Bare Sclera Technique Research Articles

A comparative study on surgical outcomes in primary pterygium excision using argon laser therapy versus bare sclera technique: A randomized prospective trial

A comparative study on surgical outcomes in primary pterygium excision using argon laser therapy versus bare sclera technique: A randomized prospective trial

A comparative study between amniotic membrane transplantation and topical mitomycin-C in recurrent pterygium management

Aim The aim of this study was to compare the outcome of amniotic membrane transplantation (AMT) and topical mitomycin-C (MMC) in the management of recurrent pterygia. Patients and methods This is a retrospective study that included 40 cases of recurrent pterygia. They were subjected to surgical excision of the pterygium with bare sclera technique. The cases were categorized into two groups, 20 cases in each group. Group 1 was managed with intraoperative topical MMC, while group 2 was managed with AMT at the time of surgery. The patients were followed-up for at least 6 months postoperatively. The outcome measures were visual acuity (VA), corneal astigmatism, recurrence, and postoperative complications. Results The duration of postoperative pain was significantly shorter in the AMT group (6.8±1.0 days) than in the MMC group (10.45±1.5 days, P<0.0001). In addition, postoperative photophobia and lacrimation persisted for a significantly longer period in the MMC group (mean=10.0±1.03 days) compared to the AMT group (mean=7.85±0.81 days, P<0.0001). At the end of follow-up period, VA improvement occurred in 60% of group 1 and in 70% of group 2 patients. However, the preoperative and postoperative decimal VA were not significantly different between the two study groups (P=0.6684 and 0.7302, respectively). In group 1, there was a significant difference between the preoperative corneal astigmatism [−3.74±2.19 diopter (D)] and the postoperative astigmatism (−2.31±1.46 D) after 6 months (P<0.01). Similarly, in group 2, there was also a significant difference between the preoperative corneal astigmatism (−3.83±2.32 D) and the postoperative astigmatism (−2.12±1.60 D) after 6 months (P<0.01). However, the difference between the two groups was statistically insignificant. In the first postoperative 2 weeks, there was a statistically insignificant higher incidence of delayed wound healing and superficial punctate keratitis in the MMC group. The corneal wound healing was faster in the AMT group (mean=4.2±0.69 days) than in the MMC group (mean=4.6±o.6 days). However, the difference was not statistically significant (P=0.0578). At 2 weeks postoperatively, there were two cases of conjunctival defect and one case of scleral thinning in the MMC group only. At the end of the follow-up period, another case, in the MMC group, developed scleral thinning; however, the cornea was clear. Conclusion AMT and MMC could be used in the management of recurrent pterygia. The AMT group showed better visual outcome without postoperative complications. However, the difference between the two groups was statistically insignificant.

Effectiveness of bare sclera technique versus conjunctival autograft transplantation for pterygium treatment

Effectiveness of bare sclera technique versus conjunctival autograft transplantation for pterygium treatment

Atypical Presentation of Recurrent Pterygium Leading to Blindness and its Successful Management: A Series of Three Cases

Recurrence of pterygium is one of the main concerns in pterygium management. Recurrent pterygium is defined as the regrowth of fibrovascular tissue over the previously excised primary pterygium area, extending beyond the limbus and advancing towards the cornea. In most cases, it is characterised by increased conjunctival inflammation, fibroblast proliferation, and a faster progression towards corneal involvement compared to primary pterygium. This rapid regrowth can lead to irregular astigmatism, symblepharon, corneal fibrosis, severe vision impairment, and rarely, blindness. Incomplete removal of the primary pterygium, excessive suturing, the bare sclera technique, smaller conjunctival grafts, thicker conjunctival grafts with Tenon’s capsule, and poor control of postoperative inflammation are some of the most common surgical factors contributing to recurrence. Among all surgical procedures, the bare sclera technique has the highest recurrence rate. In the present case series, the author presented three cases of atypical recurrent pterygium and their successful management. The first case involved recurrent double-headed pterygium with severe symblepharon, resulting in lower fornix obliteration, shortening, diplopia, and corneal neovascularisation. The second case featured Grade-IV pterygium covering the pupillary area, and the third case involved a kissing type of doubleheaded pterygium. These cases were complications of the bare sclera technique, leading to blindness. Successful treatment of recurrent pterygium can improve visual and cosmetic outcomes. This case series aimed to highlight the burden and consequences of recurrent pterygium as a cause of avoidable blindness.

Evaluating the application of argon laser on pterygium surgery: Report of 30 patients.

The recurrence rate plays a key role in using various treatments of pterygium. This study assessed the effectiveness of argon laser therapy before the excision of pterygium on the recurrence rate. The eyes (n = 60) of patients (n = 30) were divided into two groups based on the treatment. All eyes had undergone pterygium excision with the bare sclera technique. Three weeks before surgery, an argon laser was applied to 30 eyes. Patients have been followed up for 1 year, and the progression of pterygium has been evaluated at days 1, 7, 14, and 30, and then, every 2 months until month 6 and then every 3 months until month 12. Recurrence was defined as more than 1 mm growth of pterygium from the limbus. In the group with adjuvant argon laser therapy, the mean size of pterygium was 3.7 ± 0.47 mm before surgery and 2.3 ± 0.98 after 12 months (P = 0.001). These were 3.8 ± 0.43 mm and 2.4 ± 1 mm in the other group (P = 0.001). The recurrence of the pterygium was 76% (23/30) in the group treated with an argon laser and 90% (27/30) in another group (P = 0.16). There was no correlation between pterygium sizes before surgery and the pterygium recurrence rate in both eyes (P = 0.272 [right] and 0.916 [left]). Argon laser therapy on pterygium before surgery cannot decrease its recurrence rate, but its application gives a good vision and clarifies the surgery's target area.

Comparison of Conjunctival Autograft Versus Bare Sclera Technique as Treatment Modalities for Primary Pterygium

Background: Pterygium is a fibrovascular conjunctival growth within the palpebral fissure extending onto the corneal surface. Recurrence is a common post-op complication of pterygium excision surgery, with various rates depending on the techniques used for its excision. Objective: Comparison of conjunctival autograft versus bare sclera technique as treatment modalities for primary pterygium. Material & Methods: This study was done in the Department of Ophthalmology of tertiary care hospital. In a prospective randomized controlled trial a sample size of 102 eyes with primary pterygium were allocated into two equally sized groups (51 patients in each): Group A underwent pterygium excision by bare sclera method, Group B underwent pterygium excision followed by conjuctival autograft. Both groups were analyzed and compared, for recurrence and complications with a mean follow-up time of 3 months. Result: Pterygium recurrence was detected in 16 (31.37%) patients using bare sclera technique (group A) and in 4 (7.84%) patients using conjuctival autograft technique (group B), that reveal a statistically significant difference (p = 0.003) Conclusion: Both surgical techniques are effective for pterygium excision but there is a statistically significant difference (p = 0.003) of pterygium recurrence between both techinques. Pterygium excision with conjuctival autograft should opt for better results in terms of recurrence as well as other complications. Bare sclera technique can be opted for preserving conjunctiva in case of glaucoma or scaring but at the expense of pterygium recurrences. Keywords: Pterygium, conjunctival autograft technique, bare sclera, recurrence.

Risk Factors Involved in Recurrence of Pterygium Excision after Surgical Excision

Aim: To determine the effect of the type and size of growth, sex and patients age, and the application of mitomycin-C intraoperatively and its application duration effect on pterygium recurrence afterwards excision. Study Design: A retrospective and descriptive case series. Place and Duration: In Alshifa Trust Eye Hospital, Rawalpindi and the department of Ophthalmology CMH, Lahore for the duration from November 2022 to April 2022. Methods: Data files from 80 patients (80 eyes) who underwent bare sclera technique surgery with MMC at 0.2 mg / ml (0.02%) and application time ranging from 1 to 5 mints. The study included 60 males and 20 females with 46.4 years of mean age (16 to 60 years). Cases were classified according to sex, age, pterygium type and size and MMC application time. The main outcome measures were to compare the eye affected by the pterygium for any type of recurrence after at least 1-year of follow-up. Results: In our case series, the rate of pterygium recurrence was 10% in the mean follow-up of 1 year. The influencing factors like younger age at admission (<50 years), secondary pterygium (p = 0.330) was suggestively related with pterygium recurrence. There was a clear tendency of less rate of recurrence with smaller pterygium size, with MMC administration times greater than 3 minutes. However, it was not possible to obtain statistical significance due to the smaller sample size. Conclusions: This study results propose that younger age < 50-years, a history of multiple recurrences, increased size and a duration of MMC administration < 3 mints are risk factors for postoperative recurrence of pterygium

Outcome of Excision of Primary Pterygium with Bare Sclera Technique: A Study of 80 Eyes in Malaysia

In this retrospective study of 166 patients with Pterygium, it was more predominant in males (66.9%) and in 31-40 years age group (69.9%). Irritation was the most common symptom (29.5%), while 13.8% were asymptomatic. Seventy four patients (44.6%) were armed forces personnel and the rest were civilian patients in this study A total of 248 pterygia (146 mild, 94 moderate and 8 advanced) were noted in this study. Standard procedure of excision of the growth with bare sclera technique was performed in 80 eyes wherever indicated (nasal or temporal in 66 eyes, both nasal and temporal in7 eyes). During the follow up period two complications (granuloma of conjunctiva and recurrence of pterygium) were noted. Small (5 mm size) granuloma occurred during the early postoperative period in 10 out of 80 eyes (12.5%), which healed completely with medical treatment without any need of surgical intervention. The recurrence of pterygium occurred in 19 out of 80 eyes (23.7%). The mean duration of recurrence was 5.5 months with a range varying from 2 to 12 months period. Recurrence of pterygium was observed to be higher in armed forces personnel (11 out of 19 eyes, (57.9%)) than in civilian patients (8 out of 19 eyes, 42.1%). There was early recurrence of pterygium in armed forces personnel (mean duration 5.1 months) than in civilian patients (mean duration 6.6 months). The modified technique of this with addition of intraoperative conjunctival auto graft to reduce the recurrence rate of pterygium is in progress.

Evaluation of the outcomes of intraoperative subconjunctival injection of triamcinolone acetonide at the surgical site after pterygium excision using bare-sclera technique and mitomycin C

Purpose To determine the role of the intraoperative triamcinolone acetonide application after pterygium excision using bare-sclera technique and mitomycin C (MMC). Patients and methods This prospective randomized clinical study included 80 patients (80 eyes) who had primary pterygium and was done at the Alpha Center of Ophthalmology. In total, 40 eyes were treated by excision with bare-sclera technique with MMC combined with intraoperative subconjunctival triamcinolone-acetonide injection (group I) (steroid group), and the other 40 eyes were treated by excision with bare-sclera technique with MMC alone (group II) (control group). All patients were subjected to complete ophthalmic evaluation preoperatively and were followed up for 6 months postoperatively. The postoperative conjunctival inflammation rate at 1 week was the primary outcome measure, while the rate of pterygium recurrence 6 months postoperatively and intraocular pressure (IOP) was the secondary outcome measure. No complications developed intraoperatively or postoperatively. Results The postoperative conjunctival inflammation was significantly higher in group II (45%) than group I (12.5%) (P=0.001). The recurrence rate of pterygium 6 months postoperative in group I was 7.5%, while in group II was 17.5%, which was statistically insignificant (P=0.176). The mean IOP 6 months postoperative in group I was 14.2±1.9, and in group II was 13.6±1.7, which was statistically insignificant (P=0.172). Pyogenic granuloma developed in one (2.5%) eye in group I and two (5%) eyes in group II. Conclusion After pterygium excision using the technique of bare sclera and MMC, the intraoperative subconjunctival injection of triamcinolone acetonide at the surgical site was found to be beneficial in reducing the incidence of postoperative conjunctival inflammation without elevation of the IOP and decreasing the recurrence rate of the pterygium.

Tarsoconjunctival flap in scleral necrosis: report of three cases

To report a series of three cases (four eyes) of scleral necrosis after pterygium excision, in which the tarsoconjunctival flap technique was used as treatment. Three patients who progressed to scleral necrosis after surgical pterygium excision were selected. The first patient underwent excision using the bare sclera technique and developed scleral thinning in the immediate postoperative period. The second and third patients received beta irradiation and had late onset scleral necrosis. The tarsoconjunctival flap technique was performed by the [...]

Comparative Analysis of Tear Film Parameters in Patients Undergoing Pterygium Excision by Conjunctival Autograft or Bare Sclera Technique Augmented by Intraoperative Mitomycin C Application

Introduction: Excision of the pterygium has been shown to enhance tear film stability. The study was designed to assess the effects of pterygium removal utilising two different surgical procedures on tear film parameters: bare sclera with Mitomycin C (MMC) and conjunctival autograft. The bare sclera with MMC application and conjunctival autograft techniques are the two most common treatments for pterygium. Conjunctival autograft is a procedure in which the superior conjunctiva of the patient's eye is removed in one piece and the excised tissue is used to cover the area where the pterygium was removed.The bare sclera with MMC application procedure involves removing the pterygium and intraoperatively applying 0.02% MMC to the scleral bed, leaving it to re-epithelialise. Aim: Comparative analysis of improvement in tear film parameters of patients undergoing pterygium excision by conjunctival autograft or bare sclera technique augmented by intraoperative MMC application. Materials and Methods: The prospective interventional study was conducted in Department of Ophthalmology, SGT University affiliated hospital, Gurugram, Haryana, India, from January 2019 to January 2020. A total of 54 Patients were divided into two groups. Group 1 has 26 patients undergoing pterygium excision with bare sclera technique (with MMC 0.02%), and Group 2 has 28 patients undergoing pterygium excision with conjunctival autograft technique (with MMC). Tear Break-up Time (TBUT) and Schirmer's I were measured in 54 eyes with pterygium before and after surgery. Data analysis was done using Two tail (inequality) test on Statistical Package for the Social Sciences (SPSS) software version 28.0. Patients were randomly divided into two groups by using RAND between software. Results: The mean preoperative Schirmer's I was 9.333 mm which improved to 12.203 mm after pterygium excision, which was a statistically significant change irrespective of the technique used. The mean preoperative Tear Break-up Time (TBUT) was 7.212 seconds which improved to 13.059 seconds after pterygium excision, which was a statistically significant change irrespective of the technique used. In the autograft group, TBUT improved from preoperative mean value of 7.253 seconds to 14.0 seconds and Schirmer's I mean values improved from 9.178mm to 12.678 mm, respectively.In the bare sclera group TBUT improved from preoperative mean value of 7.169 second to 12.046 second and Schirmer's I mean values improved from 9.500 mm to 11.692 mm, respectively. The mean postoperative Schirmer’s1 in autograft technique was 12.678 mm and postoperative Schirmer’s1 in bare sclera technique was 11.692 mm.The postoperative improvement in both groups was statistically similar. The mean postoperative TBUT in autograft technique was 14 seconds and postoperative TBUT in bare sclera technique was 12.046 seconds. Postoperative results in the autograft group were statistically better than the bare sclera group. Conclusion: The tear film stability parameters in pterygium patients improved after surgery in both the groups. Statistical analysis of postoperative Schirmer's I data was similar in both the techniques. Although postoperative TBUT values were statistically better in the autograft group, the mean value in both the techniques were more than ten seconds. The analysis of data indicates that bare sclera technique with MMC can be used as an alternative surgical procedure in patients with scarred conjunctiva or in situations where superior conjunctiva has to be preserved for future use.

Study of visual outcome and complications following conjunctival autograft transplant in management of primary pterygium

Introduction: Pterygium is a common degenerative disease of the anterior segment of the eye characterized by a wedge-shaped fibrovascular dysplasia of the bulbar conjunctiva with a prevalence of 12%. Exact etiology is unknown; risk factors include, long term exposure of ultraviolet B rays, dust, wind, chemicals and air pollution. To minimize recurrence after the traditional bare sclera surgical technique, adjuvant therapies and modifications to the surgical technique are being adopted. Geographically, Vijayapura is located close to the equator with inherent risk of higher ultraviolet radiation exposures. Of late there is an upsurge in the number of patients with diagnosed with pterygium opting for surgical correction. Conjunctival autograft transplant is promising modification of bare sclera technique is associated with significant reduction in pterygium-induced astigmatism thereby improved visual acuity, decreased postoperative complications and decreased recurrence rates. Objective: To evaluate the visual outcome and complications following conjunctival autograft transplant in management of primary pterygium. Methods: The present study was conducted in the department of Ophthalmology, B.L.D.E. deemed to be university Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura between October 2019 to April 2021. A total of 52 patients above 18 years with a diagnosis of primary pterygium were included in the study. Age, gender, occupation, side and severity of pterygium was recorded. Preoperative visual acuity and corresponding decimal pin whole equivalent was calculated for each patient. Upon surgery with conjunctival autograft under local anaesthesia, postoperatively, visual acuity, corresponding decimal pin hole equivalent and complications were evaluated at day 1, day 7 and day 30. Comparison of pre and postoperative data was done using appropriate statistical tests. Results: Mean age of patients was 54.38±10.70 years and 69.3% belonged to the age group of 50-70 years. Slight female predominance was noted with female to male ratio of 1.17:1. Most of the patients were farmers (48.5%) followed by housewives (23.1%). All patients had nasal pterygium prominently on the left side than right (61.5% vs 38.5%). 76.9% patients had grade 2 pterygia. Preoperatively, most patients had a visual acuity of 6/24 (25%), followed by 6/36 (19.2%) and 6/60 (17.3%). The mean decimal equivalent value was 0.35±0.21. Compared to preoperative visual acuity, significant improvement was seen at postoperative day 1 (p=0.000), postoperative day 7 (p=0.001) and at postoperative day 30 (p=0.001). Similarly significant increase in the decimal equivalent postoperatively (0.001) than preoperative values. Factors including age, gender, occupation, side and severity had significant association on the visual outcome based on visual acuity at all follow ups. Most common postoperative complication at day1 was subconjunctival haemorrhage (36%) is the common one followed by graft edema (36%) and graft retraction (13.5%). Resolution of complications was seen by day 30.Conclusion: Conjunctival autograft is a feasible and safe option in patients with primary pterygium with severe grading.

SUTURELESS AND GLUE FREE CONJUNCTIVAL AUTOGRAFT (CAG) IN PTERYGIUM SURGERY WITH AUTOLOGOUS BLOOD SERUM VS BARE SCLERA TECHNIQUE.

Introduction: Pterygium is a common ocular surface disorder. The pathognomonic feature is elastotic degeneration of conjunctival stroma, and, an excessive bro-proliferative reaction. Aim: To compare and analyze the surgical outcome of pterygium excision followed by sutureless glue-free CAG with autologous blood serum vs bare sclera technique. Study Design: Prospective, Randomized control study. Materials & Methods: 32 eyes of 32 patients with primary Pterygium were selected. Ptrygium excision with Conjunctival autograft and in other group bare sclera was done and results were compared. Post-operative course were followed for 12 months after surgery. Inclusion Criteria:We included patients of all ages and gender with primary pterygium of different grades viz. grade 1, grade 2 and grade 3.We did not included temporal pterygium in our research study, as it is rare to occur. Exclusion Criteria: Glaucoma, recurrent pterygium, retinal pathology requiring surgical intervention, patients with history of previous ocular surgery or history of scleritis, Pseudo-pterygium, HIV/hepatitis B. Discussion: The standard treatment for pterygium is; excision followed by CAG. Results: Pterygium excision followed by CAG with autologous blood serum is better and recurrence rate is nil to minimal than with bare sclera technique. Conclusion: Sutureless, glue-free pterygium excision with CAG is effective, safe and cosmetically better option for management of primary pterygium also, it showed lesser recurrence rate.

A Comparative Study Between Preoperative Subconjunctival Bevacizumab Injection And Postoperative Topical Application In Prevention Of Recurrence After Excision Of Primary Pterygium In Egyptian Patients

Abstract Purpose to compare between recurrence incidence after primary pterygium excision when using preoperative subconjunctival injection of Bevacizumab (Avastin) and using it as a postoperative eye drops. Methods thirty two eyes of thirty patients (two patients had bilateral pterygium) with primary pterygia were clinically examined, classified into 3 groups and operated by simple excision with bare sclera technique. Group 1 included 10 patients received Bevacizumab (Avastin) in the form of eye drops (10 mg/ml) 3 times daily for 6 days postoperative. Group 2 included 10 patients received preoperative Bevacizumab in the form of subconjunctival injection (1.25 mg/0.05ml) single dose 1 week preoperative. Group 3 included 10 patients (12 eyes) 2 patients with bilateral Pterygium didn’t receive any form of Bevacizumab. Postoperative follow up was done clinically and by serial photography at 1 week, 1 month, 3 months and 6 months searching for signs of recurrence and/or complications. Results The results showed different grades of recurrence in 18 eyes of 32.True recurrence was seen in 7 patients of 18 (1 patient in group 1, 2 in group 2 and 4 in group3).Recurrence grades in group 1and 2 who used the Bevacizumab (20%grade II, 50% grade III, and 30% grade IV). Recurrence could be predicted by 100% depending on fibrovascular tissue appearing in the surgical bed at 3 months postoperative (P value 0.038).Preoperative fleshy pterygium has high statistical significance in realation to recurrence(P value = 0.006).Patient’s sex, residence and occupation had no statistically significant value in the process of recurrence (P value > 0.05). Patients with recurrent Pterygia (in group 1&2) had statistically significant changes in the corneal K- readings at 3 months and 6 months.No significant difference in the limbal or central corneal thickness in the operated eye and the other eye (Pvalue > 0.05). Conclusion Bevacizumab (Avastin) is a well tolerated drug with multiple drug delivery methods.The eye drops give better results than the subconjunctival injection.Appearance of fibrovascular tissue in the surgical bed at 3 months predict the recurrence by 100%. Preoperative fleshy pterygia will mostly recur again whatever Bevacizumab form was used .The corneal thickness by anterior segment OCT has no role in prediction or detection of early pterygium recurrence.

Effect of argon laser before and after surgery on primary pterygium recurrence

Background Pterygium is a common ocular surface lesion originating in the limbal conjunctiva. It has a high recurrence rate after excision; thus, there are multiple surgeries and adjuvant therapies to avoid this high recurrence rate. Aim The aim of this study is to demonstrate the effect of argon laser photocoagulation before and after surgery on primary pterygium recurrence. Patients and methods This study is a prospective interventional study that included a total of 20 eyes of 20 patients divided into two groups randomly: The follow-up period ranged between 6 and 15 months (mean: 10.5 months). Results The recurrence rate in group A was 20%, but in group B, it was 50%. However, it is still statistically insignificant (P=0.160); there was a highly significant difference between pterygium length on the cornea before and after treatment in recurrent cases in groups A and B, with shorter length in group A (P Conclusion Argon laser photocoagulation has benefits if used as adjuvant therapy to the bare sclera technique in pterygium excision as it decreases the recurrence rate. If recurrence occurs, the length of the recurrent pterygium on the cornea is less than the length preoperatively.

Association between HPV detection in swab samples and tissue specimens and ophthalmic pterygium recurrence.

PurposeTo investigate the presence of HPV on the ocular surface after surgical excision of HPV infected pterygia and the possible correlation of HPV with pterygium postoperative recurrence.Materials and methodsBoth exfoliative pterygium swab samples and respective tissue specimens were received and analyzed with real-time PCR for the detection of HPV-infected pterygia. In addition, swab samples from patients that had HPV-infected pterygia with no recurrence after 1 year of follow-up, as well as swab samples from patients with healthy conjunctiva, were analyzed.ResultsForty eyes with pterygium of 40 patients and 40 eyes with normal conjunctiva were included in the study. HPV virus was detected in the tissue specimens of 11 patients (27.5%) and in the swabs of 9 patients (22.5%). The HPV subtypes detected were 33, 39, 45, 56, 59, 66, and 68. The swab test had sensitivity of 81.82% and 100% specificity. In 15 (43%) patients, a bare sclera technique was used for pterygium removal and eleven of these patients showed recurrence of the disease. Surgical excision with use of autologous conjunctival graft was performed in twenty patients and five of them had recurrence. Patients with recurrent disease were 12.41 times more likely to have an HPV-infected pterygium (p = 0.031). Furthermore, from the 11 HPV positive patients, six had no recurrence, 1 year after surgery. In five of them, a swab sample was taken from the site of the surgical excision 1 year after surgery and real-time PCR was negative for HPV presence. ConclusionPersistence of HPV infection seems to be correlated with postoperative pterygium recurrence. Further investigation with the use of the minimally invasive proposed swab technique may contribute in the understanding of pterygium pathogenesis and in the development of a more efficient treatment planning.

Comparison Study between Intralesional Injection of MMC with Bare Sclera Excision of Pterygium and Conjunctiva Auto Grafting Technique

Background: Pterygium is a fibrovascular tissue that abnormally invades the cornea from the conjunctiva. Aim of the work: Comparison Bare sclera technique of pterygium excision immediately after injecting it with MMC and conjunctival autografting without using MMC regarding recurrence rate and other complications. Methods: This prospective interventional study included 40 cases of pterygia from September 2017 to March 2019. cases were divided into two groups: Group 1 included 20 eyes received 0.1 ml [0.01%] of intrapterygial mitomycin-C [MMC] injection, then excision with bare scleral Group 2 included 20 eyes with simple excision then covering the bare sclera with a conjunctival autograft from superior bulbar conjunctiva. Results: The mean age was 45.175 and 45.4 years in Group 1 and 2, respectively, [P = .527]. There were 7 [35%] males and 13 [65%] females in Group 1 and 8 [40%] males and 12 [60%] females in Group 2 [P = .744]. The regression rate was 5% in each Groups [P = 1]. Postoperatively, scleral hypo vascularity occurred in 5 eyes [25%] in Group 1 while never in Group 2 [P = .009]. Graft necrosis noticed in 2 cases [10%] in group 2. Conclusion: Both techniques resulted in a negligible [5%] recurrence rate. Although conjunctival graft with a significant reduction of complications as scleral hypo vascularity but with more surgical time.

A COMPARATIVE STUDY OF CONJUNCTIVAL AUTOGRAFT AND BARE SCLERA TECHNIQUES IN THE TREATMENT OF PTERYGIUM

Objective: Pterygium is a fibrovascular growth encroaching from the conjunctiva into the cornea. This study deals with the comparison of conjunctival autograft and bare sclera technique as treatment options for pterygium.
 Methods: This study was done in the ophthalmology department of Saveetha Medical College, Thandalam, Chennai. A total of 100 patients were diagnosed of pterygium was taken for the study, out of which 60 patients were operated on with conjunctival autograft and 40 patients were operated with bare sclera technique. Patients with hypertension, diabetes mellitus were excluded. Post-operative complications and recurrence were noted. All the patients were between the age group of 20-65 y.
 Results: The mean age of patients operated with conjunctival autograft was 43.6, whereas in bare sclera technique was 46.625. The maximum age was 63 and the minimum age was 23 in conjunctival autograft whereas in bare sclera technique, the maximum age was 64 and the minimum age was 22. The recurrence rate of pterygium in conjunctival autograft was 1 and the recurrence rate of pterygium in bare sclera technique was 4.
 Conclusion: The present study revealed that conjunctival autograft was a better treatment option compared to the bare sclera technique for excision of pterygium

Pterygium excision with modified bare sclera technique combined with mitomycin C.

Numerous surgical methods, with varying rates of recurrence, have been applied for the treatment of pterygium. Adjuvant mitomycin C (MMC) application has shown promising results in the prevention of recurrence. Here we propose and describe modified bare sclera technique combined with the intraoperative application of MMC for pterygium excision. Retrospective study. Primary pterygium patients who underwent pterygium excision via the bare sclera combined with 0.04% MMC technique from January 2014 to December 2016 were reviewed. In all patients, the subconjunctival pterygium strand was exposed and then sufficiently excised in combination with the safe use of MMC; i.e., the prevention of MMC dilution and diffusion to surrounding tissue. Surgical complications, recurrence rates, and recurrence onset were recorded. This study involved 32 primary pterygium eyes (grade T1 = 22 eyes; 68.7%). The mean postoperative follow-up period was 26.4 ± 14.5months (range: 12-60months). MMC was applied for 1-3min. The mean complete epithelialization was 12.6 ± 7.6days and no surgical complications were observed. In 1 patient with double-head primary pterygium, recurrence occurred at 15-months postoperative. The modified bare sclera technique combined with MMC application was found to be safe, effective, and presents good cosmetic appearance for the treatment of primary pterygium when safety points are strictly applied.

Incidence of pterygium recurrence following bare sclera technique with MMC in comparison to conjunctival autograft

Background: The gоal of this study is to compare incidence of recurrence of pterygium following bare sclera technique with mitomycin C in comparison to conjunctival autograft Methods: Our study included 40 cases subdivided into 2 groups; 20 cases managed by pterygium excision and intraoperative application of MMC 0.02% for 2 minutes and 20 cases managed by pterygium excision and limbal conjunctival auto graft transplantation ranged from 25 to 65 years old, with mean age of 44.2 years in 1st group, 43.8 years in 2nd group. SD in 1 st group +/- 10.2 and in 2nd group +/-11.3, in 1st group 14 cases (70%) were male and 6 cases (30%) were female, in 2nd group 15 cases (75%) were male and 5 cases (25%) were female. In 1st group the average of recurrence after two months is 3 cases with conjunctival recurrence. In 2nd group, the average of recurrence after two months is 1 case with episcleral vessels with p value <0.05. Results: It was found that recurrences of pterygium in patients managed with MMC are significantly higher than in patients managed with LCAG. Conclusion: LCAG is a good method in management for primary pterygium with low recurrence rate.