Efficacy and safety of recurrent pterygium surgery using human processed pericardium.

Abstract

To investigate the safety and efficacy of human processed pericardium used as an onlay after pterygium excision. Twenty-five eyes of 25 patients (11 female, 14 male) with recurrent pterygium were included in this study. The median age was 50 years (range 24-89 years). Twenty-eight percent of the eyes previously had been operated on two or more times. The mean follow-up was 9.4 months (+/- 2.1 months, range 8-15 months). Following bare-sclera surgical removal of recurrent pterygium, a patch of processed human pericardium was sutured to cover the area of excision. The pericardium was not covered with conjunctiva, nor were adjuvant radiation or antimetabolite administered. All patients were treated with a combination of dexamethasone 0.1% / chloramphenicol drops three times per day for 1 month. Ketorolac tromethamine 0.5% three times per day was added to this regimen after complete corneal reepithelialization. Recurrence (any growth >1 mm onto the cornea) was detected in 12 patients (48%). The mean time of recurrence was 4.1 +/- 1.7 months. Three patients (12.0%) presented a regrowth of fibrovascular tissue not reaching 1 mm of the cornea. Pyogenic granulomas occurred in three patients, and all of them required surgical excision. Corneal thinning was present in one patient and was treated with a therapeutic contact lens and artificial tears with complete resolution and vascularization of the thinned area. No decrease in visual acuity was observed in any patient. The use of processed pericardium in pterygium surgery is a safe procedure but is associated with a relatively high rate of recurrence. It should only be considered as an option in managing recurrent pterygium when conjunctival autografting is not an available alternative.