Conjunctival Autograft Research Articles

A study to determine the effectiveness of conjunctival autograft as an alternative to normal surgical procedures to reduce the recurrence of pterygium

Background: Pterygium is a chronic degenerative condition, in which a triangular fibrovascular growth of bulbar conjunctiva encroaches on the cornea. It is a cause of concern for both the patient due to its unsightly appearance and the surgeon due to its tendency to recur. Aims and Objectives: The present study was undertaken to determine the effectiveness of conjunctival autograft as an alternative to normal surgical procedures to reduce the recurrence of pterygium. Materials and Methods: A total of 30 patients with primary and recurrent pterygia who attended the ophthalmology, outpatient department were taken up for the study after obtaining informed consent. A standard surgical technique essentially similar to that described by Kenyon et al., was followed in all patients with a few minor modifications. All surgeries are performed using an operating microscope. Results: The majority of patients belonged to the 3rd and 4th decades. In our study of 30 cases, we had a recurrence rate of 3.0%. The results and outcome of pterygium surgery in our series stress the importance of conjunctival autograft as the procedure of choice for the surgical management of primary and recurrent pterygium in Indian eyes. The success of conjunctival autograft may be related to the significant learning curve and different surgical techniques for these procedures. Conclusion: Conjunctival autograft proves to be a simple safe and inexpensive technique with low recurrence rates for pterygium in young people. Although conjunctival autograft is a time-consuming procedure and has a significant learning curve, it is the procedure of choice for pterygium. Further detailed studies with a higher sample size are needed in this area.

Evaluation of risk factors for recurrence by anterior segment optical coherence tomography in pterygium surgery

AbstractPurpose: To study if there is an association between the values obtained by anterior segment optical coherence tomography (AS‐OCT) preoperatively and postoperatively to pterygium surgery using the technique of conjunctival autograft with biological glue and its risk of recurrence.Methods: A prospective one‐year study was carried out in 50 patients with primary pterygium who underwent excision surgery and conjunctival autograft with biological glue. All of them received the same postoperative treatment. They were followed up in the same way by taking preoperative pterygium measurements and postoperative autograft measurements by AS‐OCT and the number of recurrences was recorded. To obtain the measurements, a line was drawn perpendicular to the ocular surface at the level of the scleral spur, and the intersection of this line with the ocular surface was taken as a reference point to measure the length and the thickness of the pterygium at limbus, center and head, and the thickness of the conjunctival autograft at 1 mm (epithelial, stromal and total), 2 mm (total) and 3 mm (total).Results: The postoperatively autograft thickness AS‐OCT measurements were associated with pterygium recurrence after conjunctival autograft with biological glue surgery.Conclusions: There are measurable factors by AS‐OCT that can be correlated with a higher rate of pterygium recurrence after surgery.

Stem cells versus keratoprostheses

AbstractRoutine penetrating keratoplasty will not survive well in some circumstances, including harsh ocular surface environment, stem cell deficiency and chronic ocular inflammation. Fortunately, there have been advances to restore vision in these conditions in two directions: artificial keratoplasty and limbal stem cell transplantation. The recipient eye should have an intact lid mechanism and good tear film for stem cell transplantations. There may also be a need for future lamellar or penetrating keratoplasty with a chance for graft rejection. Treatment of unilateral limbal stem cell deficiency is relatively simple with three surgical options: Conjunctival Limbal Autograft (CLAU), Cultivated Limbal Epithelial Transplantation (CLET) and Simple Limbal Epithelial Transplantation (SLET). However, most patients have bilateral diseases like Stevens‐Johnson syndrome (SJS), aniridia and mucous membrane pemphigoid (MMP). In this scenario, an allogenic source for limbal stem cells is needed.Moreover, systemic immunosuppressive will be required to decrease the chance of rejection. Another option is Cultured Oral Mucosal Epithelial Transplantation (COMET) which usually provides less optimal visual acuity. The last option is keratoprosthesis (KPro). Many KPro devices have come and gone through, and two clear winners have emerged: Boston Keratoprosthesis KPro type I Osteo‐odonto‐keratoprosthesis, also known as the ‘OOKP’ OOKP is suitable for patients with severe dry eye and permanent lid damage. These patients should be excluded from any type of stem cell transplantation due to the inevitable chance of failure. However, Boston KPro type I may be considered as an alternative option for stem cell transplantation. Recent meta‐analysis for comparison of Keratolimbal Allograft (KLAL) and Boston KPro I in eyes affected by chemical burn has shown quite similar outcomes. Though, it should be mentioned that there are many limitations in included studies that make it difficult to reach an accurate conclusion. KPro has the advantages of shorter rehabilitation time and no need for systemic immunosuppression.Nevertheless, there is more chance of complications or loss of visual potential with KPro. Corneal surgeons should, in fact, be familiar with both options of KPro and stem cell transplantation to guide their patients towards the correct choice of treatment. The learning curve of such surgical techniques is steep. An extended follow‐up time is necessary to evaluate the safety of any method.

Manifestations of ocular irritation after pterygium surgery with sutured conjunctival autograft

Background: Ocular irritation remains the main disadvantage of the sutured conjunctival graft after pterygium excision. Evaluation of the severity of these manifestations can be helpful for better patient counselling about the expected postoperative course.Aim: To evaluate the manifestations of ocular irritation in patients treated by pterygium excision with sutured conjunctival autograft.Setting: A prospective interventional case series that evaluated the postoperative manifestations of ocular irritation in pterygium patients.Methods: Twenty-five pterygium patients were treated by pterygium excision with vicryl 8/0 sutured conjunctival autograft. The severity of postoperative foreign body sensation, pain, watering, and localised hyperemia involving the nasal conjunctival quadrant were evaluated, scored, and graded.Results: The main reported symptom was foreign body sensation, with a mean grade of 1.9 ± 0.54 recorded 3 to 4 days postoperatively, which declined one week postoperatively to a mean of 1 ± 0.45. Mild to moderate tolerable symptoms were reported in 92% at the first postoperative visit with an average score of 5 ± 1.05, which declined to an average of 1.4 ± 0.52 at one week, with all the patients reporting minimal symptoms. At the end of the follow-up, the mean index of localised nasal conjunctival hyperaemia was 2.5 ± 0.39. Recurrence was recorded in one patient (4%). No other complications were encountered.Conclusion: Sutured conjunctival autograft can be used safely with tolerable short-term minimal to moderate manifestations of ocular irritation with no significant complications.

Conjunctival Lymphangiectasia Simulating Loa Loa.

A 46-year-old woman presented with complaints of irritation in the OS for 1 year. Her ocular examination revealed normal vision and anterior segment except for an incidental finding of a worm-like lesion in the temporal conjunctiva. The lesion was transparent, linear in shape forming a complete loop, extending from the superotemporal conjunctiva to the inferior conjunctiva (Panel A). The plane of the lesion was conjunctival. The lesion showed no mobility with exposure to light or when touched with a cotton-tip applicator. Differential diagnosis of dead loa loa versus lymphangiectasia was made. Her peripheral blood smear did not reveal any microfilariae and had a normal cell count. Surgical excision revealed the lesion to be embedded within the conjunctiva and no worm came out. Only a segment of the lesion was sent for biopsy as there was no worm. Histopathology revealed hyperplastic conjunctival epithelium (Panel B; ×200) showing diffuse and intense expression with pan-cytokeratin antibody (Panel C; ×200). Subepithelial stroma showed thickened, dilated, and ectatic vessels (Panel D; ×400). The endothelial lining of vessels showed strong and intense expression with CD34 and podoplanin antibodies (Panels E and F; ×400) indicating lymphatic origin. The final diagnosis of conjunctival lymphangiectasia was made. Isolated conjunctival lymphangiectasia can be an incidental finding or associated with chemosis or persistent irritation. A trial of topical steroids can be given in symptomatic patients. Surgical excision with or without amniotic membrane graft or conjunctival autograft can be performed in nonresponsive cases. Anterior segment optical coherence tomography of conjunctival lymphangiectasia shows multiple subepithelial cystic spaces within the conjunctiva.

SURGICAL OUTCOME OF CONJUNCTIVALAUTOGRAFT USING AUTOLOGOUS BLOOD IN PATIENTS UNDERGOING PTERYGIUM SURGERY AT A TERTIARY CARE CENTRE IN KASHMIR

Background: Pterygium refers to a wing shaped brovascular growth of subconjunctival tissue that encroaches onto the cornea. Main modality of treatment of pterygium is surgical. Aim: To determine the surgical outcome of conjunctival autograft xation using autologous blood in patients attending OPD of Department of Ophthalmology, Government Medical College, Srinagar. Methods: This was a prospective interventional study conducted on 60 patients with primary pterygium attending the Department of Ophthalmology of a tertiary care centre in Kashmir over a period of 2 years from June 2019 to June 2021. Patients with recurrent pterygium, past history of ocular trauma and patients with bleeding diathesis were excluded from the study. Proper history was taken from all the patients and a detailed ophthalmological examination was done which included uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), IOP measurement. Detailed anterior segment and posterior segment examination was done. Results: Our study indicated mean age of patients as 55±3 years. There were 40 female patients (66.7%) and 20 male patients (33.3%). Majority of patients presented with grade-2 and grade-3 pterygium accounting for 50% and 25% cases respectively. Postoperative complications such as subconjunctival haemorrhage, graft edema, graft retraction and corneal epithelial defect were seen in 10%, 55%, 5% and 50% cases respectively. Graft loss and conjunctival granuloma were not seen in any of the patients in our study. Overall surgical outcome was good in our study patients with no postoperative complications at the end of 6 weeks follow-up. Conclusion: Our study concluded that majority of the patients who underwent pterygium excision with graft xation using autologous blood were females with grade-2 and grade-3 pterygium. Surgical outcome using autologous blood as a bioadhesive is a useful and good alternative to xation of conjunctival autograft using sutures or brin glue.

Comparison of Efficacy and Safety of Two Commercial Artificial Tears Between 0.18% and 0.3% Sodium Hyaluronate for Corneal Epithelial Healing in Pterygium Excision with Conjunctival Autograft Transplantation: A Study Protocol for a Randomized Controlled Trial.

To compare the efficacy, safety, and rate of healing on the corneal epithelial defect after pterygium surgery through the application of either 0.18% or 0.3% sodium hyaluronate (SH). A randomized, double-blind clinical trial was performed on patients who had pterygium surgery. Eighty-six patients were randomized to 2 groups that would receive either 0.18% SH or 0.3% SH. Measurements of area of the corneal epithelial defect using ImageJ freeware were performed. All corneal epithelial defects were measured immediately after the operation (Day 0) and for the next 3 days. The mean and SD of the area of corneal epithelial defect measured on postoperative Day 0, 1, and 2 were 9.13 ± 3.09 mm2, 5.61 ± 3.26 mm2, and 3.39 ± 2.70 mm2 for 0.18% SH group, and 8.96 ± 3.17 mm2, 4.03 ± 1.99 mm2, and 1.55 ± 1.23 mm2 for 0.3% SH group. There was no statistically significant difference of the initial area of the corneal epithelial defect on Day 0 between 0.18% and 0.3% SH group (p = 0.802). The area of the defects in the 0.3% SH group was significantly smaller than that of the 0.18% SH group on both Day 1 and Day 2 (p = 0.007, p < 0.001), respectively. Similarly, the 0.3% SH group exhibited a statistically significant higher (p < 0.001) rate of healing of the corneal epithelial defect over days 0 and 1 (4.94 ± 2.16 mm²/day) when compared to that of the 0.18% SH group (3.53 ± 1.66 mm²/day). With two commercial artificial tears, the corneal epithelial wound healing after pterygium surgery was faster in the 0.3% SH group than that of the 0.18% SH group. Superiority of 0.3% SH may be supported by the presence of epsilon-aminocaproic acid in this drug preparation. No significant adverse effects were exhibited during the short-term follow-up.

A Simple, Safe, and Effective Method for Preparing Autologous Bio-Based Fibrin Glue for Ophthalmic Use.

This study proposes a method to prepare autologous bio-based fibrin glue (FG) for use in ophthalmic surgery. FGs containing three fibrinogen concentrations and a thrombin concentrate were prepared using human blood from five donors (FG1: physiological fibrinogen concentration; FG2 and FG3: concentrated fibrinogen). The adhesion strength was tested, and the clinical safety and efficacy were studied in rabbit eyes in conjunctival surgery. A commercial FG was used as a control. From each donor, 2 mL of FG was prepared, containing 1 mL of 3.49 ± 0.78 (FG1), 17.74 ± 4.66 (FG2), or 47.46 ± 9.36 mg/mL (FG3) of fibrinogen and 1 mL of 2248.12 ± 604.20 UI/mL of thrombin. The average adhesion strength increased with the fibrinogen concentration, from 1.49 ± 0.39 kPa (FG1) to 3.14 ± 1.09 kPa (FG3). FG1 showed poor results when used for autograft adhesion. In contrast, the conjunctival autografts were successfully grafted using FG2 and FG3, revealing equivalent adhesion properties compared with commercial FG, but with less inflammation. In conclusion, FGs could be prepared on demand within minutes from small volumes of human blood, using a method that results in FGs which exhibit good adhesion capacity and are also safe and effective in a preclinical study.

Mean Change in Pterygium Induced Astigmatism in Patients Undergoing Pterygium Excision with Conjunctival Autograft

Purpose: To determine the mean change in pterygium induced astigmatism in patient undergoing pterygium excision with conjunctival auto graft. Study Design: Quasi Experimental Study. Place and Duration of Study: Department of ophthalmology Dow University of Health Sciences/CHK from March 2018 to November 2018. Methods: Thirty patients with pterygium were selected through non-probability consecutive sampling. All patients meeting inclusion criteria were enrolled after taking written consent. History of duration of symptoms and co-morbidity was taken. All surgeries were performed by consultant with more than 5 years’ experience with conjunctival auto graft under topical anesthesia. Patient was followed up after one week, 15 days and then monthly for four months with the final outcome at the end of fourth month. Difference between preoperative and postoperative astigmatism was taken as mean change. Data was analyzed on SPSS version 21. Mean and Standard deviation were calculated for all quantitative variables like age, astigmatism (keratometric reading) and duration of symptoms. Frequency and percentage was calculated for gender and grade of pterygium. P &lt; 0.05 was considered significant. Results: Mean age of the patients was 50.07 ± 12.48 years. There were 19 (63.33%) males and 11 (36.67%) females. Preoperative mean astigmatism was 3.70 ± 1.36 and postoperative mean astigmatism was 1.91 ± 0.97. Post-operative mean astigmatism was significantly low as compare to preoperative astigmatism (p = 0.0005). Conclusion: This study concludes that successful pterygium excision surgery reduces the pterygium induced refractive astigmatism and improves the visual outcome either by reducing the astigmatism or by removal of the pterygium from the visual axis as in Grade IV pterygium.

Pterygium management and comparison of different surgical approaches with supportive treatment in Rural Maharashtra

BACKGROUND: Numerous surgical procedures and changes have been ineffective in preventing the recurrence of pterygium. A prospective clinical observational analysis of 205 individuals with primary pterygium was conducted where patients were treated with various surgical procedures. The patients were observed for two to five years in order to examine the frequency of recurrences and consequences. RESULT: Patients were divided into four groups and treated using a variety of surgical methods. Straightforward excision of pterygium was the treatement of choice in group 1. Excision with conjunctival rotation pedicle graft was used on patients in Group 2. Excision and conjunctival autograft were used to treat Group 3 patients. Patients in Group 4 received excision and a 0.02 percent solution of mitomycin c drops as a postoperative treatment. Age varied from 22 to 58, with a median of 34. All four groups had an equal number of men and women. Hemorrhage, astigmatism, symblepheron, foreign body feeling, and a corneo-scleral ulcer were among complications that were reported. There were 12 percent complications in group 1, 16 percent complications in group 2, 6 percent complications in group 3, and 8 percent complications in group 4. Criteria for recurrence was defined as the regrowth of fibrovascular tissue or the appearance of an aesthetic flaw. It's 30 percent for group 1; 14 percent for group 2, 9 per cent for group 3, and 8 per cent for group 4. CONCLUSION: The least rate of recurrence was noted in patients of Group 4 who had pterygium excision with postoperative mitomycin c instillation, and complications were least common in patients in Group 3 who had pterygium resection with conjunctival autograft..

Conjunctival Autografts for Ocular Surface Reconstruction after Conjunctival Nevus Excision.

The aim of this study was to evaluate the clinical and therapeutic outcomes of the cases where we used conjunctival autografts with and without the Tenon fascia for ocular surface reconstruction after conjunctival nevus excision. This study included 63 eyes of 63 patients who underwent conjunctival nevus excision between January 2013 and December 2020. Although a Tenon-free conjunctival autograft was used in 32 eyes of 32 patients in group 1, a Tenon-containing conjunctival autograft was used in 31 eyes of 31 patients in group 2. The clinical and histopathological characteristics of the nevus, complete graft epithelization, cosmetic outcomes, and postoperative complications were evaluated. Conjunctival autografts were harvested from the contralateral eye in 3 eyes (9.3%) in group 1 and 2 eyes (6.4%) in group 2 ( P = 0.66). Postoperatively, the mean defect size at the harvest site was 5.3 ± 1.4 mm in group 1 and 5.5 ± 1.5 mm in group 2 ( P = 0.47). Graft edema was observed in only 1 case (3.1%) in group 1 and 6 cases (19.3%) in group 2 ( P = 0.04). Although a complete graft epithelization was observed in all eyes in group 1, fluorescein staining was present in 2 eyes (6.4%) in group 2 ( P = 0.14). Cosmetically, retracting and shrinking grafts were absent in group 1, whereas group 2 had in 4 eyes (12.9%) ( P = 0.03). Neither group had conjunctival scarring, symblepharon, eyelid cicatrization, dysmotility, or pannus at the donor site. Ocular surface reconstruction with a Tenon-free conjunctival autograft after conjunctival nevus excision provides excellent cosmetic and functional results without significant complications.

Evaluating the Efficacy and Safety of Different Pterygium Surgeries: A Review of the Literature.

The search for the “gold standard” in the surgical treatment of pterygium has been ongoing for over two decades. Despite the development of various surgical techniques, recurrence rates range from 6.7% to 88% depending on the method used. This review discusses the latest and most commonly used methods for the surgical removal of pterygium, primarily focusing on efficacy and safety. Moreover, this review includes articles that either evaluated or compared surgical methods and clinical trials for primary and recurrent pterygium. Limited data are available on combined methods as well as on the efficacy of adjuvant treatment. The use of adjuvant intraoperative mitomycin C (MMC) and conjunctival autografting (CAU) are the two most highly recommended options, as they have the lowest rates of postoperative recurrence.

Outcome of Pterygium Excision with Conjunctival Autograft in a Tertiary Hospital in Southern Nigeria

Aim: To report the outcome of pterygium surgery with conjunctival autograft at a tertiary hospital in Southern Nigeria.&#x0D; Methods: This is a retrospective non comparative study of post operative outcomes in which the medical records of all patients who had pterygium excision with conjunctival autograft from July 2016 to June 2021 at Nigerian Navy Reference Hospital Calabar, Nigeria were reviewed. All the patients were followed up for a minimum of 6 months. Data collected were sex, age, grade of pterygium, indication for pterygium surgery, post operative complications and recurrent pterygium growth.&#x0D; Results: Forty – three eyes of 38 patients were operated on. There were 23 males and 15 females (M:F = 1.5:1). Age range was 28 to 61 years (mean 40.9 ± 8.4). Age range with the highest surgery was 31 to 40 years. Grade two pterygium accounted for most of the cases (88.4%) followed by grade three (9.3%) and grade one (2.3%). The most common indication for pterygium surgery was cosmetic (55.8%) followed by recurrent inflammation (34.9%) and the least indication was blurring of vision (9.3%).&#x0D; Of the 43 eyes operated, one had recurrence giving a recurrence rate of 2.3%. One patient each developed granuloma and conjunctival cyst while three patients had subgraft hemorrhage.&#x0D; Conclusion: Primary pterygium excision with conjunctival autograft has a low recurrence rate consistent with previously published reports.

Case series about physiological astigmatism and the impact of pterygium surgery

IntroductionPterygium is a benign conjunctival fibrovascular neoformation progressively encroaching on the cornea, it can cause corneal distortion and induce astigmatism, or aggravate pre-existing physiological astigmatism, which is defined as ≤ 0.50 D and not requiring optical correction. The radical treatment of pterygium is purely surgical, with conjunctivo-limbal grafting and conjunctival autografting emerging as the surgical techniques of choice. The main objective of the study was to investigate whether pterygium surgery does not worsen the preoperative physiological astigmatism. Material and methodsThis is a prospective cohort study conducted in the ophthalmology department of the Mohammed V Military Hospital in Rabat over a period of 12 months, including 43 stage II/III/IV pterygia that were operated on by conjunctival autograft by the same surgeon. First, we looked for an association between pterygium surgery and variations in astigmatism. For quantitative variables we used the Wilcoxon test. In a second step we split the file into two distinct groups according to the value of preoperative astigmatism≤ 0.5 D or >0.5 D in order to detect the impact of pterygium surgery on physiological astigmatism. Statistical analysis of the data was performed by comparing the distribution of these characteristics. ResultsThe median astigmatism was 1 D (0.25; 2.50). 35% of our population had preoperative astigmatism ≤0.5 D. The Wilcoxon test showed that there was a statistically significant difference between preoperative and postoperative astigmatism (p = 0.001). The paired sample T-test showed no statistically significant difference between the preoperative and postoperative outcome in the physiological astigmatism population (p = 0.53). ConclusionMany studies have shown the benefits of pterygium excision on astigmatism, but few studies have specified the impact of this surgery on physiological astigmatism. Our study showed that pterygium surgery does not alter physiological astigmatism.

COMPARISON OF SUTURELESS, GLUE-LESS CONJUNCTIVAL AUTOGRAFT VERSUS SUTURED LIMBAL CONJUNCTIVAL AUTOGRAFT FOR PRIMARY PTERYGIUM

Objectives: The objective of the study was to compare and evaluate efficacy of two surgical techniques for the management of primary pterygium in terms of complications and post-operative signs and symptoms. Methods: The study included 60 patients with primary pterygium. The mean age was 42±10 years (range 22–62 years). Simple excision under local anesthesia was performed followed by closure of the bare sclera by suture less and glue free conjunctival autograft in 30 patients (Group I), versus the conventional method of a sutured conjunctival autograft in 30 patients (Group II). Results: At Visit 1, 6 patients (20%) of Group I had Graft edema in comparison to 5 patients (16.67%) in Group II. Subcutaneous hemorrhage was noted in 6 (20%) patients in both the groups. Graft retraction was noticed in 4 patients (13.33%) in Group I and in 2 patients (6.66%) in Group II. Graft dislodgement was observed in 1 patient (3.33%) in Group I. One (3.33%) case of recurrence was reported at 6 months in Group I whereas 2 (6.67%) cases were reported in Group II. One case of Granuloma was reported in Group II. There were significantly lower post-operative signs and symptoms in Group I as compared to Group II in the 1st post-operative week and the difference between the two groups was statistically significant (p&lt;0.05) at visit 1 and visit 2. The satisfaction survey revealed higher overall satisfaction score for Group I as compared to Group II. Conclusion: Sutureless technique may be considered as a viable alternative to sutured technique in terms of surgical outcomes. It scores better in terms of post-operative symptoms when compared to sutures.

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.

Comparison of Autologous Blood Coagulum (ABC) and Suture at Recurrence Rate and Graft Stability of Postoperative Primary Pterygium Using Conjunctival Autograft: A Meta-Analysis From Randomized Controlled Trial

Introduction: The main challenge of pterygium management is the postoperative recurrence rate. Currently, the use of surgical sutures for conjunctival autograft fixation, which has prolonged surgery duration, has a risk of increased inflammation and infection. Recently, some reports about autologous blood coagulum (ABC) for conjunctival autograft fixation. This technique has a minimal cost and minimal risk of infection. Purpose: The study aimed to evaluate the postoperative recurrence rate and graft stability after using ABC and sutures. Methods: A systematic research was done on Pubmed, Cochrane Library, and Science Direct online databases for all relevant randomized controlled trials (RCTs) up to 18 July 2020. The collected RCTs were independently screened and identified to match the inclusion criteria. The relevant data were compiled in population, intervention, control, outcomes (PICOs) format and analyzed with Review Manager 5.3 software. Results: Nine RCTs involving a total of 764 patients were assessed. The primary outcome indicates that ABC significantly reduced the recurrence rate compared to sutures (RR = 0.51, 95% CI 0.27 to 0.98, p = 0.04). Meanwhile, in graft stability, the suture was statistically better than ABC (RR = 1.95, 95% CI 1.27 to 3.01, p = 0.002). As a secondary outcome, the duration of surgery was significantly shorter in ABC than in sutures (MD -15.22, 95% CI -22.57 to -7.88, p&lt;0.0001). Conclusions: Although the graft is less stable, ABC may be a promising approach after pterygium excision. The use of autologous blood for conjunctival autograft fixation in primary pterygium was associated with a lower recurrence rate and shorter duration of surgery.

Preoperative Intralesional Bevacizumab Injection in Primary Pterygium in Tunisian Patients: A Randomized Controlled Prospective Study.

To assess the efficacy and safety of a single preoperative intralesional bevacizumab injection as an adjuvant treatment before primary pterygium surgery. We conducted a randomized controlled interventional study from January 2019 to December 2020. The study included a total of 60 patients (60 eyes) with primary pterygium. We defined two groups of 30 patients each. Group A received an intralesional injection of bevacizumab (Avastin), 1 month before surgery (lesion excision and conjunctival autograft). Group B (control) had only the surgical treatment. Patients were followed up 7 days (D7), 1 month (M1), 3 months (M3), and 6 months (M6) postoperatively. Pre-, per-, and postoperatively, photographs of the lesions were taken, as well as a histopathological examination. The main outcome measures were the change in functional discomfort following intralesional bevacizumab injection and pterygium recurrence. Recurrence was defined as fibrovascular tissue growth invading the cornea. Therapeutic success was defined as the absence of pterygium recurrence in M6. The mean age of the 60 patients was 54.17 ± 10.53. After bevacizumab injection, the preoperative functional discomfort score decreased significantly (P = 0.048). There was a significant improvement in grade and color intensity (P = 0.001). We noted no local nor systemic complications after intralesional injection of bevacizumab. After pterygium excision, the success rate was statistically higher in Group A (P = 0.047). There was no significant difference in either final best-corrected spectral visual acuity or astigmatism between the two groups. We noted a statistically significant association between recurrence and color intensity (P = 0.046), vascular density (P = 0.049), and the degree of elastic tissue degeneration (P = 0.040). A single preoperative subconjunctival injection of bevacizumab 1 month before surgery decreases the vascularity of newly formed blood vessels and hence may reduce the recurrence rate.

A Randomized Controlled Trial to Manage Postoperative Ocular Pain after Pterygium Excision with Conjunctival Autograft Transplantation with a Single Application of 2% Sodium Hyaluronate.

Purpose To assess the effectiveness of a single application of 2% sodium hyaluronate (SH) in controlling pain after pterygium excision as compared with that of a control group. Methods We performed a prospective randomized controlled trial in the patients who underwent pterygium excision. The outcome of topical application of 2.0% SH was measured using the visual analogue scale (VAS), in comparison with that observed in a control group (without SH). The area of ocular surface defects was assessed by ImageJ freeware. Analysis of pain scores and ocular surface defects were observed from both groups immediately after the operation, Day 0, and 3 subsequent days. Results Thirty patients were randomly divided into control group and SH treatment group. The initial area of the ocular surface defect on Day 0 was approximately the same for both groups (p=0.242). The medians of pain score assessed by the VAS on Days 0, 1, and 2 were 5, 3, and 0 for the SH group and 6, 5, and 3 for the control group, respectively. The pain score was statistically significantly decreased in the SH group compared to the control group on Day 1 (p < 0.001) and Day 2 (p < 0.001). The pain level of both groups was nearly the same on Day 3 (p=0.141). The area of ocular surface defects was significantly different between two groups on Day 1 (p < 0.001) and Day 2 (p < 0.001). Postoperative complications were not observed. Conclusion A single topical application of 2% SH in pterygium excision was effective in relieving pain in the early postoperative period without any adverse effects. This innovation may provide alternative pain control in pterygium surgery.

Comparison of surgical techniques for recurrent pterygium

ObjectifSi l'autogreffe conjonctivale (AGC) et la greffe de membrane amniotique (GMA) s'accompagnant de mitomycine-C (MMC) représentent les traitements les plus efficaces du ptérygion primitif, on ne sait toujours pas quel est le meilleur traitement chirurgical du ptérygion récurrent. Nous avons donc entrepris d'examiner le taux de récurrence du ptérygion récidivant après son exérèse chirurgicale réalisée par ACG ou par GMA avec ou sans MMC. MéthodesNous avons réalisé un examen rétrospectif des dos..;’siers médicaux de patients adultes qui ont subi l'exérèse chirurgicale d'un ptérygion récurrent au Boston Medical Center entre janvier 1999 et juillet 2019. Le taux de récurrence postopératoire a été comparé entre 4 groupes de traitement chirurgical: AGC + MMC, AGC, GMA + MMC et GMA. Ont également été enregistrées les complications peropératoires et postopératoires. RésultatsAinsi, 41 yeux de 38 patients ayant subi l'exérèse chirurgicale d'un ptérygion récurrent répondaient à nos critères. Le taux de récurrence postopératoire observé se chiffrait à 0 % (0 œil sur 8) dans le groupe AGC + MMC, à 17,7 % (3 yeux sur 17) dans le groupe AGC, à 45,5 % (5 yeux sur 11) dans le groupe GMA + MMC et à 80,0 % (4 yeux sur 5) dans le groupe GMA. Le taux de récurrence postopératoire était significativement moindre dans le groupe AGC, comparativement au groupe GMA, tant avec (p = 0,045) que sans (p = 0,021) administration adjuvante de MMC. On ne note aucune différence statistiquement significative quant au taux de nouvelle récurrence avec ou sans MMC dans les groupes AGC (p = 0,52) ou GMA (p = 0,31). Il s'est produit 1 cas de complication possible de l'administration de MMC qui aurait entraîné la dissolution complète de la membrane amniotique. ConclusionsLes résultats de notre étude portent à croire que l'AGC se traduit par un taux moindre de nouvelle récurrence que la GMA dans le traitement chirurgical du ptérygion récurrent. L'administration peropératoire de MMC pourrait diminuer le taux de récurrence, mais la diminution n'est pas significative sur le plan statistique, sans compter que la MMC peut entraîner des complications.