A randomised trial comparing 0.02% mitomycin C and limbal conjunctival autograft after excision of primary pterygium

Limbal-conjunctival autograft healing process-early postoperative OCT angiography study

PURPOSE

To assess the normal healing process of limbal-conjunctival autograft (LCA) after pterygium removal during the early postoperative period using anterior segment optical coherence tomography angiography (OCTA).

METHODS

Prospective case series of seven patients undergoing pterygium removal with LCA transplantation procedure, imaged with anterior segment OCTA, and anterior segment colour photos prior to the procedure and on postoperative day (POD) 1, 3, 7 and 30. Revascularization of the graft was analysed quantitatively and qualitatively to estimate patterns of blood vessel growth. Association between revascularization to graft thickness was also investigated.

RESULTS

On POD 1, all autografts showed either minimal flow signal or no signal at all (Mean 7.1 ± 3.3%). Regrowth of blood vessels into the graft was detected on OCTA scans on POD3 (8.7 ± 3.6%) to 7 (14.3 ± 4.1%), as nonorganised vessels formation in their appearance. Blood vessels were seen growing in a centrifugal pattern towards the surrounding conjunctiva, originating from the underlying episcleral vessels. Revascularization flow signal was seen throughout nearly all graft extent on day 30 (21.6 ± 2.2%). Graft oedema was evident on the first week (Mean 611 ± 120 μm, 695 ± 84 μm, 639 ± 96 μm of POD 1, 3 and 7, respectively), reducing substantially by day 30 (300 ± 108 μm).

CONCLUSIONS

OCTA imaging can be used to assess the LCA healing process during the early postoperative period. Revascularization occurring as early as 3-7 days post-surgery, seems to originate from the underlying episcleral vessels. Therefore, careful handling of the bare scleral surface during surgery may be prudent for achieving an adequate healing process.

Evaluating the Efficacy and Safety of Different Pterygium Surgeries: A Review of the Literature

The search for the "gold standard" in the surgical treatment of pterygium has been ongoing for over two decades. Despite the development of various surgical techniques, recurrence rates range from 6.7% to 88% depending on the method used. This review discusses the latest and most commonly used methods for the surgical removal of pterygium, primarily focusing on efficacy and safety. Moreover, this review includes articles that either evaluated or compared surgical methods and clinical trials for primary and recurrent pterygium. Limited data are available on combined methods as well as on the efficacy of adjuvant treatment. The use of adjuvant intraoperative mitomycin C (MMC) and conjunctival autografting (CAU) are the two most highly recommended options, as they have the lowest rates of postoperative recurrence.

Changes in corneal curvature and visual acuity in North Indian adults after pterygium excision with modified sutureless, glueless limbal-conjunctival autograft

Purpose:

To identify the exact time point during after following pterygium excision with a modified technique of sutureless, glueless limbal-conjunctival autograft, when stabilization of the change in corneal curvature is achieved; correlate size of pterygium with uncorrected visual acuity and astigmatism at baseline, and assess changes in these parameters postoperatively over time.

Methods:

This prospective study longitudinally assessed 30 eyes of 30 north Indian adults with primary pterygium encroaching upon ≥1 mm of the cornea pre- and postoperatively at 1 week and then monthly for 4 months, recording uncorrected (UCVA) and best-corrected logMAR visual acuity, astigmatism and keratometry. Results were analyzed using ANOVA, Mauchly’s test of sphericity with Greenhouse–Geisser correction, and post-hoc test using Bonferroni correction. Pearson’s correlation coefficient r > 0.5 was considered clinically significant, and P < 0.05 statistically significant.

Results:

Pterygium size was well correlated with pre-operative astigmatism (r = 0.867, P < 0.001) and pre-operative UCVA (r = 0.856, P < 0.001). There was mean improvement of 0.43 logMAR units of visual acuity (P < 0.00001), a mean increase of 0.79D of keratometric value for the flatter meridian (P < 0.00001) and a mean reduction of 2.00D of astigmatism (P < 0.00001). At 2-month follow-up, the keratometric value for the flatter meridian approached the final keratometric reading at 4 months such that the difference was not significant (t = 1.185, P = 0.245). There were no significant complications or recurrence during the follow-up period.

Conclusion:

Pterygium excision with modified autograft reduced corneal astigmatism and improved visual acuity comparable to classical technique. Alteration in corneal curvature stabilizes 2 months after surgery, when spectacle correction can be given to patients.

Profile of complications in pterygium surgery - A retrospective analysis

Purpose:

Analysis of complication profile after pterygium excision, in primary and recurrent pterygia.

Methods:

Retrospective analysis of all the patients who had undergone pterygium excision in a tertiary center in South India from 2010 to 2018 was analyzed. A total of 2356 eyes in 2028 patients were included in the study. Patients who had undergone conjunctival autografting for primary pterygium, conjunctival limbal autografting for recurrent pterygium, vertical split conjunctival autografting for double head pterygium were included in the study. In all the surgical procedures fibrin glue was used for fixation of the autograft. The follow-up period ranged from 6 months to 75 months, with an average of 17 months. Patients with less than 6 months of follow-up were excluded from the study.

Results:

The following postoperative complications were noted, Sub-conjunctival hemorrhage in 912 eyes (38.7%), edema of the graft in 522 cases (22.15%), graft loss in 22 cases (0.93%), graft retraction in 692 cases (29.37%) and sliding of the graft was seen in 9 cases (0.38%). Granuloma was seen in 4 cases (0.16%) at the host site and 5 cases (0.21%) at the donor site. Recurrence was seen in 34 patients (1.44%). Other severe complications like corneal melt were seen in only 1 case (0.04%) who was operated on for recurrent pterygium. In comparison between primary and recurrent pterygia; subconjunctival hemorrhage, edema of the graft, graft loss, and recurrence was significantly (P < 0.05%) higher in recurrent pterygia.

Conclusion:

Various complications can occur post pterygium surgery as listed above. Selecting a proper procedure for a particular type of pterygium with a proper graft fixation technique will improve the outcome with minimal complications.

Recurrence rate with inferior conjunctival autograft transplantation compared with superior conjunctival autograft transplantation in pterygium surgery: a meta-analysis

Background

Conjunctival autograft transplantation from superior conjunctiva is often chosen to lower the postoperative recurrence rate for pterygium treatment. However, inferior conjunctival autograft (ICA) might be taken as an alternative surgery method, especially under certain conditions. Consequently, we designed this research to estimate and contrast the result of inferior conjunctival autograft and superior conjunctival autograft (SCA) on the postoperative recurrence rate.

Methods

We searched through network database (PubMed, Embase and Cochrane Central Register of Controlled Trials) to choose suitable randomized controlled trials (RCTs). Based on Cochrane review methods, we evaluated eligibility and risk of bias of included studies. The primary measures included postoperative recurrence rate. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were assessed. RevMan 5.3 software was utilized to conduct statistical analysis.

Results

Four RCTs composed of a total of 438 eyes were included in this meta-analysis, with 234 eyes in the inferior conjunctival autograft group and 204 eyes in the superior conjunctival autograft group. Statistical meta-analysis revealed that the postoperative recurrence rate was similar between the two groups (RR = 0.77, 95% CI: 0.36 to 1.62, P = 0.49). Only two RCTs applied the postoperative pain scale and one of them did not provided adequate numbers.

Conclusions

Our meta-analysis indicated that inferior autograft transplantation and superior autograft transplantation had a similar effect on postoperative recurrence rate. The inferior autograft group might have a less postoperative pain. Subsequent RCTs which have more patients participated and more outcomes are needed to confirm our conclusions in years to come.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-021-01889-4.

Targeted delivery of mitomycin C-loaded and LDL-conjugated mesoporous silica nanoparticles for inhibiting the proliferation of pterygium subconjunctival fibroblasts

Pterygium is a degenerative disease that characterized by excessive fibrovascular proliferation. To reduce the recurrence rate, surgery is the main strategy, in combination with adjacent procedures or adjunctive therapy. One of the most common adjunctive agents, mitomycin C (MMC), is known as an alkylating agent that inhibits fibroblast proliferation but is limitedly applied in pterygium due to various complications. A previous study demonstrated that activated pterygium subconjunctival fibroblasts overexpressed low-density lipoprotein (LDL) receptors. In this study, we designed and synthesized MMC-loaded mesoporous silica nanoparticles conjugated with LDL (MMC@MSNs-LDL) to deliver MMC into activated pterygium fibroblasts in a targeted manner. The MMC loading efficiency was approximately 6%. The cell viability test (CCK-8 assay) revealed no cytotoxicity for the empty carrier MSNs at a concentration of ≤1 mg/ml after administration for 48 h in subconjunctival fibroblasts. Primary pterygium and normal human subconjunctival fibroblasts with or without stimulation by vascular endothelial growth factor (VEGF) were treated as follows: 1) 10 μg/ml MMC@MSNs-LDL for 24 h (MMC concentration: 0.6 μg/ml); 2) 0.2 mg/ml MMC for 5 min then cultured for 24 h after MMC removal; and 3) normal culture without any drug treatment. At 24 h, the anti-proliferative effect of MMC@MSNs-LDL in activated pterygium fibroblasts was similar to that of MMC (cell viability: 46.2 ± 5.5% vs 40.5 ± 1.1%, respectively, P = 0.349). Furthermore, the cytotoxicity of MMC@MSNs-LDL to normal fibroblasts with or without VEGF stimulation was significantly lower than that of traditional MMC (cell viability: 75.6 ± 4.4% vs 36.0 ± 1.5%, respectively, P < 0.001; 84.7 ± 5.5% vs 35.7 ± 1.3%, P < 0.001). The binding of fluorescently labeled MMC@MSNs-LDL in fibroblasts was assessed using confocal fluorescence microscopy. The uptake of targeted nanoparticles in fibroblasts was time dependent and saturated at 6 h. VEGF-activated pterygium fibroblasts showed more uptake of MMC@MSNs-LDL than normal fibroblasts with or without VEGF activation (both P < 0.001). Our data strongly suggest that MMC@MSNs-LDL had an effective antiproliferative role in activated pterygium fibroblasts, with reduced toxicity to normal fibroblasts compared to traditional application of MMC. LDL-mediated drug delivery might have great potential in the management of pterygium recurrence.

Fifteen-year results of a randomized controlled trial comparing 0.02% mitomycin C, limbal conjunctival autograft, and combined mitomycin C with limbal conjunctival autograft in recurrent pterygium surgery

PURPOSE

To compare the long-term outcomes of recurrent pterygium surgery between three different techniques.

METHODS

We performed a 15-year follow-up study of a randomized controlled study on surgical management of recurrent pterygium. Group 1 received limbal conjunctival autograft (LCAU); group 2 received intraoperative mitomycin C (MMC) 0.02% for 5 min; and group 3 received combined LCAU + MMC 0.02% for 5 min. Consecutive patients enrolled in the original study (from April 2001 to March 2003) were invited back for a detailed clinical examination to document the long-term outcomes. The main outcome measures included the recurrence rate, residual conjunctival bed status, and complications from any of the surgical methods.

RESULTS

Sixty-two patients were recruited in the original study. Eight patients had passed away and 12 patients were uncontactable or not responded. One patient who had bilateral operations refused to return for follow-up and one eye had insufficient data for analysis. Finally, 40 eyes of 40 patients were included for analyses. One eye developed a recurrence over 15 years and none required a tertiary pterygium operation. The patient received LCAU for a temporal recurrent pterygium developed a 2.2-mm recurrence.

CONCLUSIONS

All three techniques yielded favorable outcomes for patients with recurrent pterygium. The use of LCAU was associated with better cosmetic outcome.

Identification and Interaction Analysis of Significant Genes and MicroRNAs in Pterygium

PURPOSE

MiRNAs have been widely analyzed in the occurrence and development of many diseases, including pterygium. This study aimed to identify the key genes and miRNAs in pterygium and to explore the underlying molecular mechanisms.

METHODS

MiRNA expression was initially extracted and pooled by published literature. Microarray data about differentially expressed genes was downloaded from Gene Expression Omnibus (GEO) database and analyzed with the R programming language. Functional and pathway enrichment analyses were performed using the database for Annotation, Visualization and Integrated Discovery (DAVID). The protein-protein interaction network was constructed with the STRING database. The associations between chemicals, differentially expressed miRNAs, and differentially expressed genes were predicted using the online resource. All the networks were constructed using Cytoscape.

RESULTS

We found that 35 miRNAs and 301 genes were significantly differentially expressed. Functional enrichment analysis showed that upregulated genes were significantly enriched in extracellular matrix (ECM) organization, while downregulated genes were mainly involved in cell death and apoptotic process. Finally, we concluded the chemical-gene affected network, miRNA-mRNA interacted networks, and significant pathway network.

CONCLUSION

We identified lists of differentially expressed miRNAs and genes and their possible interaction in pterygium. The networks indicated that ECM breakdown and EMT might be two major pathophysiological mechanisms and showed the potential significance of PI3K-Akt signalling pathway. MiR-29b-3p and collagen family (COL4A1 and COL3A1) might be new treatment target in pterygium.

Early postoperative outcomes of pterygium surgery: Sutures versus autogenous serum in-situ fixation of limbal conjunctival autograft

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.

Clinical results for combination of fibrin glue and nasal margin suture fixation for attaching conjunctival autografts after pterygium excision in Chinese pterygium patients

This study was designed to compare postoperative complications and postoperative discomfort when using glue combined with nasal margin suture fixation versus fibrin glue or sutures alone to attach conjunctival autografts among Chinese patients during pterygium excisions.We analyzed the medical records of 150 eyes of 150 patients with primary pterygium, in which the autografts were secured by 3 different methods after pterygium excision: 50 eyes were secured with fibrin glue, 50 eyes were secured with glue + nasal sutures, and 50 eyes were secured with sutures. The more than 6 months of follow-up observation data included postoperative complications (graft loss/displacement, dehiscence, proliferative granuloma, inflammation, and hemorrhage), recurrence, and postoperative discomfort. A logistic regression procedure was conducted to evaluate the relationship between graft complications and the pterygium grade.Graft loss/displacement occurred in 3 patients (6%) in the glue group. Graft dehiscence occurred in 8 patients (16%) in the glue group (P < .001), with 2 developing into proliferative granuloma, compared with none in the glue + nasal sutures group and the sutures group at the 3-month postoperative follow-up. Pterygium recurrence occurred in 1 patient (2.2%) in the glue group and 2 patients (4.4%) in the sutures group, compared with none in the glue + nasal sutures group at the 6 to 9 month postoperative follow-up (P = .315). There were fewer postoperative symptoms (pain, foreign body sensation, and tearing) at days 1 and 7 in the fibrin glue and glue + nasal sutures groups than in the sutures group (P < .01). The pterygium grade was a significant risk factor for graft complications (Odd ratio, OR: 5.98, Confidence interval, CI: 1.193-29.992, P = .03) in the glue group.The modified conjunctival autograft fixation with glue + sutures on the nasal margin resulted in more stable grafts and less graft-associated complications. There was a low level of postoperative patient discomfort in the glue + sutures group. A higher grade of pterygium led to an increased rate of complications in the glue group.

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

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.

The Efficiency of Limbal Conjunctival Autografting in Pterygium Surgery

PURPOSE

To investigate the efficiency of limbal conjunctival autografting technique in pterygium surgery.

METHODS

Eighty-four eyes of 68 patients with pterygium were treated by simple excision technique and 29 eyes of 24 patients with pterygium were treated by limbal conjunctival autografting technique. The definition of recurrence was fibrovascular tissue over the limbus onto the cornea in the area of previous pterygium excision.

RESULTS

The ages of the patients were between 25 and 88. The follow-up periods ranged from 6 to 25 months. The patients treated by simple excision technique were followed up for 6 to 25 (average 15+/-6) months and the patients treated by limbal conjunctival auto-grafting technique were followed up for 7 to 24 (average 17+/-5) months. The recurrence rates were 27% (23 eyes) and 7% (2 eyes), respectively. There was a statistically significant difference in the recurrence rate between the patients who underwent simple excision and those who underwent limbal conjunctival autografting (p=0.016).

CONCLUSIONS

Limbal conjunctival autografting is an effective surgical technique for the treatment of pterygium. It has a low recurrence rate when compared with the simple excision technique.

Comparison among adjuvant treatments for primary pterygium: a network meta-analysis

PURPOSE

Pterygium is a frequent ocular disease, where the major challenge is the high level of recurrence after its surgical removal. We performed a network meta-analysis to identify, among several adjuvant treatments for primary pterygium, which is the best to prevent recurrence.

METHODS

A search was conducted using PubMed, Scientific Electronic Library Online, Latin American and Caribbean Centre on Health Sciences and Cochrane Eyes and Vision Group Trials Register between 1993 and 2015 for randomisedclinical trials (RCTs) comparing adjuvant treatments following primary pterygium surgery.

RESULTS

24 RCTs that studied 1815 eyes of 1668 patients were included and allowed direct and indirect comparison among 14 interventions through network meta-analysis. The rank from the best to worse treatment to prevent recurrence is: conjunctival autograft + ciclosporin 0.05% eye drops, bare sclera + intraoperativemitomycin C (MMC) <0.02%, bare sclera + beta therapy (2500 cGy single dose), conjunctival autograft + beta therapy (1000 cGy single dose), bare sclera + MMC 0.02% eye drops, conjunctival autograft, bare sclera + intraoperative MMC >0.02%, bare sclera + ciclosporin 0.05% eye drops, bare sclera + intraoperative 5-fluorouracil 5%, amniotic membrane transplantation, bare sclera + intraoperative MMC 0.02%, conjunctival autograft + bevacizumab 0.05% eye drops, bare sclera + bevacizumab 0.05% eye drops and bare sclera alone.

CONCLUSION

The best adjuvant treatment to prevent recurrence after primary pterygium surgery is the association of conjunctival autograft and ciclosporin 0.05% eye drops. Bare sclera technique alone should be discontinued since it is associated with high recurrence rates.

A New Conjunctival Free Flap Design Technique for Pterygium Surgery: Stamp Technique

PURPOSE

To introduce a new conjunctival free flap design technique for pterygium surgery.

PATIENTS AND METHODS

This study was a retrospective medical chart review of 20 patients (21 eyes) who underwent pterygium excision and conjunctival free flap by one surgeon. The following surgical procedures were used in conjunctival free flap design during pterygium surgery. We used the paper wrapper of 10-0 nylon, which will be used for the conjunctival suture, for making an imprint of the recipient defect. The paper was cut to an ellipsoidal shape of 2 to 3 mm larger than the recipient defect with utility scissors. The margin of the recipient defect was marked using a gentian violet pen. The paper was positioned carefully on the recipient defect and pushed down gently with a cotton tip. After removing the paper, the margin of the conjunctival defect was imprinted on the paper in the shape of a "C," The paper was cut according to the inner line of the "C" marking. The paper was placed on the superior conjunctiva. Conjunctival marking was applied according to the outline of paper with a pen.

RESULTS

The operation duration ranged from 64 min to 132 min (mean 88 min). The conjunctival free flap was identical to the recipient defect. Complications included recurrence (5%), wound dehiscence (19%), and granulation (5%).

CONCLUSIONS

We think that this stamp technique is an efficient method for designing donor conjunctiva that is identical to the defect for free conjunctival transplantation during pterygium surgery.

Comparison of 4 Techniques for Limbal-Conjunctival Autograft Fixation in Primary Pterygium Surgery

Purpose

To compare 4 limbal-conjunctival autograft fixation techniques—conventional suture, commercial fibrin glue, autologous fibrin glue, and cautery—in primary nasal pterygium surgery.

Methods

This is a retrospective and descriptive study. The postoperative patient discomfort, graft edema, ocular inflammation, and other complications of 4 limbal-conjunctival autograft fixation techniques in primary nasal pterygium surgery were evaluated.

Results

Postoperative patient discomfort was significantly lower with the sutureless techniques (p<0.001), with fixation with cautery having the lowest rate of discomfort. Graft edema and ocular inflammation during the early postoperative period were significantly higher when fibrin glue techniques were used (p<0.001). The recurrence rate did not show a statistically significant difference (p = 0.682) among the 4 groups.

Conclusion

In primary nasal pterygium surgery, limbal-conjunctival autograft fixation using cautery is the technique with the lowest postoperative discomfort rate and without a statistically significant increase in recurrence rate when compared to conventional suture and fibrin glue techniques.

Pterygium surgery using the principle of contact inhibition: results of 13 years' experience

Purpose

To report a technique to prevent pterygium recurrence using the principle of contact inhibition.

Methods

Two hundred and fifteen patients (232 eyes; average age, 64.1 years) with primary pterygia who underwent pterygium surgery at the Hara Eye Hospital between 1999 and 2012. We retrospectively evaluated the patients who underwent the following procedure to prevent pterygium recurrence. The surface conjunctiva on the pterygium body was not removed. After removing the pterygium body, by placing a narrow pedicle autoconjunctival flap along the corneal limbus and tying it tightly to the front area of the residual conjunctiva, there is no room for the active residual tissue to proliferate, thus preventing a recurrence by contact inhibition. The key factor is conjunctival suturing, which establishes face-to-face contact of both areas of cut conjunctival tissue. Mitomycin C is applied locally for 3 min intraoperatively and 5 days postoperatively. The main outcome measure was the prevention of pterygium recurrence using this technique.

Results

By the end of the average follow-up of 5 years 4 months, three eyes (1.3%) had a recurrence. Among the 232 eyes, 23 eyes had large pterygia extending to the pupillary area. Using the surgical technique, there were no recurrences. No specific characteristic of the recurrence was found in association with the eye, sex, and preoperative grade.

Conclusions

This surgery has three relevant features: (1) reconfirmation of the effect of contact inhibition, (2) the anatomic structure of the conjunctival sac scarcely changes postoperatively, because the surface conjunctiva of the pterygium body is not removed, and (3) a low recurrence rate.

Electronic supplementary material

The online version of this article (doi:10.1007/s00417-016-3558-9) contains supplementary material, which is available to authorized users.

Quantification of Astigmatism Induced by Pterygium Using Automated Image Analysis

PURPOSE

To determine the factors influencing pterygium-induced astigmatism (PIA) and to develop a prediction model of PIA using these factors.

METHODS

This cross-sectional study included 97 eyes of 97 patients who underwent a pterygium excision and a limbal conjunctival autograft. Anterior segment photographs were taken preoperatively, and corneal topography was done preoperatively and at 3 months postoperatively. PIA was defined as the vector difference between the topographic astigmatism preoperatively and at 3 months postoperatively. Image analysis was performed using anterior segment photographs to measure the relative length (RL) (horizontal length of pterygium invading the cornea/horizontal corneal diameter), relative width (width of pterygium invading the cornea/vertical corneal diameter), relative area (area of pterygium invading the cornea/total corneal area), and vascularity index (VI) (degree of vascularity). Association between these factors and PIA was evaluated with univariate and multivariate analyses. We also attempted to generate a model for prediction of PIA using these factors.

RESULTS

Univariate analysis showed that the RL, relative width, relative area, and VI were significantly associated with PIA (P < 0.001 for all variables, Pearson coefficient (r) = 0.708, 0.555, 0.606, and 0.642, respectively). In multivariate analysis, only the RL (P < 0.001) and VI (P < 0.001) had significant correlation with PIA. A multiple regression model for PIA was generated as follows: PIA = 0.080 × RL (%) + 0.039 × VI - 0.823 (r = 0.502, F = 95.71, P < 0.001).

CONCLUSIONS

Larger lengths and increased vascularity were associated with larger PIA. PIA can be predicted by evaluating the length and vascularity of pterygium involving the cornea.

Large pterygium surgery: When coverage of the scleral bed justifies graft rotation

OBJECTIVE

To perform a 12 month follow-up study to assess the safety and effectiveness of resection and conjunctival autograft fixed with Tissucol® in selected cases of large pterygium. The orientation of the graft was adapted to the morphology of the scleral bed for a better coverage free of traction, with limbal position being lost.

METHODS

A prospective, non-comparative study of 10 cases of grade II or superior pterygium (7 primary, 3 recurrent) with at least 8mm of limbal extension. A wide scleral bed was obtained after pterygium and Tenon resection, with larger grafts being required to cover the defects. A superior conjunctival autograft was harvested and fixed to bare sclera using Tissucol. The orientation was adapted to the morphology of the scleral bed and limbal position was lost. Patients were periodically assessed for recurrence and complications for a period of 12 months.

RESULTS

Minor complications occurred in 4 eyes. In one case a buttonhole was formed during dissection of the graft. Two presented with small limbal dehiscence, but epithelialisation was completed in the first week. In a third case, it was necessary to increase topical corticosteroids for pyogenic granuloma on the donor site, with secondary increased intraocular pressure (IOP). There were no recurrences after 12 months follow-up.

CONCLUSIONS

A conjunctival graft of appropriate size adapted to the morphology of the scleral bed to ensure good coverage free of tension, provides good surgical results in selected cases of pterygium, regardless of the conservation the limbal orientation, with no recurrences after one year follow-up.

Intraoperative Fluorescein Staining of Cryopreserved Amniotic Membrane Grafts to Improve Visualization During and After Pterygium Surgery: A Novel Technique

Supplemental Digital Content is Available in the Text.

Purpose:

To describe a new method of enhancing the visualization of amniotic membrane grafts with fluorescein staining during pterygium surgery.

Methods:

Pterygium excision surgery using intraoperatively stained cryopreserved amniotic membranes was performed on 346 eyes. A sterile 0.6 mg sodium fluorescein strip was placed directly onto the amniotic membrane in the manufacturer's original packaging, and the stained allograft was then transplanted onto the planned site. Staining intensities, at 3, 5, and 10 minutes of dye immersion, were compared. Immediate postoperative pain rating (scale 0–10), visibility of the fluorescein-stained amniotic membrane graft, and conjunctival autograft and amniotic membrane graft elevation, dehiscence, retraction, or displacement were recorded. The recurrence rate of the study population was compared with that of a previous cohort of 121 patients who underwent pterygium excision with conjunctival autograft without stained amniotic membrane.

Results:

Direct contact of the fluorescein strip on the amniotic membrane at 3, 5, and 10 minutes showed no differences in subjective staining intensity. Fluorescein-stained amniotic membrane was easily detected on the ocular surface during and 24 hours after pterygium surgery. The average immediate postoperative pain rating was 0.8 ± 1.8. No intraoperative complications or postoperative amniotic membrane graft dehiscence, retraction, or displacement occurred. The recurrence rate using fluorescein-stained amniotic membrane (3 patients, 0.9%, mean follow-up time 31.8 ± 18.6 weeks) did not differ from that of the previous cohort without the stained amniotic membrane (2.5%; χ²(1) = 1.837, P = 0.183).

Conclusions:

Fluorescein strip staining of the amniotic membrane is a novel and safe intraoperative method to enhance visualization and handling of the graft during and after ocular surgeries.

Comparison of intra-operative 0.02% mitomycin C and sutureless limbal conjunctival autograft fixation in pterygium surgery: five-year follow-up

PURPOSE

To compare efficacy and safety between fibrin sealant assisted limbal conjunctival autograft fixation and intra-operative MMC in pterygium surgery.

METHODS

Prospective, comparative, interventional case series. Forty eyes of 40 patients with nasal primary pterygium, 18 male and 22 female, were enrolled. The patients were assigned to two groups, and each contained nine male and 11 female based on the pterygium area encroaching onto the cornea. In one group, the conjunctival autograft was attached to the sclera with fibrin sealant, and in the other group, 0.02% MMC was applied after the pterygium was removed. All the patients were followed up postoperatively on days 1, 3, 7 and 14 then at months 1, 2, 6, 12 and 60. The main outcome measures included operating time, postoperative discomfort, cornea endothelial damage, recurrence rate and complications.

RESULTS

The average operating time was significantly shorter (p = 0.044) in the fibrin sealant group, and fewer postoperative symptom complaints were received as well. On postoperative month 1, no significant differences in the mean endothelial cell count, mean CV and mean 6A% were observed between these two groups. By the end of 5-year follow-up, the recurrence rate was 0% in the fibrin sealant group and 20% in the MMC group (p = 0.106), and there were no severe visual acuity threatening complications in either group.

CONCLUSION

There were no severe complications after long-term follow-up if intra-operative MMC was strictly and carefully used. Overall, this sutureless method is more effective than traditional MMC.

Bare sclera resection followed by mitomycin C and/or autograft limbus conjunctiva in the surgery for pterygium: a Meta-analysis

AIM

To evaluate the recurrence and complications after bare sclera resection (BSR) combined with mitomycin C (MMC) treatment and/or autograft limbus conjunctiva (ALC) in the surgery for pterygium.

METHODS

Meta-analysis was used to evaluate the differences in patient outcomes between BSR of pterygium with or without MMC and/or ALC. All included studies were randomized trials of patients with pterygium who received BSR followed by MMC and/or ALC in the surgery. The recurrence of pterygium and other complications resulting from different treatments were extracted for analysis.

RESULTS

Thirteen studies met the inclusion criteria. The recurrence of pterygium with intraoperative (IO) MMC was higher than that with ALC (OR=2.38, 95% confidence interval 1.45-3.91, I (2)=29%). Postoperative MMC resulted in an incidence of recurrence similar to that of ALC (OR=0.66, 95% confidence interval 0.30-1.42, I (2)=0%), and IO MMC treatment in combination with ALC produced similar patient outcomes to ALC alone (OR=0.41, 95% confidence interval 0.16-1.01, I (2)=16%). Other complications such as punctate epitheliopathy, scleral thinning and ischemia, irritation and persistent epithelium defect, were more common in patients in the MMC group as compared to those treated with ALC.

CONCLUSION

The recurrence of pterygium with BSR followed by ALC is lower than that of BSR followed by MMC, and the incidence of other complications is lower. While ALC is a more effective strategy for treating pterygium, the quality of the ALC transplant should be considered when the patient has a history of glaucoma.

Conjunctival metaplasia after pterygium excision and limbal autograft

PURPOSE

To investigate the changes of conjunctival epithelium in the pterygium and donor graft sites after pterygium excision and limbal conjunctival autograft.

METHODS

This study included 16 eyes of 15 patients who underwent pterygium excision and limbal conjunctival autograft. Epithelial impression cytology specimens of both the pterygium and donor graft were obtained preoperatively and at months 1, 3, and 6, at the pterygium and donor graft sites, respectively. In each specimen, changes in the conjunctival epithelium, including the nucleus-to-cytoplasm (N/C) ratio and goblet cell density (GCD), were evaluated. Morphologic changes in the cells and nuclei were also evaluated.

RESULTS

Preoperatively, both N/C ratio and GCD were significantly higher in specimens from the pterygium than in those from the donor site. At both sites, GCD decreased rapidly at 1 month after surgery and then gradually recovered. No significant difference in GCD was found between the two sites at 1, 3, and 6 months postoperatively. Although there was no significant difference in the N/C ratio at 1 and 3 months, the N/C ratio at the pterygium site was significantly greater than that at the donor site at 6 months. At 6 months postoperatively, changes suggesting squamous metaplasia, including elongation of the cells and pyknotic changes in the nuclei, were noted in five samples (31.3%) from the pterygium site but not in any of the samples obtained from the donor site.

CONCLUSIONS

Conjunctival epithelial metaplasia may return after pterygium removal, which may be associated with the high rate of pterygium recurrence.

Recurrence and Complications of Pterygium Extended Removal Followed by Extended Conjunctival Transplant for Primary Pterygia

Purpose

To study the recurrence rate and complications after primary pterygium removal using pterygium extended removal followed by extended conjunctival transplant.

Methods

Sixty-eight eyes of 57 consecutive patients with primary pterygia underwent pterygium removal using pterygium extended removal followed by extended conjunctival transplant between April 2010 and October 2014. The follow-up period lasted for at least 36 months after the procedure.

Results

No recurrences were reported after a mean follow-up period of 40.0 ± 5.7 months (minimum of 36 months). One case (1.4%) developed Tenon granuloma at the donor site 2 weeks after surgery, and it was surgically removed. Transient graft swelling was observed in 22% of the cases, and transient diplopia was observed in 17.6%. Both graft swelling and diplopia resolved gradually in all cases during the early postoperative period. Loss of corrected distance visual acuity was not reported.

Conclusions

Pterygium extended removal followed by extended conjunctival transplant is an effective technique for primary pterygia and resulted in a 0% recurrence rate with minimal intraoperative and postoperative complications.

Healing indicators after pterygium excision by optical coherence tomography

PURPOSE

To establish the sequence of tomographic changes in the tissue recovery process after pterygium excision and to propose healing indicators.

METHODS

Optical coherence tomography (OCT) images were taken at 1 week, 1, 3 and 6 months after lesion excision in 73 eyes of 73 patients (33 male, 40 female; mean age 50, S.D. 5.0, range 40-70 years) with primary nasal pterygium. Biomicroscopy was performed at each visit and at 12 months, to diagnose clinical healing or lesion recurrence. The presence of well demarcated corneal epithelium, conjunctival epithelium, limbal demarcation area, and graft thickening were analysed. Comparisons between tomographic data of both clinical situations were made at each time point using contingency tables.

RESULTS

Eleven eyes displayed lesion recurrence (R group) and 62 eyes showed no recurrence (NR group). Normal anatomical structures, corneal and conjunctival epithelium and limbal demarcation area, were identified by OCT images in a higher percentage of NR cases over time, compared to the R group where most of the cases presented without these markers of tissue recovery. In contrast, the variable graft thickening, which analysed a pathological event, revealed similar results in both groups (p > 0.05; Fisher's exact statistic), with a clear decrease of cases which showed graft thickening over time. Differences between groups started at 1 month, when no eye had yet presented clinical recurrence, with greater identification of corneal epithelium in the NR group (p = 0.04; Fisher's exact statistic). At 3 months, corneal and conjunctival epithelium identification tended to be more frequent in the NR than in the R group (in both cases, p = 0.0001; Fisher's exact statistic). Finally, at 6 months these different patterns consolidated, with a significantly higher number of limbal demarcation areas being identified in the NR group (p = 0.001; Fisher's exact statistic). In fact, this landmark of a normally structured limbus was never found in the R group.

CONCLUSIONS

The sequence of tissue restoration, according to OCT images, seems to start in the cornea and end in the limbal area, similar to the process of pterygium injury in reverse. Although the visualisation of corneal epithelium could be an early indicator of successful surgery, identification of the limbal demarcation area, as a normal limbal pattern in OCT images, seems to be a better positive predictive value in diagnosing healing.

Twelve-Year Outcomes of Pterygium Excision with Conjunctival Autograft versus Intraoperative Mitomycin C in Double-Head Pterygium Surgery

Purpose. The study aims to compare the long-term outcome of conjunctival autograft (CAU) and mitomycin C (MMC) in double-head pterygium surgery. Methods. This is a follow-up study of a comparative interventional trial. Thirty-nine eyes of the 36 patients with double-head pterygium excision in the original study 12 years ago were recruited for clinical assessment. Seven out of the 36 patients were lost. In the original study, each eye with double-head pterygium was randomized to have pterygium excision with CAU on one "head" (temporal or nasal) and MMC on the other "head." All patients were invited for clinical assessment for conjunctival bed status and the presence of pterygium recurrence in the current study. Results. There was no significant difference between the size, morphology, and type of pterygium among the two treatment groups. The recurrence rate of CAU group and MMC group 12 years after excision was 6.3% and 28.1%, respectively (P = 0.020). Among eyes without recurrence, the conjunctival bed was graded higher in the MMC group than the CAU group (P = 0.024). Conclusion. The use of conjunctival autograft has a significantly lower long-term recurrence rate than mitomycin C in double-head pterygium surgery.

Recurrence rate with use of intraoperative Mitomycin C versus Conjunctival Autograft following pterygium excision

Objectives: To determine the recurrence rate following Conjunctival Autograft versus Mitomycin C for pterygium excision.

Methods: Fifty Patients in this Randomized Clinical Trial who underwent pterygium excision from July 2013 to October 2013 at Department of Ophthalmology, Ziauddin University Hospital, Keamari, Karachi were included. All patients underwent detailed ophthalmic examination before surgery. Few drops of lidocaine were instilled, subconjunctival xylocaine 2% was injected. The pterygium was then excised from bulabar conjunctiva and peeled off from the corneal surface. Mitomycin C was applied to bare sclera in group A and Conjunctival autograft taken from superior bulbar conjunctiva of same eye was sutured to the bare sclera in group B. Data for pterygium recurrence was collected and analyzed using SPSS version 17.

Results: Among the 50 patients operated 64% (n=32) were male and 36% (n=18) female. Their age ranged from 28 -58 years with mean age 44.8yrs. Right eye was affected in 54% (n= 27) patients and left in 46% (n= 23). In group “A” (intraoperative MMC) conjunctival granuloma was noted in 1(4%), pterygium recurrence 4(16%) and ocular irritation was experienced by 5 (20%) patients. In group “B” (CAG) graft retraction was seen in 2(8%), patients, 1(4%) patients experienced persistent redness over the grafted tissue and pterygium recurrence was seen in 2(8%) patient. All of them were followed at day 1, week1, week 4 and week 12.

Conclusion: Both Conjunctival Autograft and Mitomycin C are effective in reducing the recurrence of pterygium but CAG gives better cosmetic results, the only drawback with it is the duration of the procedure.

Analysis of recurrence patterns following pterygium surgery with conjunctival autografts

The aim of this article is to evaluate and classify pathogenetic origins based on morphologic reproliferative patterns in patients who underwent pterygium excision with a conjunctival autograft. In this retrospective, observational case series, a total of 116 eyes of 116 patients with pterygium who underwent pterygium excision with a conjunctival autograft between February 2009 and May 2011 were reviewed. Using consecutively recorded photographs, we evaluated preoperative morphologic severity, postoperative complications, recurrences, and growth patterns. The regrowth of fibrovascular tissue was observed in 14 of our study cases (12.1%). Of these, 5 cases (4.3%) showed clinically significant recurrences. We observed 3 different morphologic patterns of recurrence: regrowth over the epithelial defect; transformation of the conjunctival graft into the pterygial tissue; and regrowth from unexcised pterygial tissue. Each recurrence pattern showed characteristic fibrovascular growth, the origin of this regrowth, and grade of severity. In 25 cases (21.6%), postoperative complications were observed. Of the analyzed variables, age <40 years (P = 0.019; odds ratio [OR], 5.82; 95% confidence interval [CI], 1.34-25.28) and the presence of postoperative complications (P = 0.008; OR, 6.32; 95% CI, 1.62-24.58) were statistically significant in multivariate analyses using logistic regression. The use of conjunctival autografts for pterygium surgery is effective, but recurrences are observed in some cases exhibiting unique pathogenic patterns according to their origin. A complete understanding of the pathogenesis of these lesions based on their morphologic regrowth pattern will help to prevent recurrences in patients who undergo pterygium surgery.

Safety profile and complications of autologous limbal conjunctival transplantation for primary pterygium

PURPOSE

Primary pterygium is a fibrovascular proliferation over the nasal cornea, probably resulting from the limbal stem cell deficiency. Intraoperative mitomycin-C application seems to associate with reduced recurrences, however produced ocular surface problems and vision threatening complications. The present clinical study investigated the safety profile of autologous limbal conjunctival transplantation in terms of recurrence rate, as the main outcome measure and complications as the secondary outcome.

METHODS

The present study was randomised, interventional and prospective clinical study conducted from a tertiary Hospital. Pterygium excision was performed with limbal conjunctival autograft availed from the affected eye. Secondary pterygia resulting from inflammation, trauma and other diseases were excluded. Patients were followed up for 18 months for recurrence and other complications. Microsoft Office Excel 2007 was used for statistical analysis.

RESULTS

A total of 71 eyes of sixty-eight patients with primary pterygia included between November 2007 and October 2010. The study recruited 35 (51%) males and 33 (49%) females with mean age of 36.9 with ±12.82 years standard deviation (mean, SD) ranging from 19 to 75 years. Age grouped by range intervals categorised into six groups. Pterygium was diagnosed in 32 (45%) right eyes and 39 (55%) left eyes. There were 65 (91.55%) nasal and 4 (5.63%) temporal pterygium and no case of double head pterygia found. Average horizontal extension of the pterygium measured was 1.67 mm (±4.23) from the apex to the corneal limbus. Graft oedema in 1 (0.71%) patient, graft bleed in 2 (1.42%) cases and 1 (0.72%) case of granuloma observed. No recurrences encountered during 18 months follow up.

CONCLUSIONS

Pterygium occurred predominantly in the younger population group 36.9 mm (±12.82) probably due to the increased outdoor activity with high exposure to sunlight and dusty atmosphere. Absence of recurrences was probably attributable to the smaller pterygium size of 1.67 mm (±4.23), use of the autologous limbal conjunctival graft and treatable intra and post operative complications successfully.

Comparison of Two Techniques for the Treatment of Recurrent Pterygium: Amniotic Membrane vs Conjunctival Autograft Combined with Mitomycin C

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.

Comparing Treatment Options of Pterygium: Limbal Sliding Flap Transplantation, Primary Closing, and Amniotic Membrane Grafting

Purpose

To compare 3 surgical treatment options of pterygium: limbal sliding flap transplantation, primary closing, and amniotic membrane grafting methods.

Methods

Seventy-five patients with primary pterygium were included in the study Snellen visual acuity measurement, grading pterygium, slit-lamp examination, keratometry, and anterior segment photography were performed preoperatively. Twenty-eight eyes of 28 patients (group 1) underwent limbal-conjunctival sliding flap transplantation, 22 eyes of 22 patients (group 2) underwent amniotic membrane grafting, and 25 eyes of 25 patients (group 3) underwent primary closing surgery The patients were followed up on the first day and the first week after surgery and then at months 1, 3, 6, and 12.

Results

The mean size of the pterygium preoperatively was 3.58 ± 1.1 mm in group 1, 3.95 ± 0.90 mm in group 2, and 3.5 ± 0.87 mm in group 3. The mean follow-up time was 15.07 ± 13.8 months in group 1, 20.2 ± 6.7 months in group 2, and 28.04 ± 9.9 months in group 3. Grade 4 corneal recurrence rate in follow-up was 7.1% in group 1, 27.3% in group 2, and 56% in group 3 (p = 0.00). Mean recurrence times were 4.0 ± 1.7, 4.4 ± 3.3, and 4.4 ± 3.6 months according to groups 1, 2, and 3 (p = 0.963). After the surgery, corneal astigmatism decreased and keratometric values increased significantly in all the groups with no statistically significant difference between the groups (p>0.05).

Conclusions

Limbal-conjunctival sliding flap transplantation is an efficient method to manage primary pterygium. It may be a safe and effective initial treatment option to reduce risk of recurrence and postoperative complications of pterygium surgery.

Ten-year results of a randomized controlled trial comparing 0.02% mitomycin C and limbal conjunctival autograft in pterygium surgery

OBJECTIVE

To compare the long-term outcome of pterygium surgery and the long-term effect on endothelial counts after mitomycin C (MMC) or limbal conjunctival autograft (LCAU) in pterygium surgery.

DESIGN

We performed a 10-year follow-up study of a randomized controlled trial.

PARTICIPANTS

A total of 115 eyes of 114 patients with primary pterygium were treated with intraoperative MMC (n = 63) or LCAU transplants (n = 52). A total of 76 patients completed the current 10-year long-term follow-up (47 in the MMC group, 29 in the LCAU group).

METHODS

This is a follow-up study of a randomized controlled trial of a cohort of 114 patients in 2 groups that was performed at the Prince of Wales Hospital 10 years ago: group 1, intraoperative 0.02% MMC for 5 minutes; group 2, LCAU. Consecutive patients enrolled in the original study (recruitment began in February 2001) were invited back for a detailed clinical examination to document the long-term outcome of both surgical groups.

MAIN OUTCOME MEASURES

The main outcome measures included the recurrence rate, residual conjunctival bed status, complications, and corneal endothelial cell density (ECD) differences.

RESULTS

A total of 115 eyes of 114 patients were enrolled and randomized in our previous study. For the current study, 76 of the 114 patients (47 in the MMC group, 29 in the LCAU group) were contacted, whereas 18 patients were lost to follow-up and 20 patients had died. The mean follow-up period was 138 ± 2 months in the MMC group and 137 ± 2 months in the LCAU group. Twelve of 47 patients (25.5%) in the original MMC group and 2 of 29 patients (6.9%) in the LCAU group had recurrent pterygium (P = 0.021). The mean ECD was 2,39 2 ± 342 cells/mm(2) in the MMC group and 2,390 ± 388 cells/mm(2) in the LCAU group (P = 0.978). There was no significant difference in the ECD between the operated eyes and the fellow eyes in both groups (P = 0.926 MMC, P = 0.468 LCAU). No other significant ocular complications were observed in either group at the 10-year postoperative follow-up.

CONCLUSIONS

Limbal conjunctival autograft was more effective than intraoperative MMC in minimizing pterygium recurrence at the 10-year follow-up. Treatment with intraoperative MMC was not associated with long-term corneal endothelial cell loss.

Collagen matrix implantation following pterygium excision: outcomes of a preliminary tested hypothesis

This study was conducted to evaluate the effect of collagen matrix implant on pterygium recurrence compared with a control group following pterygium removal surgery. Following informed consent, twenty eyes of 20 patients (females = 13, males = 7, aged 23-67 years) were randomly allocated into two equal groups. Pterygia of all patients were excised using the bare sclera technique; however, for patients in the intervention group a 1×2 mm collagen matrix graft (iGen™) was implanted subconjunctivally. Patients were followed up for recurrence and complications within six months. Results revealed that only two eyes in the control group and one eye in the intervention group developed recurrence (p=0.50); no dellen formation was observed. In conclusion, the use of biodegradable collagen matrix implants (iGen™) following pterygium excision seems to be associated with a lower risk of recurrence; however, the statistical difference between groups was not significant. Further studies with adequate sample size are recommended.

[Conjunctival limbal autograft versus simple excision with intra-operative mitomycin C in pterygium surgery: a comparative study]

PURPOSE

The purpose of our study is to evaluate the long-term anatomical and functional results of conjunctival-limbal autograft (AGCL) compared to simple excision with intraoperative mitomycin C.

PATIENTS AND METHODS

We conducted a prospective comparative study of 60 eyes of 60 patients presenting with primary pterygium. These patients were divided into two groups, matched according to the age and the stage of the pterygium. Thirty eyes of 30 patients were treated with conjunctival limbal autograft (AGCL group), and 30 eyes of the other 30 patients were treated with simple excision with intraoperative mitomycin C (MMC group). Minimum follow-up was 24 months.

RESULTS

The mean age of our patients was 50.6 and 51.3 years in the AGCL and MMC groups, respectively. A male predominance with male to female ratio of 1.5 was noted in both groups. We found more pterygium recurrences in the MMC group. Indeed, seven patients (23.3%) in the MMC group experienced a recurrence. In comparison, we found only a single recurrence (3.33%) in the AGCL group with a statistically significant difference (P=0.026). With regard to postoperative complications, we noted three inflammatory granulomas in the AGCL group (10%). In the MMC group, we observed two cases (6.66%) of delayed corneal healing with superficial punctate keratitis and epithelial defect and one case (3.33%) of symblepharon. There was no statistically significant difference in mean visual acuity gain between the two groups (AGCL: 1.76 lines; MMC: 2.82 lines; P=0.133).

CONCLUSION

Pterygium surgery by excision with conjunctival limbal autograft is an effective technique offering a low rate of long-term recurrences and few complications.