Conjunctival Autograft Versus Amniotic Membrane Transplantation After Double Pterygium Excision: A Randomized Trial.

Abstract

To compare the outcome of amniotic membrane transplantation (AMT) and conjunctival autograft (CAG) after pterygium excision in patients with nasal and temporal pterygium (double pterygium) in the same eye. Tertiary care medical center. A total of 33 eyes of 33 patients with previously unoperated double pterygium were enrolled in the randomized trial, of which 31 remained in follow-up at 1 year. Eyes with double pterygium were randomized to either nasal AMT and temporal CAG (nasal AMT group) or to temporal AMT and nasal CAG (temporal AMT group). The primary prespecified outcome was pterygium recurrence at the excised site 1 year after pterygium excision. At 1 year none of the 31 pterygia randomized to CAG showed recurrence in either the nasal or temporal location (0%, 95% confidence interval, 0%-11.2%). In contrast, 8 of 31 pterygia randomized to AMT exhibited recurrence at 1 year (25.8%, 95% confidence interval, 11.9%-44.6%), with 4 temporal recurrences and 4 nasal recurrences. The recurrence rate was significantly higher for AMT than CAG (P = 0.005: primary analysis), but not significantly different between the nasal and temporal sites (P ≥ 0.99). The use of CAG in pterygium surgery led to fewer recurrences than AMT, irrespective of the site of replacement.