all the procedures without any supplemental anesthesia and sedation. The pain reported by patients, recorded by a 0 to 10 scale, was low during the entire surgery. The technique with conjunctival autograft using a fibrin sealant allowed for short operative times and good aesthetic and functional results. CONCLUSIONS Topical anesthesia with ropivacaine is safe and effective in pterygium surgery. The Long-lasting anesthesia with this agent permitted performing our surgical procedures with autograft conjunctival graft and fibrin glue to attach the flap with low pain perceived by our patients, low surgical invasivity, and short duration of surgery.
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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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