Cosmetic outcome of femtosecond laser-assisted pterygium surgery

Darren Shu Jeng Ting,Hla M Htoon,Angel Jung Se Ji,Jodhbir S Mehta,Yi Fang Lee,Yu-Chi Liu,Tien-En Tan

doi:10.1186/s40662-021-00230-w

Abstract

BackgroundTo examine the cosmetic outcome of femtosecond laser-assisted pterygium surgery (FLAPS) with conjunctival autograft (CAG) and its potential predictive factors.MethodsThis was a prospective interventional case series (NCT02866968). We included 29 patients (29 eyes) with primary pterygium who underwent FLAPS. Cosmetic outcome was graded by two graders (an ophthalmology resident and an experienced ophthalmologist) using Hirst classification system (1–4 = excellent–poor). Weighted Cohen’s kappa analysis was performed to examine the intra- and inter-rater reliability. The relationship between cosmetic outcome and various factors were determined by Spearman’s correlation coefficients (r).ResultsThe preoperative severity of pterygium (Tan grading system) was mild/atrophic (7%), moderate/intermediate (62%), and severe/fleshy (31%). An ultrathin CAG (mean thickness of 74.5 ± 9.8 μm) was fashioned intraoperatively. An excellent cosmetic outcome of FLAPS (median ± IQR) was observed at 3 months (1.0 ± 1.0) and remained similar at 6 months (1.0 ± 0.0) and 12 months (1.0 ± 0.0) postoperatively. At final follow-up, 27 (93%) patients achieved good-to-excellent cosmetic outcome, with 1 (3%) patient having a poor outcome due to incomplete pterygium removal. Weighted kappa analysis of Hirst grading system showed excellent intra-rater (κ = 0.86–0.95) and inter-rater reliability (κ = 0.84–0.88). There was a weak and borderline significant correlation between good cosmetic outcome and reduced postoperative CAG thickness (r = 0.38, P = 0.06) but not with age, gender, preoperative pterygium severity, or intraoperative CAG thickness.ConclusionsFLAPS can result in an excellent cosmetic outcome, which may be attributed to the beneficial effect of an ultrathin CAG.Trial registrationClinicalTrials.gov, NCT02866968. Registered in July 2016,

Highlights

To examine the cosmetic outcome of femtosecond laser-assisted pterygium surgery (FLAPS) with conjunctival autograft (CAG) and its potential predictive factors
In view of the high recurrence rate, this technique has been superseded by removal with conjunctival autograft (CAG), which is considered the gold standard for managing pterygium in clinical practice [5, 6]
We demonstrated that femtosecond laser could be employed to fashion a consistently ultrathin CAG during pterygium surgery and achieve a low rate of postoperative complication or recurrence [16, 17]

Summary

Introduction

To examine the cosmetic outcome of femtosecond laser-assisted pterygium surgery (FLAPS) with conjunctival autograft (CAG) and its potential predictive factors. Surgery is the mainstay of treatment for symptomatic or cosmetically unacceptable pterygium. Direct removal of pterygium with a bare sclera technique (2021) 8:7 was widely performed due to the ease and speed of the procedure. In view of the high recurrence rate (around 38–88%), this technique has been superseded by (extended) removal with conjunctival autograft (CAG), which is considered the gold standard for managing pterygium in clinical practice [5, 6].

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