Outcome of pterygium excision after various surgical techniques-is excision with simple conjunctival closure still lege artis?

Abstract

There is no consensus about the best method for pterygium excision. Variable recurrence rates have been reported in the literature depending on the surgical technique. To evaluate the postoperative outcome after pterygium excision depending on the preoperative extent of the pterygium and the surgical method. A total of 109 patients (72men, 37women) who underwent 109 pterygium surgeries were retrospectively analyzed. In 87cases postoperative data over a5-year follow-up period were available. Besides recording the preoperative extent of the pterygium the functional outcome was analyzed and recurrence rates of the various techniques by simple excision with primary conjunctival closure (SE), conjunctival autograft (BHT) and amniotic membrane transplantation (AMT) were compared. Overall, recurrence was noted in 21 %. The recurrence rate of SE was 20 %. After BHT fewer recurrences (11 %) were seen than after AMT (39 %). After the intraoperative use of mitomycinC (MMC) more recurrences (31 %) occurred than without the use of MMC (17%). In 45 % of the cases delayed recurrence occurred after the first postoperative year. In our opinion the method of SE is not obsolete. Good results can be achieved with SE in pterygia with a small extent. The lowest recurrence rate was seen after BHT; therefore, BHT is the method of choice in general and especially for larger pterygia. The higher recurrence rate after intraoperative use of MMC is probably caused by selection bias. Regular follow-up examinations are required beyond the first postoperative year for timely detection of delayed recurrence.