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Arun K, Grillon F, Georgoudis P. Primary Pterygium Excision Surgery: Analysis of Risk Factors and Clinical Outcomes. Cureus 2024; 16:e62440. [PMID: 38882219 PMCID: PMC11179689 DOI: 10.7759/cureus.62440] [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: 06/15/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose To evaluate clinical outcomes of primary pterygium excision surgery and analyze risk factors for pterygium recurrence. Setting Eye Treatment Centre, Cornea and External Diseases Service, Whipps Cross Hospital, London, United Kingdom. Methods Retrospective case series of eyes undergoing primary pterygium excision between August 2017 and July 2022. Patients who underwent "pterygium excision" documented in the electronic patient record system were identified. Patients with recurrent pterygium and those lost-to-follow-up were excluded. The duration of follow-up, type of surgery performed (primary conjunctival closure, conjunctival autograft, and amniotic membrane transplantation), recurrences with respect to the type of surgery performed, and postoperative complications were collected and analyzed. Results In total, 83 eyes (from 79 patients) were included. The mean age of our patient cohort was 59.3 ± 5.9 years. The most common ethnic distribution was Black Caribbean (15.7%). Conjunctival autograft was performed in 76 eyes (91.6%), primary conjunctival closure was performed in five eyes (6%) and amniotic membrane transplantation was performed in two eyes (2.4%). The recurrence rate with conjunctival autograft was 1.3% with a median time to recurrence of 2.98 months. Recurrence was significantly more common in patients below the age of 40 years (p=0.03). Recurrence was not significantly associated with gender (p=0.23), ethnicity (p=0.17), or grade of surgeon (p=0.38). Conclusion Our findings demonstrate the effectiveness of conjunctival autograft with fibrin glue fixation for the surgical management of primary pterygium. Recurrence was found to be significantly more common in patients under the age of 40 years old. However, recurrence was not associated with ethnicity, gender, or surgeon grade.
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Kusano Y, Den S, Yamaguchi T, Nishisako S, Fukui M, Shimazaki J. Risk Factors for Recurrence in the Treatment of Recurrent Pterygium. Cornea 2024; 43:740-745. [PMID: 37948044 DOI: 10.1097/ico.0000000000003422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/30/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE The aim of this study was to identify the postoperative recurrence rate of recurrent pterygium and to evaluate risk factors for the recurrence. METHODS This study was a retrospective interventional nonrandomized consecutive case series. In this single-center study, 119 eyes of patients with recurrent pterygium who underwent surgery with a follow-up period of >12 months after the surgery were analyzed. The clinical characteristics of pterygium were classified according to the length of corneal involvement and Tan grade. The main outcome was the recurrence rate. The secondary outcome was the risk factors for recurrence. RESULTS The mean follow-up period was 42 ± 28.6 months. Recurrence was observed in 15 patients (12.6%). The average postoperative recurrence period was 7.7 ± 6.7 months. Twelve patients experienced a recurrence within 12 months. Eyes with recurrence had a significantly greater length of corneal involvement (2.47 ± 0.72 mm) and number of previous surgery (1.9 ± 1.3) than those without (1.97 ± 0.74 mm, and 1.3 ± 0.7, both P = 0.04). Multivariate analysis showed that recurrence was significantly associated with the length of corneal involvement (odds ratio [OR] 2.38, 95% confidence interval [CI], 1.02-5.57, P = 0.05) and the number of previous surgeries (OR: 1.91, 95% CI, 1.03-3.58, P = 0.04) but not with sex (OR: 3.71, 95% CI, 0.90-15.2, P = 0.07), age (OR: 0.99, 95% CI, 0.94-1.04, P = 0.59), and use of mitomycin C (OR: 0.31, 95% CI, 0.07-1.21, P = 0.09). CONCLUSIONS The postoperative recurrence rate of recurrent pterygium was 12.6%. The preoperative length of corneal involvement and number of previous pterygium surgeries were significantly correlated with recurrence. Male sex and nonuse of mitomycin C tended to correlate with recurrence.
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Affiliation(s)
- Yuki Kusano
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
- Department of Ophthalmology, Kumamoto Shinto General Hospital, Kumamoto, Japan
| | - Seika Den
- Department of Ophthalmology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan; and
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Sota Nishisako
- Cornea Center Eye Bank, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Masaki Fukui
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
- Cornea Center Eye Bank, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
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Membrane of Plasma Rich in Growth Factors in Primary Pterygium Surgery Compared to Amniotic Membrane Transplantation and Conjunctival Autograft. J Clin Med 2021; 10:jcm10235711. [PMID: 34884413 PMCID: PMC8658705 DOI: 10.3390/jcm10235711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/24/2021] [Accepted: 12/04/2021] [Indexed: 12/20/2022] Open
Abstract
This prospective and comparative study aimed to compare the use of a conjunctival autograft (CAG), plasma rich in growth factors fibrin membrane (mPRGF) or amniotic membrane transplantation (AMT) in primary pterygium surgery. Patients were assigned for surgery with CAG (group A), mPRGF (group B), or AMT (group C). Pterygium recurrence, Best Corrected Visual Acuity (BCVA), graft size (measured with anterior segment optical coherence tomography (AS-OCT)), and ocular surface symptoms (visual analogue scale (VAS) and ocular surface disease index (OSDI)) were evaluated. Thirteen eyes in group A, 26 in group B, and 10 in group C were evaluated. No changes in BCVA (p > 0.05) were found. Recurrence cases for groups A, B, and C were none, two, and two, respectively, and three cases of pyogenic granulomas in group A. The horizontal/vertical graft size was lower in group B vs group A (p < 0.05) from months 1 to 12. The improvement in VAS frequency for groups A, B, and C was: 35.5%, 86.2%, and 39.1%, respectively. The OSDI scale reduction for groups A, B, and C was: 12.7%, 39.0%, and 84.1%. The use of the three surgical techniques as a graft for primary pterygium surgery was safe and effective, showing similar results. The mPRGF graft represents an autologous novel approach for pterygium surgery.
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Lee SJ, Yang HS, Choi JH, Yu J, Chung YR. Clinical Outcomes between Amniotic Membrane Transplantation and Conjunctival Autograft Using Fibrin Glue for Pterygium Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.5.605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hong HJ, Huh MG, Park DJ. Changes in Eye Movement Amplitude after Conjunctivo-Limbal Autograft in Patients with Recurrent Pterygium, Ocular Motility Restriction. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Long-Term Results of P.E.R.F.E.C.T. for PTERYGIUM. Cornea 2020; 40:1141-1146. [PMID: 33009095 DOI: 10.1097/ico.0000000000002545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/09/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify the recurrence rate, complication rate, cosmetic results, and patient satisfaction after P.E.R.F.E.C.T. for PTERYGIUM more than 10 years after surgery. METHODS This is a prospective cohort study with 312 patients (351 surgeries). All patients underwent pterygium removal using P.E.R.F.E.C.T. for PTERYGIUM in 1 eye or both eyes by the author. The main parameters studied were recurrence rate, complication rate, esthetic outcomes, and patient satisfaction. RESULTS Two hundred twenty-nine patients (77% of surviving cohort group) were able to be followed up with 16 patients deceased. The basic biographical data of the group followed up and those lost to follow-up were not different. The follow-up period was 153 ± 20 months. Twenty-five percent of the surgeries were for recurrent pterygia. The recurrence rate was zero, and there were no serious complications. Ninety-four percent of patients were graded as having normal or excellent cosmetic appearance by the surgeon, and 95% of the patients graded the appearance of their eye as greater than 8 of 10. Ninety-four percent of the patients gave more than 8 of 10 as their satisfaction with the service and surgery. CONCLUSIONS P.E.R.F.E.C.T. for PTERYGIUM provides long-term and stable results for primary and recurrent pterygium patients with a zero recurrence rate and excellent cosmetic appearance of the eye and no serious complications. P.E.R.F.E.C.T. for PTERYGIUM should be considered as the standard by which other pterygium surgeries should be compared. Cosmetic outcomes after pterygium surgeries are now a more sensitive measure of success than recurrence rate alone.
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Razmjoo H, Kashfi SA, Mirmohammadkhani M, Pourazizi M. Recurrence Rate and Clinical Outcome of Amniotic Membrane Transplantation Combined with Mitomycin C in Pterygium Surgery: Two-Year Follow-Up. J Res Pharm Pract 2020; 9:10-15. [PMID: 32489955 PMCID: PMC7235454 DOI: 10.4103/jrpp.jrpp_19_127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/17/2019] [Indexed: 11/17/2022] Open
Abstract
Objective: To evaluate the recurrence rate and outcome of pterygium surgery with amniotic membrane transplantation (AMT) and intraoperative mitomycin C (MMC). Methods: This prospective clinical study included patients with pterygium who were candidates for pterygium excision. After the surgical excision, intraoperative local MMC were applied in the standard protocol followed by AMT. The outcome measures were recurrence and the size change of lesion. Kaplan-Meier estimation and regression analyses were performed. Findings: Fifty five eyes of 55 consecutive patients including 30 male (54.5%) and 25 female (45.5%) with mean age of 47.12 ± 15.95 years were operated. The mean follow-up period was 15.21 ± 2.67 months. The overall recurrence rate was 34.5% (19/55 cases). The estimated recurrence time for larger size of pterygium before surgery was short and marginally significant (17.14 ± 0.58 month in size of ≤3.0 mm versus. 18.56 ± 0.60 month in size of <3 mm; P= 0.06). A statistically significant association was found in reduced model among the size change of the pterygium and standardized coefficient was −0.012 (P = 0.044) and −0.743 (P < 0.001) for age and size of lesion before surgery, respectively. Conclusion: Our findings suggest that increasing age and pterygial tissue are the risk factors for recurrence and pterygium has a substantial recurrence rate even after AMT combined with MMC.
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Affiliation(s)
- Hasan Razmjoo
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed-Abolfazl Kashfi
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran.,Department of Epidemiology and Biostatistics, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohsen Pourazizi
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Historical Considerations and Innovations in the Perioperative Use of Mitomycin C for Glaucoma Filtration Surgery and Bleb Revisions. J Glaucoma 2020; 29:226-235. [DOI: 10.1097/ijg.0000000000001438] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lee H, Jeong H, Lee CM, Shin JA, Jang SW, Lee JH, Park SY, Kim JY, Tchah H. Antifibrotic Effects of Sakuraso-Saponin in Primary Cultured Pterygium Fibroblasts in Comparison With Mitomycin C. ACTA ACUST UNITED AC 2019; 60:4784-4791. [DOI: 10.1167/iovs.19-27153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Hun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hana Jeong
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chang Mok Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jin-A Shin
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Wuk Jang
- Department of Biomedical Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Hyuck Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - So Young Park
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hungwon Tchah
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Kam KW, Young AL. 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. Graefes Arch Clin Exp Ophthalmol 2019; 257:2683-2690. [PMID: 31650270 DOI: 10.1007/s00417-019-04499-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/10/2019] [Accepted: 09/26/2019] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Ka Wai Kam
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.,Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Alvin L Young
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. .,Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
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Sun Y, Zhang B, Jia X, Ling S, Deng J. Efficacy and Safety of Bevacizumab in the Treatment of Pterygium: An Updated Meta-Analysis of Randomized Controlled Trials. J Ophthalmol 2018; 2018:4598173. [PMID: 30254755 PMCID: PMC6145151 DOI: 10.1155/2018/4598173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 07/10/2018] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Studies investigating efficacy and safety of bevacizumab in pterygium have increased and reported controversial results. Thus, we updated this meta-analysis to clarify the issue. METHODS Studies were selected through search of the databases Embase, PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) from their inception up until June 2017. The pooled risk ratio (RR) and 95% confidence interval (CI) were calculated for recurrence and complication rates by using random effects model. RESULTS 1045 eyes in 18 randomized controlled trials (RCTs) enrolled. Overall, the pooled estimate showed a statistically significant effect of bevacizumab on the reduction of recurrence (RR 0.74, 95% CI 0.56-0.97, P=0.03). Subgroup analyses presented significant results beneficial to bevacizumab (primary pterygium group, RR 0.53, 95% CI 0.33-0.83, P=0.006; conjunctival autograft group, RR 0.48, 95% CI 0.25-0.91, P=0.02; and follow-up longer than 12 months group, RR 0.36, 95% CI 0.13-0.99, P=0.05). No statistically significant difference was observed in complication rates. CONCLUSIONS Application of bevacizumab showed a statistically significant decrease in recurrence rate following removal of primary pterygia, or in cases with conjunctival autograft, or with follow-up longer than 12 months, while complications were not increased.
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Affiliation(s)
- Yi Sun
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Bowen Zhang
- Surgical Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xiuhua Jia
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Shiqi Ling
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Juan Deng
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
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Nganga Ngabou CGF, Makita C, Ndalla SS, Nkokolo F, Messe Ambia Koulimaya R, Diatewa B. [Pterygium surgery by conjunctiva autograft with autologous blood fixation]. J Fr Ophtalmol 2018; 41:425-432. [PMID: 29776761 DOI: 10.1016/j.jfo.2017.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/05/2017] [Accepted: 10/16/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Pterygium surgery is marked by the possibility of recurrences; one of the techniques which results in the least recurrences is conjunctival autograft. Fixation of the conjunctiva had traditionally been accomplished with sutures. In recent years, conjunctival grafting has also been performed with fibrin glue. Even more recently, with a view towards improving the quality of postoperative results, some surgeons recommend the use of autologous blood. This study aims to evaluate the stability of this latest method of graft fixation, while assessing its postoperative results. METHODOLOGY After diagnosis of pterygium, the patients underwent pterygium surgery with a conjunctival graft fixated with autologous blood. They were then monitored for one year, at 24h postoperatively, then seven days, 15 days, one month 3months, and every 3months thereafter. RESULTS In totl, 84.21 % of the patients demonstrated stable postoperative fixation; 5.26 % of patients experienced significant displacement of the graft. After one year of follow-up, 15.79 % of patients experienced recurrent pterygium. Recurrences were more frequent in younger patients and in patients with previous recurrence. CONCLUSION Pterygium surgery by conjunctival graft fixated with autologous blood is a safe surgery, with results similar to other pterygium surgery techniques with conjunctival autograft. However, this technique has the advantage less irritation, no risk of transmitting infection and lower cost.
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Affiliation(s)
- C G F Nganga Ngabou
- Centre Hospitalier et Universitaire de Brazzaville (CHU-B), 13, avenue Auxence Ikonga, BP 32, Brazzaville, Congo.
| | - C Makita
- Centre Hospitalier et Universitaire de Brazzaville (CHU-B), 13, avenue Auxence Ikonga, BP 32, Brazzaville, Congo
| | - S S Ndalla
- Clinique Ophthalmology, Association pour la préservation de la vue, 20 bis, rue Mayama, plateaux des 15 ans Brazzaville, BP 32, Brazzaville, Congo
| | - F Nkokolo
- Clinique Ophthalmology, Association pour la préservation de la vue, 20 bis, rue Mayama, plateaux des 15 ans Brazzaville, BP 32, Brazzaville, Congo
| | - R Messe Ambia Koulimaya
- Centre Hospitalier et Universitaire de Brazzaville (CHU-B), 13, avenue Auxence Ikonga, BP 32, Brazzaville, Congo
| | - B Diatewa
- Centre Hospitalier et Universitaire de Brazzaville (CHU-B), 13, avenue Auxence Ikonga, BP 32, Brazzaville, Congo
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Monden Y, Hotokezaka F, Yamakawa R. Recurrent pterygium treatment using mitomycin C, double amniotic membrane transplantation, and a large conjunctival flap. Int Med Case Rep J 2018; 11:47-52. [PMID: 29563842 PMCID: PMC5848662 DOI: 10.2147/imcrj.s150969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to evaluate the clinical outcomes of surgery for recurrent pterygia using mitomycin C (MMC), double amniotic membrane transplantation (AMT), and a large conjunctival flap. Patients and methods This retrospective case series included 31 eyes in 31 patients with recurrent pterygia. All patients underwent pterygium excision, application of MMC, double AMT, and placement of a large conjunctival flap. Outcome measures were visual acuity, astigmatism, and recurrence. Recurrence was defined as the presence of fibrovascular proliferative tissue crossing the limbus. Results The patients' mean age was 68.2 years. The mean follow-up period was 3.6 years. The mean preoperative and postoperative best-corrected visual acuities (logMAR conversion) were 0.23 and 0.13, respectively. There was a significant difference between the mean preoperative (-3.85 D) and postoperative (-2.22 D) astigmatism. The recurrence rate was 3.2% (1/31 cases). Conclusion Surgical pterygium excision with application of MMC, double AMT, and placement of a large conjunctival flap was an effective treatment for recurrent pterygia.
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Affiliation(s)
- Yu Monden
- Department of Ophthalmology, Kurume University School of Medicine, Fukuoka, Japan
| | - Fumi Hotokezaka
- Department of Ophthalmology, Kurume University School of Medicine, Fukuoka, Japan
| | - Ryoji Yamakawa
- Department of Ophthalmology, Kurume University School of Medicine, Fukuoka, Japan
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Demirok A, Simsek S, Cinal A, Yasar T. Intraoperative Application of Mitomycin C in the Surgical Treatment of Pterygium. Eur J Ophthalmol 2018; 8:153-6. [PMID: 9793768 DOI: 10.1177/112067219800800306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To investigate the effectiveness of intraoperative mitomycin C in pterygium surgery. Methods The effectiveness of intraoperatively administered mitomycin C and the occurrence of postoperative complications were evaluated in 17 patients with two recurrences of pterygium. The authors employed the “bare-sclera technique” and placed a sterile sponge soaked in a 0.02% mitomycin C solution intraoperatively in the episcleral space for 3 minutes. The control group (15 patients) underwent only surgical excision. Patients were followed for 21 to 30 months. Results The pterygium recurred in one (5.9%) of the 17 patients in group 1 and in six (40%) of the 15 controls. Statistical analysis using Fisher's exact test showed a significant (p=0.027) reduction of recurrences of pterygium in the group treated intraoperatively with mitomycin C. No serious complications or side effects arose during the follow-up period. Conclusions Mitomycin C administered intraoperatively can be considered an effective treatment to improve the success rate after surgical excision.
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Affiliation(s)
- A Demirok
- Yüzüncü Yil Universitesi Tip Fakültesi, Van, Türkey
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Limbal conjunctival versus amniotic membrane in the intraoperative application of mitomycin C for recurrent pterygium: a randomized controlled trial. Graefes Arch Clin Exp Ophthalmol 2016; 255:375-385. [PMID: 27761704 DOI: 10.1007/s00417-016-3509-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/25/2016] [Accepted: 10/03/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE This study compared the outcomes of a limbal conjunctival autograft (LCAG) with those of an amniotic membrane graft (AMG) followed by intraoperative 0.02 % mitomycin C (MMC) to treat recurrent pterygium. METHODS In this randomized controlled trial, ninety-six eyes with recurrent pterygium were enrolled and randomly allocated into two groups using a computer-generated random number table. Pterygium removal was followed by intraoperative 0.02 % MMC for 3 min and then either LCAG or AMG transplantation. The major outcomes were recurrence rate, conjunctival inflammation grade, healing time of the corneal epithelial defect, eye-movement amplitude (EMA), uncorrected distance visual acuity (UDVA), and complications. RESULTS A follow-up of 12 months was conducted for 93 eyes of 82 patients. Grade D (recurrence) presented in one eye of the LCAG group and five eyes of the AMG group, with no between-group difference (p = 0.196). However, Grades A, B, and C presented in 46, zero and zero eyes of the LCAG group respectively, and in 37, two and two eyes of the AMG group respectively, with the surgical bed generally showing a better appearance in the LCAG group than in the AMG group (p = 0.008). Compared with baseline values, the postoperative EMA improved significantly in both groups (p < 0.001 for the LCAG group; p = 0.001 for the AMG group), as did UDVA (p = 0.005 for the LCAG group; p = 0.012 for the AMG group). No between-group differences were found in terms of the healing time for epithelial defect, conjunctival inflammation grade, or the frequency of complications such as punctate epithelial keratitis, episcleral melting, corneal pannus, and delayed corneal epithelium healing. CONCLUSIONS LCAG transplantation with intraoperative 0.02 % MMC is as efficacious in treating recurrent pterygium as AMG transplantation with MMC. The former procedure results in an attractive cosmetic appearance but might result in limbal damage in some eyes. The surgeon's familiarity with these procedures should determine the method of treatment.
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Developments and current approaches in the treatment of pterygium. Int Ophthalmol 2016; 37:1073-1081. [DOI: 10.1007/s10792-016-0358-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 09/18/2016] [Indexed: 01/10/2023]
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Fibroblast biology in pterygia. Exp Eye Res 2016; 142:32-9. [DOI: 10.1016/j.exer.2015.01.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 01/08/2015] [Accepted: 01/12/2015] [Indexed: 12/31/2022]
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Yadav AR, Bhattad KR, Sen PA, Jain EB, Sen A, Jain BK. Outcome of different techniques of pterygium excision with conjunctival autografting in pediatric population: Our experience in central India. Indian J Ophthalmol 2015; 63:491-5. [PMID: 26265638 PMCID: PMC4550980 DOI: 10.4103/0301-4738.162599] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aim: To analyze surgical outcome of pterygium excision with conjunctival autografting in pediatric population ≤16 years. Settings and Design: Retrospective case series. Materials and Methods: A case sheet review of 145 patients (167 eyes) aged ≤16 years consecutively presented with pterygium from April 2008 to August 2014 in the single center was done. Twenty-six eyes of 25 children who underwent pterygium excision with conjunctival autograft were analyzed. Different techniques used to secure conjunctival autograft in a position were multiple interrupted 8-0 vicryl sutures, single 8-0 vicryl suture in the center of graft and sutureless glue free. Outcome measures were a failure of surgery and recurrence. Results: Of the total 167 eyes, 26 eyes of 25 children, mean age 13.07 ± 3.08 years (range 7–16 years) were managed surgically with pterygium excision and conjunctival autograft. The rest of the patients were managed conservatively. In 18 eyes, the graft was secured with multiple sutures, in 6 eyes with a single suture, whereas in 2 eyes, sutureless glue-free graft opposition was done. Mean follow-up was 8.03 months. No case of graft retraction, graft dehiscence or graft displacement was found. Recurrence occurred in 6 eyes and managed surgically. Conclusions: Occurrence of pterygium is not uncommon in the pediatric population. A single suture or sutureless glue-free technique may be good alternative for securing conjunctival autograft after pterygium excision in children.
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Affiliation(s)
- Amit R Yadav
- Department of Paediatric Ophthalmology, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
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Sheppard JD, Mansur A, Comstock TL, Hovanesian JA. An update on the surgical management of pterygium and the role of loteprednol etabonate ointment. Clin Ophthalmol 2014; 8:1105-18. [PMID: 24966664 PMCID: PMC4063821 DOI: 10.2147/opth.s55259] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Pterygium, a sun-related eye disease, presents as wing-shaped ocular surface lesions that extend from the bulbar conjunctiva onto the cornea, most commonly on the nasal side. Pterygia show characteristic histological features that suggest that inflammation plays a prominent role in their initial pathogenesis and recurrence. Appropriate surgery is the key to successful treatment of pterygia, but there is also a rationale for the use of anti-inflammatory agents to reduce the rate of recurrence following surgery. Multiple surgical techniques have been developed over the last two millennia, but these initially had little success, due to high rates of recurrence. Current management strategies, associated with lower recurrence rates, include bare sclera excision and various types of grafts using tissue glues. Adjunctive therapies include mitomycin C and 5-fluorouracil, as well as the topical ocular steroid loteprednol etabonate, which has been shown to have a lower risk of elevated intraocular pressure than have the other topical ocular steroids. Here, the surgical management of pterygium is presented from a historical perspective, and current management techniques, including the appropriate use of various adjunctive therapies, are reviewed, along with an illustrative case presentation and a discussion of the conjunctival forceps designed to facilitate surgical management. Despite thousands of years of experience with this condition, there remains a need for a more thorough understanding of pterygium and interventions to reduce both its incidence and postsurgical recurrence. Until that time, the immediate goal is to optimize surgical practices to ensure the best possible outcomes. Loteprednol etabonate, especially the ointment formulation, appears to be a safe and effective component of the perioperative regimen for this complex ocular condition, although confirmatory prospective studies are needed.
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Katırcıoglu YA, Altiparmak U, Engur Goktas S, Cakir B, Singar E, Ornek F. Comparison of Two Techniques for the Treatment of Recurrent Pterygium: Amniotic Membrane vs Conjunctival Autograft Combined with Mitomycin C. Semin Ophthalmol 2014; 30:321-7. [PMID: 24506693 DOI: 10.3109/08820538.2013.874468] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To compare the results of amniotic membrane transplantation (AMT) combined with mitomycin C (MMC) to the results of free conjunctival autograft (CA) combined with MMC for the treatment of patients with recurrent pterygium. METHODS In this prospective study, 60 eyes of 55 patients with recurrent pterygium were included and randomly assigned into group I (n = 30) who underwent AMT combined with MMC (AMT-MMC) and group II (n = 30) who underwent CA combined with MMC (CA-MMC). During a mean follow-up of 27.2 ± 20.8 months, recurrence of pterygium, change in uncorrected visual acuity and complications (including pain, corneal, conjunctival or scleral changes) were analyzed and were compared between groups. RESULTS Five eyes of 5 patients were lost to follow-up and were removed from analysis. The mean age (p = 0.274), the mean follow-up (p = 0.063), the number of prior pterygium excision surgeries (p = 0.641) and the mean preoperative visual acuity (p = 0.959) were similar in both groups. Recurrence was seen in 2 eyes (8%) in AMT-MMC group and 4 patients (13.3%) in CA-MMC group (p = 0.531). Postoperative visual acuity (p = 0.237), change in visual acuity (p = 0.525), severe pain (p = 0.531) and epithelial defect lasting more than 5 days (p = 0.510) were similar in both groups. CONCLUSIONS Amniotic membrane combined with MMC has similar recurrence rate to CA combined with MMC, in patients with recurrent pterygium. Similar outcomes and complication rates make AMT-MMC a promising method for the treatment of recurrent pterygium cases.
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Affiliation(s)
| | - Ugur Altiparmak
- a Ministry of Health, Ankara Training and Research Hospital , Ankara , Turkey
| | - Seniz Engur Goktas
- a Ministry of Health, Ankara Training and Research Hospital , Ankara , Turkey
| | - Burcin Cakir
- a Ministry of Health, Ankara Training and Research Hospital , Ankara , Turkey
| | - Evin Singar
- a Ministry of Health, Ankara Training and Research Hospital , Ankara , Turkey
| | - Firdevs Ornek
- a Ministry of Health, Ankara Training and Research Hospital , Ankara , Turkey
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Mahar PS, Manzar N. The study of etiological and demographic characteristics of pterygium recurrence: a consecutive case series study from Pakistan. Int Ophthalmol 2013; 34:69-74. [DOI: 10.1007/s10792-013-9797-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Accepted: 02/13/2013] [Indexed: 10/26/2022]
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Zaky KS, Khalifa YM. Efficacy of preoperative injection versus intraoperative application of mitomycin in recurrent pterygium surgery. Indian J Ophthalmol 2013; 60:273-6. [PMID: 22824595 PMCID: PMC3442461 DOI: 10.4103/0301-4738.98703] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: To determine the efficacy of preoperative subconjunctival injection of mitomycin C a day before surgery in the management of recurrent pterygium. Materials and Methods: Randomized comparative case series. Fifty eyes with recurrent pterygium were randomly divided into two groups; the mitomycin injection group (25 eyes) and the mitomycin application group (25 eyes). The mitomycin injection group underwent preoperative subconjunctival injection of mitomycin C in low dose (0.1 ml of 0.15 mg/ml) a day before bare sclera pterygium excision surgery. The mitomycin application group underwent bare sclera pterygium excision with topical application of mitomycin C (same concentration). Results: At one year of follow-up, 24 of 25 eyes (96%) in the mitomycin injection group and 23 of 25 (92%) eyes in the mitomycin application group were free of recurrence. The difference was statistically insignificant. As regards postoperative complications, delayed epithelization (more than two weeks) occurred in two eyes (8%) in the mitomycin injection group and in one eye (4%) in the mitomycin application group. Scleral thinning was reported in one eye (4%) in the mitomycin application group which resolved within three weeks after surgery, no other serious postoperative complications were reported. Conclusion: Preoperative subconjunctival injection of mitomycin C in low dose (0.1 ml of 0.15 mg/ml) a day before pterygium surgery is a simple and effective modality for management of recurrent pterygium. It has the advantage of low recurrence and complications’ rate.
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Affiliation(s)
- Khaled S Zaky
- Department of Ophthalmology, Suez Canal University, Ismailia, Egypt
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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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Kim JW, Ahn J, Kook KH, Yang H. Recurrence Rates of Conjunctival Autograft Transplantation With Aminiotic Membrane Transplantation in Primary Pterygium Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.2.163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jong Wan Kim
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Jaehong Ahn
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Koung Hoon Kook
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Hongseok Yang
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
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The recurrence of pterygium after different modalities of surgical treatment. Saudi J Ophthalmol 2010; 25:411-5. [PMID: 23960956 DOI: 10.1016/j.sjopt.2010.10.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Revised: 09/22/2010] [Accepted: 10/18/2010] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To assess and compare the recurrence rate of pterygium after limbal stem cell transplantation versus amniotic membrane transplantation (AMT) as ocular surface reconstructing measures in recurrent pterygium, also evaluation of the use of antimetabolite drugs as adjunctive therapy for AMT. PATIENTS AND METHODS Prospective randomized comparative study included 60 eyes of 48 patients with recurrent pterygia. Informed consents were taken from all patients. Primary pterygium excision was performed 6-15 months ago; the cases were divided randomly into three equal groups: Group 1: included 20 eyes with excision of the pterygium and application of limbal stem cell transplantation with conjunctival autograft, group 2: included 20 eyes with excision of the pterygium followed by AMT and group 3: included 20 eyes in which surgical excision of pterygium was followed by intra-operative application of low-dose of MMC (0.05%) for 3 min then using AMT. RESULTS The study included 36 males and 12 females of age ranged from 28 to 52 years. The recurrence rate was 2 eyes in group 1 (10%) (limbal stem cell transplantation + conjunctival autograft), 6 eyes in group 2 (30%) (AMT) and 4 eyes (20%) in group 3 (MMC + AMT). The rate of recurrence was significantly different between the three groups (P < 0.001). CONCLUSIONS Limbal stem cell transplantation together with conjunctival autografting proved to be more effective in prevention of pterygium recurrence and in rapid restoration of normal epithelial morphology. MMC in addition to AMT decreases the incidence of recurrence.
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Hirst LW. Recurrent pterygium surgery using pterygium extended removal followed by extended conjunctival transplant: recurrence rate and cosmesis. Ophthalmology 2009; 116:1278-86. [PMID: 19576496 DOI: 10.1016/j.ophtha.2009.01.044] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 01/27/2009] [Accepted: 01/28/2009] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To assess the rate of recurrence, complications, and cosmesis after recurrent pterygium removal with P.E.R.F.E.C.T. for PTERYGIUM (Pterygium Extended Removal Followed by Extended Conjunctival Transplant). DESIGN A case series study of P.E.R.F.E.C.T. for PTERYGIUM was conducted by 1 surgeon with a 1-year follow-up to assess the recurrence, complication rate, and cosmesis. PARTICIPANTS A total of 111 consecutive patients with recurrent pterygium removals. INTERVENTION A major modification of conjunctival autograft surgery was used to treat recurrent pterygia. MAIN OUTCOME MEASURES The recurrence rate, complications, and cosmesis after excision of recurrent pterygia using P.E.R.F.E.C.T. for PTERYGIUM. RESULTS There were no patients with recurrence in 111 consecutive patients, and all but 2 patients were followed for at least 1 year. One patient developed an exotropia that required no treatment, and 1 patient lost 4 lines of vision as a result of a corneal ulcer. CONCLUSIONS In this series, P.E.R.F.E.C.T. for PTERYGIUM resulted in a zero recurrence rate (2 patients lost to follow-up) with few complications and a good cosmetic appearance.
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Affiliation(s)
- Lawrence W Hirst
- University of Queensland and Queensland Eye Institute, Brisbane, Australia
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Katircioğlu YA, Altiparmak UE, Duman S. Comparison of Three Methods for the Treatment of Pterygium: Amniotic Membrane Graft, Conjunctival Autograft and Conjunctival Autograft plus Mitomycin C. Orbit 2009; 26:5-13. [PMID: 17510864 DOI: 10.1080/01676830600972724] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare three techniques combined with excision in the treatment of primary and recurrent pterygium: amniotic membrane transplantation, conjunctival autograft, and conjunctival autograft plus mitomycin C. MATERIALS AND METHODS Forty-nine eyes of 49 subjects (30 primary, 19 recurrent pterygium) were included in this study. Combined with excision, 25 eyes (18 primary, 7 recurrent pterygium) were treated with conjunctival autografts (Group 1), and 16 eyes (12 primary, 4 recurrent pterygium) were treated with amniotic membrane transplantation for the closure of the defect (Group 2). In 8 eyes (all recurrent pterygium) low-dose mitomycin C (0.02%) was applied topically to the defect area and a conjunctival autograft was applied thereafter (Group 3). The three groups were compared with regard to the recurrence of pterygium and the defect area requiring treatment. RESULTS The number and percentages of recurrence seen in groups 1, 2 and 3 were as follows: 4 (16%), 4 (25%), and 0(-), respectively. For the treatment of primary pterygium cases, amniotic membrane closure and conjunctival autograft closure were comparable in effectiveness (p > 0.05). In the treatment of recurrent pterygium, there was no significant difference between the three techniques (p > 0.05). Amniotic membrane closure and conjunctival autografts were equally effective for the treatment of both primary and recurrent pterygium (p > 0.05). The graft size was significantly larger in the cases with recurrent pterygium (p = 0.016). CONCLUSIONS Amniotic membrane closure and conjunctival autografts seem to be equally effective in the prevention of recurrence of primary pterygium. Conjunctival autografts combined with mitomycin C are as effective as the above two techniques to prevent recurrence in the treatment of recurrent pterygium. Due to the larger area of subconjunctival fibrosis, a larger defect area is created after the excision of pterygium tissue and a larger graft is needed to close this defect in recurrent pterygium. This factor can guide the surgeon during the planning of the surgery to choose the most appropriate technique for closure of the defect.
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Affiliation(s)
- Yasemin Arslan Katircioğlu
- Department of Ophthalmology, S.B. Ankara Research & Training Hospital, Ophthalmology Clinics, Ankara. Turkey.
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Long-Term Results and Prognostic Factors of Fractionated Strontium-90 Eye Applicator for Pterygium. Int J Radiat Oncol Biol Phys 2008; 72:1174-9. [DOI: 10.1016/j.ijrobp.2008.02.075] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 02/25/2008] [Accepted: 02/26/2008] [Indexed: 11/18/2022]
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Kheirkhah A, Blanco G, Casas V, Hayashida Y, Raju VK, Tseng SC. Surgical strategies for fornix reconstruction based on symblepharon severity. Am J Ophthalmol 2008; 146:266-275. [PMID: 18514608 DOI: 10.1016/j.ajo.2008.03.028] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Revised: 03/26/2008] [Accepted: 03/27/2008] [Indexed: 12/22/2022]
Abstract
PURPOSE To identify surgical strategies of fornix reconstruction for symblepharon graded according to the length from the limbus to the lid margin, to the width, and to associated inflammation. DESIGN Retrospective, comparative, interventional case series. METHODS In 61 eyes with symblepharon, cicatrix lysis and amniotic membrane transplantation (AMT) were performed with sutures (n = 34) or fibrin glue (n = 27) together with (n = 47) or without (n = 14) intraoperative mitomycin C (MMC), plus fornix reconstruction using anchoring sutures without (n = 30) or with (n = 7) oral mucosal graft or with conjunctival autograft (n = 4). Overall, success was defined as an outcome of complete success (restoration of an anatomically deep fornix) or partial success (focal recurrence of scar), and failure was defined as the return of symblepharon. RESULTS For a follow-up of 25 +/- 10.8 months, the overall success was achieved by the first attempt in 52 eyes (85.2%) and failure resulted in nine eyes (14.8%); however, the success rate improved to 59 eyes (96.7%) with additional attempts. At the first attempt, AMT alone achieved overall successes in 92.8% of grade I eyes and in 100% of grade II eyes. Additional anchoring sutures achieved successes in 100% of grade I eyes, 70% of grade II eyes, and 71.4% of grade III/IV eyes. Additional oral mucosa or conjunctival autograft achieved successes in 100% of grade III/IV eyes. The complete success was correlated positively with lower grades of symblepharon or intraoperative use of MMC, but negatively correlated with younger ages, canthal involvement, or use of anchoring sutures. Anatomic improvement was accompanied by reduction of preoperative conjunctival inflammation (n = 40), improved visual acuity (n = 14), improved ocular motility (n = 18), improved eyelid closure (n = 3), and feasibility of contact lens wear (n = 10). CONCLUSIONS Successful outcome can be achieved by selectively deploying cicatrix lysis and AMT, intraoperative MMC, anchoring sutures, and oral mucosal or conjunctival autograft based on the severity of pathogenic symblepharon.
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Özdemir M. CONJUNCTIVAL Z-PLASTY FOR PTERYGIUM: COMPARISON WITH CONJUNCTIVAL AUTOGRAFTING. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2008. [DOI: 10.29333/ejgm/82583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kim M, Chung SH, Lee JH, Lee HK, Seo KY. Comparison of Mini-Flap Technique and Conjunctival Autograft Transplantation without Mitomycin C in Primary and Recurrent Pterygium. Ophthalmologica 2008; 222:265-71. [DOI: 10.1159/000137670] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Accepted: 04/26/2007] [Indexed: 11/19/2022]
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Katbaab A, Anvari Ardekani HR, Khoshniyat H, Jahadi Hosseini HR. Amniotic membrane transplantation for primary pterygium surgery. J Ophthalmic Vis Res 2008; 3:23-7. [PMID: 23479517 PMCID: PMC3589214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the outcomes of primary pterygium excision with adjunctive amniotic membrane transplantation. METHODS In an interventional case series, consecutive patients with primary pterygia underwent surgical excision with transplantation of preserved amniotic membrane onto bare sclera. Patients were followed for at least 12 months and the results were evaluated in terms of recurrent pterygium growth and complications. RESULTS Fifty eyes of 50 consecutive patients including 27 male and 23 female subjects with mean age of 43.36±10.88 years were operated. The pterygia extended onto the corneas for 4.69±1.2 (range 3 to 7) mm. Only one eye (2%) demonstrated recurrent pterygium growth which responded to subconjunctival mitomycin C injection. Another eye (2%) developed amniotic membrane retraction which eventually required a second transplantation leading to complete resolution. CONCLUSION Primary pterygium excision with amniotic membrane transplantation is a safe and effective surgical technique with low recurrence rate.
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Affiliation(s)
| | - Hamid-Reza Anvari Ardekani
- Correspondence to : Hamid-Reza Anvari Ardekani, MD. Poostchi Eye Research Center. Poostchi St., Shiraz, Iran; Tel/Fax: +98 711 2302830, +98 917 3160142; e-mail:
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Fallah MR, Golabdar MR, Amozadeh J, Zare MA, Moghimi S, Fakhraee G. Transplantation of conjunctival limbal autograft and amniotic membrane vs mitomycin C and amniotic membrane in treatment of recurrent pterygium. Eye (Lond) 2006; 22:420-4. [PMID: 17159974 DOI: 10.1038/sj.eye.6702657] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM To compare the efficacy and complications of conjunctival limbal autograft (CLAU) and amniotic membrane transplantation (AMT) vsintraoperative mitomycin C (MMC) and AMT for treatment of recurrent pterygium. METHODS Forty eyes of 40 patients with recurrent pterygium underwent CLAU and AMT (20 eyes) or intraoperative MMC (0.02%, 3 min) and AMT (20 eyes). Three eyes (15%) had symblepharon before surgery in each group. Recurrence was compared in each group by using chi(2) test. RESULTS No major postoperative complications occurred during 6-19 months of follow-up. In CLAU/AMT group, no pterygium recurrence was observed. Recurrence occurred in four eyes (20%) in MMC/AMT group after 3 and 4 months (P-value=0.035, chi(2) test). No recurrence of pterygium or symblepharon was seen in six eyes with recurrent pterygium and symblepharon (three eyes in each group). CONCLUSION CLAU with AMT seems to be more effective than intraoperative MMC with AMT for treatment of recurrent pterygium.
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Affiliation(s)
- M R Fallah
- Department of Ophthalmology, Farabi Eye Hospital, Eye Research Center, Tehran University of Medical Science, Tehran, Iran
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Chen KH, Hsu WM. Intraoperative ethanol treatment as an adjuvant therapy of pterygium excision. INTERNATIONAL JOURNAL OF BIOMEDICAL SCIENCE : IJBS 2006; 2:414-21. [PMID: 23675010 PMCID: PMC3614651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Recurrence of pterygium is the main concern for ophthalmic surgeons after the excision of pterygium. To evaluate the efficacy and safety of ethanol treatment during pterygium excision in preventing the recurrence of pterygia. A prospective randomized study was performed of 78 eyes in primary pterygium patients treated by excision. Primary pterygium patients were randomly assigned to ethanol group (38 eyes given intraoperative ethanol) or mitomycin-c (MMC) group (40 eyes given intraoperative MMC). Ethanol (20%) was applied for 60 seconds to the pterygial and its adjacent corneal surfaces before pterygium excision. After excision, the excised site of sclera was soaked with 20% Ethanol for 60 seconds. In group 2, MMC (0.25 mg/ml) was applied for 60 seconds to the bare sclera after pterygium excision. The outcomes were followed for more than one year. Pterygium recurred in 2 (5.3%) of 38 eyes in ethanol group and 4 (10.0%) of 40 eyes in MMC group. Final appearance of the pterygium excision area was satisfactory in 73.6% of group1 and 67.5% of group 4. No patients experienced severe complications postoperatively. In comparison with MMC treatment, intraoperative ethanol is more efficacious in preventing recurrence of pterygium and causes fewer complications. It suggests this regimen as an alternative for the treatment of pterygium, especially for those patients of high risk group for MMC treatment complications.
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Affiliation(s)
- Ko-Hua Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan (ROC);
- National Yang-Ming University 201, Section II, Shih-Pai Road, Taipei, Taiwan (ROC);
- Division of Medical Engineering, National Health Research Institutes. Taipei, Taiwan (ROC)
| | - Wen-Ming Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan (ROC);
- National Yang-Ming University 201, Section II, Shih-Pai Road, Taipei, Taiwan (ROC);
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Affiliation(s)
- Jessica C Matsumoto
- Chu Vision Institute, 7760 France Avenue S., Suite 140, Edina, MN 55435, USA
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Uçakhan OO, Kanpolat A. Combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C in the treatment of primary pterygium. Clin Exp Ophthalmol 2006; 34:219-25. [PMID: 16671901 DOI: 10.1111/j.1442-9071.2006.01197.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To introduce a new technique of conjunctival reconstruction after primary pterygium excision, and to evaluate the efficacy of combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C application in preventing recurrence of primary pterygium. METHODS In a prospective, non-comparative case series, 43 eyes of 41 consecutive patients with primary pterygium were studied. In all patient eyes, after excision of pterygia, 0.02% mitomycin C was applied topically for 2 min over the exposed scleral surface and "symmetrical conjunctival flap transposition" was performed to reconstruct the conjunctival defect. The main outcome measures were pterygium recurrence or any complications related with surgery or mitomycin C. RESULTS The mean age of the patients was 47.5 +/- 12.4 years (range 30-70 years). Among the 38 patients who were not lost to follow up, three patient eyes (7.5%) had grade 1, 24 eyes (60.0%) had grade 2 and 13 eyes (32.5%) had grade 3 pterygium. The mean follow up was 12.2 +/- 5.7 months (range 7-28 months). No recurrence or sight-threatening complications were encountered in any patient eye throughout the follow-up period. CONCLUSION Combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C application may be an effective surgical alternative in preventing recurrence of primary pterygium. Although the procedure seems to be free from severe complications, surgeons and patients should be well aware of the risk of late radiomimetic complications of mitomycin C. Comparative, randomized trials with more number of patients and longer follow up are required to further establish the safety and efficacy of this treatment strategy.
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Affiliation(s)
- Omür O Uçakhan
- Department of Ophthalmology, Ankara University School of Medicine, Cankaya 06680, Ankara, Turkey.
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Abstract
PURPOSE To evaluate the safety and efficacy of a preoperative injection of mitomycin C (MMC) in combined pterygium and cataract surgery. METHODS This was a prospective, nonrandomized, interventional trial. Thirty-nine patients with cataract and pterygium enrolled in a prospective, nonrandomized trial. All patients underwent combined pterygium and cataract surgery. Twenty-seven received a single 0.1-mL injection of 0.15 mg/mL MMC into the pterygium head 4 weeks before surgery and 12 did not. Patients were followed for 12 to 23 months postoperatively. Recurrence of pterygium, side effects, and complications of MMC were recorded. RESULTS Recurrent pterygium developed in none of the patients treated with MMC preoperatively and in 5 of the nontreated patients. Two patients in the pretreated group had allergic conjunctivitis immediately after MMC injection. No other local eye complications or adverse systemic reactions were recorded. CONCLUSIONS Preoperative injection of MMC into the head of the pterygium 4 weeks prior to combined pterygium and cataract surgery resulted in no recurrence and no serious complications up to 12 to 23 months of follow-up postoperatively. This procedure may be recommended to save time and cost and to prevent the possible side effects of MMC when administered topically at the time of cataract surgery. Further follow-up and additional studies will be needed to determine the long-term safety and efficacy.
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Affiliation(s)
- Rahamim Avisar
- Department of Ophthalmology and External Eye Disease Clinic, Rabin Medical Center, Petah Tiqva, Tel Aviv University, Israel.
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Levy RL, Naidu S, Jacobson L. Safety and Efficacy of the Technique of Complete Tenon’s Membrane Excision and Mitomycin C in Pterygium Surgery. Eye Contact Lens 2005; 31:105-8. [PMID: 15894875 DOI: 10.1097/01.icl.0000140908.17491.a0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Despite the established efficacy of mitomycin C (MMC) in preventing recurrence after pterygium surgery, there is no consensus on the optimal operative technique or dose of MMC. METHODS The authors retrospectively evaluated 90 single-headed pterygium resections performed with excision of the entire pterygium to the plica and removal of all Tenon's membrane from the scleral bed and rectus muscle. Bare sclera was exposed to 0.4 mg/mL MMC for 5 minutes for primary pterygia and 6 minutes for recurrent pterygia. These procedures were compared to a previous series of 58 procedures using bare sclera technique with MMC, but without extensive Tenon's membrane removal. RESULTS Extensive Tenon's membrane removal was associated with significantly fewer recurrences (6.7% vs. 21%; P< or =0.025) and significantly less pyogenic granuloma formation (24.4% vs. 40%; P< or =0.05). In addition, there were no vision-threatening complications, such as scleral melting or persistent corneal epithelial defects, in any of the patients. CONCLUSIONS These findings suggest that complete removal of all Tenon's membrane in the affected quadrant combined with topical MMC in the aforementioned dose is a safe method of pterygium excision with a low rate of recurrence and pyogenic granuloma formation.
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Affiliation(s)
- Richard L Levy
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
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Ma DHK, See LC, Hwang YS, Wang SF. Comparison of Amniotic Membrane Graft Alone or Combined With Intraoperative Mitomycin C to Prevent Recurrence After Excision of Recurrent Pterygia. Cornea 2005; 24:141-50. [PMID: 15725881 DOI: 10.1097/01.ico.0000141237.71837.d8] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Without effective adjunctive therapy, the recurrence rate after excision of recurrent pterygia is high. In an effort to determine a way to better reduce the recurrence of pterygia, we compared the efficacy and safety of amniotic membrane graft (AMG) alone and AMG combined with intraoperative mitomycin C after excision of recurrent pterygia. METHODS Patients with recurrent pterygia were randomly assigned to receive excision of pterygia followed by AMG alone or AMG combined with intraoperative 0.025% mitomycin C for 3 minutes (AMG-mitomycin C). Patients who could be followed up for more than 12 months were entered for data analysis. Conjunctival (potential) and corneal (true) recurrence of pterygia and other complications were recorded. RESULTS The group receiving AMG alone was made up of 48 eyes in 48 patients, and the group receiving AMG-mitomycin C consisted of 47 eyes in 46 patients. No significant difference was found in age distribution, sex distribution, or duration of follow-up between the 2 groups. Regarding the recurrence rates of each group, 6 conjunctival (12.5%) and 6 corneal (12.5%) recurrences developed in the AMG group, and 4 conjunctival (8.5%) and 6 corneal (12.8%) recurrences developed in the AMG-mitomycin C group. No significant difference was found in the conjunctival and corneal recurrence rate between the 2 groups (P=0.623 and 0.966, respectively; log rank test), and no major complications developed in either group. CONCLUSIONS AMG alone can be considered an effective alternative adjunctive treatment of recurrent pterygia. The addition of intraoperative mitomycin C did not further reduce the recurrence rate.
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Affiliation(s)
- David Hui-Kang Ma
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Segev F, Jaeger-Roshu S, Gefen-Carmi N, Assia EI. Combined mitomycin C application and free flap conjunctival autograft in pterygium surgery. Cornea 2003; 22:598-603. [PMID: 14508255 DOI: 10.1097/00003226-200310000-00003] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the long-term postoperative outcome and complication rate of combined intraoperative low-dose mitomycin C application and free conjunctival autograft for the treatment of pterygium. METHODS In a prospective, consecutive, noncomparative case series, a series of 46 consecutive patients (50 eyes) with primary pterygium (43 eyes) or recurrent pterygium (7 eyes) were studied. The patients' ages ranged from 23.0 to 80.0 years (mean, 53.4 years). All patients underwent pterygium excision combined with intraoperative low-dose mitomycin C application (0.02% for 2 minutes) and free conjunctival autograft. The mean follow-up period was 29.2 months (range 12 to 41 months). The main outcome measures were recurrence of pterygium and postoperative complications. RESULTS Pterygium recurred to a small extent (0.5 mm) in one eye (2%) of a patient with recurrent pterygium. There were no intraoperative complications. Subconjunctival graft hematoma appeared soon after surgery and resolved spontaneously in five eyes (10%). One eye developed transient high intraocular pressure without optic nerve or visual field defect, and one eye developed mild symblepharon. There were no sight-threatening complications or serious side effects. CONCLUSIONS By applying a single low dose of mitomycin C combined with free conjunctival autograft during pterygium excision, the recurrence rate of pterygium can be markedly reduced.
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Affiliation(s)
- Fani Segev
- Department of Opthalmology, Meir Hospital, Sapir Medical Center, Kfar-Saba, Israel
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Abstract
PURPOSE To evaluate the effect of covering the sclera with conjunctiva during surgical treatment of pterygium on the rate of postoperative complications, cosmetic outcome, and risk of recurrence. METHODS A comparative, prospective clinical design was used. The study population consisted of 371 consecutive patients with unilateral primary advanced pterygium. All underwent bare sclera technique for pterygium excision. At completion of surgery, topical mitomycin C 0.02% was applied for 5 minutes. In the first 189 patients (group A), the conjunctiva was sutured to the sclera 2 mm from the limbus. The next 146 patients (group B), the conjunctiva was sutured at the limbus, covering the whole scleral postexcision defect. In the last 36 patients (group C), the conjunctiva remained unsutured to the sclera. The patients were followed for complications, cosmetic outcome, and recurrence for 26 months. RESULTS After 26 months, 12 patients in group A (6.35%), 10 in group B (6.85%), and 9 in group C (25%) had recurrent pterygium. There were no cases of acute drug toxicity or scleral melting. Treatable delen were noted in 2 patients in group A (1.05%), 2 (1.36%) in group B, and 9 (25%) in group C. The cosmetic appearance was much better in group A than in groups B and C. CONCLUSIONS Leaving the whole sclera uncovered in pterygium surgery places patients at high risk of complications and recurrence. There is no difference in complications and recurrence between covering the whole sclera with conjunctiva and leaving 2 mm bare, although the latter yields a more esthetic outcome.
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Affiliation(s)
- Rahamim Avisar
- Cornea and External Eye Disease Clinic, Department of Ophthalmology, Rabin Medical Center, Golda Campus, Petah Tiqva, Israel.
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Abstract
PURPOSE To evaluate the postoperative outcome and recurrence rate of bare sclera technique combined with intraoperative application of mitomycin C (MMC) 0.02% for 5 minutes in the treatment of primary and recurrent double-head pterygia. METHODS A prospective, noncomparative interventional case series of 13 eyes in 13 patients with primary (n = 10) or recurrent double-head pterygia in one eye operated on by one surgeon (R.A.). They all had bare sclera excision combined with intraoperative application of MMC 0.02% for 5 minutes. All patients were followed postoperatively for recurrence of the lesion, aesthetic outcome, and incidence of eye complications. RESULTS Mean follow-up was 36.3 +/- 3.8 months for the patients with primary and 28.4 +/- 2.7 months for the patients with recurrent double-head pterygia. There was only one recurrence in one of the three eyes in the group with recurrent pterygia (33.33%). The only significant complication observed was a pyogenic granuloma in two of the recurrent and one of the primary cases. CONCLUSIONS The bare sclera technique combined with intraoperative MMC 0.02% for 5 minutes is an effective and safe procedure for double-head pterygia. This method can serve as a useful alternative to amniotic membrane transplantation in countries where the latter is not available and in patients in whom conjunctival autograft is not feasible.
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Affiliation(s)
- Rahamim Avisar
- Department of Ophthalmology and External Eye Disease Clinic, Rabin Medical Center, Golda Campus, Petah Tikva, Israel.
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Abstract
The treatment of pterygium is still quite controversial, with various treatments being advocated in the scientific literature. Unfortunately, there are very few well-conducted controlled clinical trials of treatments. However, years of anecdotal and noncontrolled studies have confirmed that some methods, such as bare scleral closure, are no longer acceptable in the treatment of pterygium and that other methods are likely to be more useful. In the future it will be important to develop a grading system, and surgeons will need to be conservative in the treatment of pterygium until such time as a single treatment provides a lower recurrence rate and complication rate.
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Affiliation(s)
- Lawrence W Hirst
- University of Queensland, Divison of Ophthalmology, Princess Alexandra Hospital, Ipswich Road, Woolloongabba 7, Queensland 4102, Australia
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Avisar R, Gaton DD, Loya N, Appel I, Weinberger D. Intraoperative mitomycin C 0.02% for pterygium: effect of duration of application on recurrence rate. Cornea 2003; 22:102-4. [PMID: 12605040 DOI: 10.1097/00003226-200303000-00003] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the effect of a 3- and 5-minute intraoperative application of topical mitomycin C 0.02% on the recurrence of pterygium. METHODS A comparative, prospective clinical design was used. The study population consisted of 134 consecutive patients with unilateral primary advanced pterygium (growth of 3 mm or more horizontally from the limbus). All underwent excision of the lesion, leaving the sclera bare. At completion of surgery, topical mitomycin C 0.02% was applied for 3 minutes in the first 60 patients (group A) and for 5 minutes in the remaining 74 patients (group B). The patients were followed for 26 months by slit-lamp biomicroscopic examination of the anterior segment. Recurrent pterygium was defined as the postoperative appearance of a fibrovascular tissue crossing the limbus. RESULTS After 12 months of follow-up, pterygium recurred in 20 patients (33.3%) in group A and in two patients (2.7%) in group B. After 15 months, the recurrence rates were 36.6% and 5.4%, respectively, and remained unchanged at 26 months. There were no cases of drug toxicity in either group. CONCLUSIONS Five-minute intraoperative application of a single dose of 0.02% mitomycin C is safe and more effective than a 3-minute application in recurrence of pterygium.
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Affiliation(s)
- Rahamim Avisar
- Cornea and External Eye Disease Clinic, Department of Ophthalmology, Rabin Medical Center, Golda Campus, Petah Tiqva 49 100, Israel.
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Shimazaki J, Kosaka K, Shimmura S, Tsubota K. Amniotic membrane transplantation with conjunctival autograft for recurrent pterygium. Ophthalmology 2003; 110:119-24. [PMID: 12511356 DOI: 10.1016/s0161-6420(02)01453-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To study the effect of amniotic membrane transplantation (AMT) combined with either limbal autograft transplantation (LAT) or conjunctival autograft transplantation (CAT) in recurrent pterygium. DESIGN Retrospective, noncomparative, interventional case series. PARTICIPANTS Twenty-seven eyes of 27 patients with recurrent pterygium. The mean number of prior surgeries was 3.1 (range, 1-10). Fifteen eyes each had restriction of ocular movement and symblepharon before surgery. INTERVENTION Patients were treated by AMT with either LAT (n = 15) or CAT (n = 12). MAIN OUTCOME MEASURES Recurrence of pterygium, improvement in ocular movement, and symblepharon formation. RESULTS Twenty-three (85.2%) of 27 eyes showed no recurrence with a mean observation period of 67.0 weeks. Fourteen eyes (93.3%) each showed improvement in ocular movement restriction and symblepharon after AMT. In four eyes that developed recurrence, three had LAT and one had CAT combined with AMT, suggesting that there was no difference in surgical outcome between LAT and CAT. CONCLUSIONS AMT with CAT is a safe and effective method for recurrent pterygium, especially that associated with ocular movement restriction and symblepharon. Considering the potential adverse effects associated with limbal excision, AMT plus CAT may be preferred over AMT plus LAT.
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Affiliation(s)
- Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College, Chiba, Japan.
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Dadeya S, Malik KPS, Gulliani BP. Pterygium Surgery: Conjunctival Rotation Autograft Versus Conjunctival Autograft. Ophthalmic Surg Lasers Imaging Retina 2002. [DOI: 10.3928/1542-8877-20020701-03] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dekaris I, Gabrić N, Karaman Z, Mravicić I, Kastelan S. Limbal-conjunctival autograft transplantation for recurrent pterygium. Eur J Ophthalmol 2002; 12:177-82. [PMID: 12113561 DOI: 10.1177/112067210201200301] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the usefulness of limbal-conjunctival autograft transplantation (LCAT) for the treatment of recurrent pterygium. PATIENTS AND METHODS Seventeen eyes with advanced recurrent pterygium underwent LCAT All had already been treated at least twice either by simple excision (n=15) or by conjunctival rotation autograft (n=2). Three eyes (17.65%) had symblepharon at the time of surgery, so LCAT was combined with amniotic membrane transplantation. The autograft was taken from the supero-lateral part of the same eye and transferred to the area where the pterygium had been excised. RESULTS During 6-18 months of follow-up no postoperative complications occurred. In 15 eyes (88.24%) no pterygium recurrence was recorded; recurrence occurred in two eyes (11.76%) after 8 and 5 months. In three eyes with a combined symblepharon formation, remission of both pterygium and symblepharon growth was obtained. CONCLUSIONS LCAT seems to be a promising and safe procedure for recurrent pterygium.
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Affiliation(s)
- I Dekaris
- Ophthalmology Department, Lions Croatian Eye Bank, GH Sveti Duh, Zagreb, Croatia.
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