Ocular Discomfort in Pterygium Patients

The Effect of a Novel Strategy in Treating Primary Pterygium: A Prospective Randomized Clinical Study

OBJECTIVE

We sought to compare the efficacy and safety of conjunctival autograft (CAG), amniotic membrane transplantation (AMT) with postoperative interferon alfa-2b (IFN alfa-2b), and modified conjunctival autograft plus amniotic membrane transplantation (mCAG plus AMT) with postoperative IFN alfa-2b for primary pterygium.

DESIGN

Randomized controlled clinical trial.

METHODS

Eyes with nasal and primary pterygia were randomized in a 1:1:1 ratio to receive CAG, AMT with IFN alfa-2b, or mCAG plus AMT with IFN alfa-2b. Subjects were followed up for 12 months. Primary outcomes included recurrence rate and complications. Secondary outcomes included corneal epithelium status, ocular surface symptom score, and visual acuity change.

RESULTS

Eighty-five subjects (30 in the CAG group, 25 in the AMT group, and 30 in the CAG+AMT group) completed the 12-month follow-up. No complication or grade 4 recurrence was found. There was no significant difference among the 3 groups in recurrence grade, corneal epithelium status, and visual acuity change. Compared with mCAG+AMT, CAG has a negative effect (β = -0.62, P = .001), and AMT has a negative effect (β = -2.02, P < .001) on postoperative symptom scores. Compared with AMT, CAG has a positive effect (β = 1.28, P < .001) on postoperative symptom scores.

CONCLUSIONS

All 3 strategies had good safety and clinical efficacy in the study. Compared with conjunctival autograft, the 2 surgeries using no autograft or limited autograft was less traumatic and gave more flexibility for future ocular surface condition changes.

Comparison of Inferior and Superior Conjunctival Autograft for Primary Pterygium

PURPOSE

To determine the postoperative symptom by using inferior conjunctival autografting (ICA) rather than superior conjunctival autografting (SCA) after excision of pterygium.

METHODS

This prospective randomized control study evaluated 80 eyes of 80 consecutive patients undergoing primary pterygium surgery. Patients in each subgroup were then randomized into the ICA (n = 40) or SCA (n = 40) group. All patients were asked to return for follow up on days 1, 2, 3, 5, 7, and 14 then at months 1, 3, 6, and 12 postoperatively. Outcome measures were postoperative patient discomfort, corneal epithelial healing time, complications and recurrence rate.

RESULTS

Fluorescein staining revealed complete corneal epithelial healing time was 3.1 ± 0.5 d (range 2-4) in the ICA group and 3.3 ± 0.6 d (range 2-4) in the SCA group (p = 0.11). Pain scores were significantly less in the ICA group than the SCA group on follow-up days 3 and 5 (p < 0.05). Postoperative foreign body sensation scores on follow-up days 5 and 7 were significantly lower in the ICA group than the SCA group (p < 0.05). Epiphora scores were significantly less in the ICA group than the SCA group on follow-up days 3, 5, and 7 (p < 0.05). No statistically significant differences between two groups were found for the overall (conjunctival and corneal) recurrence rates (5% versus 7.5%, p = 0.64). No serious complications were encountered.

CONCLUSION

Pterygium excision with ICA led to less postoperative discomfort for patients with primary pterygium.

Threshold to predict astigmatism reduction after pterygium excision

PURPOSE

To compare corneal astigmatism after pterygium excision, using limbal-conjunctival autograft (LCA) with and without mitomycin C (MMC) and to establish a threshold for postoperative astigmatism reduction.

METHODS

Sixty-eight eyes with primary pterygium were consecutively sampled and assigned to LCA with MMC (MMC+) or LCA without MMC (MMC-). Corneal lesion length, corneal lesion area, preoperative corneal astigmatism (PRCA), and postoperative corneal astigmatism (POCA) at 1, 3, and 6 months were assessed.

RESULTS

Thirty-six men and 24 women (60 eyes), aged between 24 and 65 years (mean ± SD, 41 ± 8.2 years), completed the study. Thirty-one eyes were included in the MMC+ group and 29 were in the MMC- group. Both groups showed astigmatism reduction (p < 0.05; paired, two-tailed t test) 1 month after the surgery and remained stable. No differences were found between groups in corneal lesion length, corneal lesion area, or astigmatism results at the four time points (p > 0.05, independent t test). Preoperative corneal astigmatism showed a significant correlation with POCA at 6 months (r = 0.529; p < 0.01). According to receiver operating characteristic curve analysis, the better threshold for astigmatism reduction with the surgery was 1.05 diopters of PRCA, with 82.5% sensitivity and 80.5% specificity.

CONCLUSIONS

Both surgical procedures could have similar astigmatism results. Pterygium patients with more than 1.05 diopters of PRCA could reduce it after the surgery. Direct relationship between PRCA and POCA revealed that postoperative astigmatism reduction was partial. Therefore, for minimizing final astigmatism, preoperative values should be slightly above the threshold.