Abstract
BackgroundRepeated surgery excisions could induce obvious irregular astigmatism in patients with recurrent pterygium. Our study is aimed to illustrate the effect of adjunct excimer laser phototherapeutic keratectomy (PTK) in limbal-conjunctival autograft transplantation on visual quality for patients with recurrent pterygium.MethodsRetrospective case-control study. Eyes that underwent pterygium excision with (PTK group) or without (control group) PTK from 2006 to 2017 were retrospectively included. Recurrence rate, preoperative and postoperative surface regularity index (SRI), surface asymmetry index (SAI), cylinder and LogMAR vision were collected. Postoperative anterior segment optical coherence topography and in vivo confocal microscopy were performed to monitor the cornea epithelium healing and cellular recovery process respectively.ResultsA total of 99 eyes of 99 patients were collected, of which 39 were treated with PTK and 60 without PTK. The mean follow-up time was 50.4 ± 38.1 months. The recurrence rate was 10.3% (4 eyes) in the PTK group and 13.3% (8 eyes) in the control group (p = 0.759). The SRI decreased 0.53 (range: − 0.88, 2.81), SAI decreased 0.53 (range: − 0.64, 2.94), and the cylinder decreased 2.08 (range:-0.16, 9.40) D in the PTK group, and the corresponding values were 0.48 (range:-0.45, 2.27), 0.27 (range:-1.06, 2.21) and 0.71 (range:-1.75, 3.55) D in the control group, respectively (Z = 1.76, 2.15, and 3.97, p = 0.005, 0.016, and 0.000 respectively). LogMAR vision improved in both groups after surgery, with an improvement of 0.18 (range: 0.00, 0.70) in the PTK group and 0.06 (range: − 0.12, 0.50) in the control group (Z = 4.08, p = 0.000). Besides, the eyes treated with PTK showed faster re-epithelization and better cellular recovery.ConclusionsFor recurrent pterygium, surgical excision with adjunct PTK might be a better option with improved corneal surface and vision outcomes.
Highlights
Repeated surgery excisions could induce obvious irregular astigmatism in patients with recurrent pterygium
Our study compares the clinical outcomes of limbal-conjunctival autograft transplantation (LCAT) with or without adjunct phototherapeutic keratectomy (PTK) in patients with recurrent pterygium and illustrates the effects of PTK on the corneal surface after repeated pterygium removal
No differences were found between two groups regarding the number of previous pterygium excision surgeries before this study (Table 1)
Summary
Repeated surgery excisions could induce obvious irregular astigmatism in patients with recurrent pterygium. Our study is aimed to illustrate the effect of adjunct excimer laser phototherapeutic keratectomy (PTK) in limbal-conjunctival autograft transplantation on visual quality for patients with recurrent pterygium. Repeated surgical removal could cause obvious postoperative irregular astigmatism and the recurrence rate could be even higher after secondary operation [7]. In 1998, Talu H, et al reported the application of excimer laser phototherapeutic keratectomy (PTK) combined with simple excision to treat recurrent pterygium [6]. Our study compares the clinical outcomes of limbal-conjunctival autograft transplantation (LCAT) with or without adjunct PTK in patients with recurrent pterygium and illustrates the effects of PTK on the corneal surface after repeated pterygium removal
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