Primary Pterygium Excision 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

Primary Pterygium Excision Surgery: Analysis of Risk Factors and Clinical Outcomes.

Purpose To evaluate clinical outcomes of primary pterygium excision surgery and analyze risk factors for pterygium recurrence. Setting Eye Treatment Centre, Cornea and External Diseases Service, Whipps Cross Hospital, London, United Kingdom. Methods Retrospective case series of eyes undergoing primary pterygium excision between August 2017 and July 2022. Patients who underwent "pterygium excision" documented in the electronic patient record system were identified. Patients with recurrent pterygium and those lost-to-follow-up were excluded. The duration of follow-up, type of surgery performed (primary conjunctival closure, conjunctival autograft, and amniotic membrane transplantation), recurrences with respect to the type of surgery performed, and postoperative complications were collected and analyzed. Results In total, 83 eyes (from 79 patients) were included. The mean age of our patient cohort was 59.3 ± 5.9 years. The most common ethnic distribution was Black Caribbean (15.7%). Conjunctival autograft was performed in 76 eyes (91.6%), primary conjunctival closure was performed in five eyes (6%) and amniotic membrane transplantation was performed in two eyes (2.4%). The recurrence rate with conjunctival autograft was 1.3% with a median time to recurrence of 2.98 months. Recurrence was significantly more common in patients below the age of 40 years (p=0.03). Recurrence was not significantly associated with gender (p=0.23), ethnicity (p=0.17), or grade of surgeon (p=0.38). Conclusion Our findings demonstrate the effectiveness of conjunctival autograft with fibrin glue fixation for the surgical management of primary pterygium. Recurrence was found to be significantly more common in patients under the age of 40 years old. However, recurrence was not associated with ethnicity,gender, or surgeon grade.

Comparison of recurrence rate of primary pterygium using conjunctival autograft with sutures versus suture-free approach.

Objective: To compare the recurrence rate of primary pterygium treated with conjunctival autograft (CAG) using sutures versus a suture-free approach. Methodology: From July 2022 to December 2022, a quasi-experimental study was carried out at the Institute of Ophthalmology, Liaquat University of Medical & Health Sciences Jamshoro. A total of 110 patients with primary pterygium underwent treatment with conjunctival autograft using sutures or a suture-less/glue-free approach, under local anaesthesia. The patients were monitored for 12 months after surgery to assess recurrence and complications, and all procedures were performed by a single surgeon. Data was collected and analyzed on SPSS version 22. Result: The study included 110 patients with pterygium, mostly males (71.81%) and from rural areas, with the nasal location being the most common. Group A had 3 recurrences at 3 and 6 months, while Group B had 4 recurrences at similar intervals. Group A had fewer complications, including graft oedema, retraction, granuloma, and giant papillary conjunctivitis, while Group B had three cases of retraction. The recurrence rate was found to be 5.08% and 7.70% with and without sutures (P value ≥ 0.53) respectively. Conclusion: The excision of primary pterygium using conjunctival autograft with sutures or suture-free/glue-free methods are safe and uncomplicated procedure that results in lower levels of induced astigmatism, improved cosmetic appearance, no tissue loss, reduced recurrence of pterygium, and decreased risk of, scleral thinning, granuloma formation. Suture-free conjunctival autograft results in less postoperative manifestation like discomfort foreign body sensation, shorter surgery time, and high levels of patient satisfaction compared to conjunctival autograft with sutures. Key words: Primary pterygium, autograft and pterygium. recurrence rate of pterygium, suture with pterygium.

Timing optimization for primary pterygium excision with conjunctival-limbal autograft to restore the corneal optical properties.

To propose the optimal value of baseline corneal astigmatism and pterygial morphological profiles for primary pterygium surgery to restore the corneal optical properties. We analysed 93 eyes from 84 subjects with nasal-only primary pterygium who underwent pterygium excision with conjunctival-limbal autograft and were assessed perioperatively using anterior segment swept-source optical coherence tomography (AS SS-OCT). We collected data on anterior corneal astigmatism (ACA) and root mean square (RMS) values for anterior corneal lower- (LoA) and higher-order aberrations (HoA) as corneal optical properties using AS SS-OCT. Using preoperative ACA and four pterygial morphological profiles (horizontal invasion length [HIL], height, thickness and the ratio of residual corneal thickness [RCT] to central corneal thickness [CCT]) measured in AS SS-OCT, we plotted receiver operating characteristic (ROC) curves. These curves aimed to determine cut-off values predicting a perioperative decrease exceeding 50% in ACA, RMS LoA and RMS HoA, as well as postoperative residual ACA higher than 1.25D. Preoperative ACA > 1.42D (AUC = 0.934) and >3.60D (AUC = 0.946) proved most effective in identifying subjects with perioperative decrease exceeding in ACA and RMS LoA, respectively. HIL > 3.34 mm (AUC = 0.941) was most effective in distinguishing subjects with perioperative reduction exceeding 50% in RMS HoA. Preoperative ACA > 5.78D (AUC = 0.776) and HIL > 5.03 mm (AUC = 0.700) significantly distinguished subjects with postoperative residual ACA higher than 1.25D. Optimizing the restoration of corneal astigmatism and aberrations after pterygium surgery may be facilitated by determining the optimal surgical timing based on preoperative ACA and HIL values.

Superior versus inferior conjunctival rotational flap in primary pterygium surgery

Background Conjunctival rotational flap is one of the surgical treatment options for pterygium with variable recurrence rates. Taking a conjunctival flap from the superior bulbar area is sometimes unfeasible due to scarring, ocular surface disease, or previous trabeculectomy. Aim This study aimed to compare the superior versus the inferior conjunctival rotational flap results following primary pterygium excision. Patients and methods This is a retrospective, interventional, comparative study that enrolled 120 patients having primary pterygium. The patients were recruited from the Ophthalmology Department, Beni Suef University Hospital, Beni Suef, Egypt during the period from June 2020 to June 2022. The patients were classified into two groups: group I that included 73 (60.8%) patients who underwent the superior conjunctival flap technique, and group II that included 47 (39.2%) patients who underwent the inferior flap technique. Slit-lamp findings were reported during the scheduled appointments, with a focus on pterygium recurrence and other complications. Postoperative follow-up was performed for 6–18 months. Results The recurrence rate among the inferior conjunctival flap group (12.8%) was higher than in the superior conjunctival flap group (9.6%), with no statistically significant difference (P=0.585). No additional postoperative complications, such as flap separation, dullen formation, or granulomas occurred in either group. Conclusion There was no statistically significant difference in the outcome of the superior and inferior conjunctival rotational flaps in primary pterygium excision. We propose that inferior conjunctival flap preference can result in favorable outcomes in circumstances where the superior bulbar conjunctiva is required for protection or cannot be used.

Comparative Assessment of Mitomycin C versus Limbal Conjunctival Autograft for Primary Pterygium Removal: An Evaluation of Efficacy

Objective: This study aims to evaluate and contrast the outcomes achieved by application of mitomycin C 0.02% intra-operatively versus employing limbal conjunctival autograft after the removal of primary pterygium. Study Design: Randomized controlled trial (RCT) Place and duration: The research was carried out at the Ophthalmology Department of Ghazi Hospital in Dera Ghazi Khan, spanning from October 2021 to September 2022. Methodology: The research included 62 participants who were divided into two groups; one group receiving Mitomycin C and the other group underwent limbal conjunctival autograft. The main variables assessed in the study were the laterality of pterygium, size of pterygium extending over the limbus, preoperative and postoperative best corrected visual acuity, and the rate of pterygium recurrence in both groups. The analysis of data was conducted utilizing SPSS version 24. Results: In Group MMC, 48.4% of patients showed right laterality, while in Group LCAU, 58.1% (p=0.445) showed it. The average size of pterygium crossing the limbus, as well as preoperative and postoperative best corrected visual acuity, were similar between both groups (p>0.050). Regarding recurrences, the percentages at 3, 6, and 9 months, as well as after 1 year, were higher in Group MMC (12.9%, 6.5%, 16.1%, 9.7%, 45.2%) compared to Group LCAU (9.7%, 9.7%, 3.2%, 6.5%, 29%), but these differences were not statistically significant (p=0.526). Conclusion: Limbal conjunctival autograft appears to be more effective in preventing recurrence following the excision of primary pterygium compared to intraoperative application of Mitomycin C. However, both techniques, whether simple excision with LCAU or MMC application, demonstrate acceptable outcomes with only minor differences in recurrence rates. Surgeon expertise and preferences in local practice play significant roles as main risk factors influencing the choice between these two methods.

Conjunctival Autograft with Mitomycin C (MMC) in Primary Pterygium Excision

Purpose: To evaluate role of conjunctival Autograft (CAG) with Mitomycin C (MMC) in primary pterygium excision. Place and Duration of Study: Mughal eye hospital Lahore from 2020 to 2022. Methods: Patients with primary pterygium were operated. Pterygium excision was followed by Mitomycin C (MMC) 0.02% application for 2 minutes under the conjunctiva at base of the pterygium and this was followed by CAG. Patients were followed up at 1 week, 1 month and 2 months to see recurrence and any side effects of MMC. Google sheets were used for recording data of pterygia. Results: A total of 385 eyes of 316 patients with primary pterygium were included in the study. There were 209 males and 107 females. Mean age was 35 years (range 26 to 58 years). Follow up ranged from one month to 2 months. Four eyes (1%) had recurrence. It was noted that blood vessels of recurrent pterygium grew above or below the conjunctival graft on the side which was short. No complication of MMC was observed. There were 2 cases of graft dehiscence due to early breakdown of sutures. Conclusion: Recurrence after pterygium excision can be reduced to minimum by application of MMC with CAG and it is a safe procedure. Recurrence mostly encroaches on the cornea from above or below the conjunctival graft. A large conjunctival graft is thus necessary to cover the pterygium area and prevent recurrence. MMC is safe. Suturing the conjunctival graft provides minimum chances of graft loss.

Outcomes of Fibrin Glue for Graft Fixation in Primary Pterygium Surgery with Conjunctival Autograft

Objective: To evaluate the recurrence rate and postoperative complications of fibrin glue fixation of conjunctival autografts following primary nasal pterygium excision. Materials and Methods: The present study was a retrospective study of all eyes with primary nasal pterygium that underwent pterygium excision with conjunctival autograft transplantation using fibrin glue for graft fixation at Mettapracharak (Wat Rai Khing) Hospital between July 2017 and December 2018. The author analyzed pterygium recurrence rates and postoperative complications such as graft loss, graft displacement or dehiscence, pyogenic granuloma, or any other complications. Results: Fifty-seven eyes of 57 patients were evaluated, of which 43 (75.4%) were female. The mean age was 57.09±1.38 years (range of 34 to 80 years). No serious complications occurred. One eye (1.8%) sustained recurrence in the six months follow-up. All grafts were intact. Graft displacement requiring suturing occurred in three cases (5%). Graft dehiscence was observed in 29.8%, and in all cases epithelialized without intervention. Other postoperative complications included pyogenic granuloma in 3.5%, graft edema, subgraft hemorrhage in 21.1%, and elevation of intraocular pressure over 21 mmHg in 5.3%. Conclusion: Fibrin glue for fixation for conjunctival autografts after primary nasal pterygium excision is safe and effective. The most common complication in the present study was graft dehiscence, which did not require surgical intervention. Keywords: Conjunctival autograft; Fibrin glue; Pterygium recurrence rate; Graft dehiscence

Comparison of efficacy and safety of sutureless glue-free versus suture technique for autogenous conjunctivolimbal grafting in primary pterygium excision

To compare the efficacy and safety of sutureless glue-free versus suture technique for autogenous conjunctivolimbal grafting in primary pterygium excision. A prospective observational study was conducted in thirty consecutive patients of primary progressive pterygium after taking their informed written consent and ethical clearance in a tertiary eye care centre of Northern India. Patients were randomly divided equally into group “A” and “B” each constituting fifteen patients. Group A patients underwent suture technique and group “B” patients underwent sutureless technique for conjunctivolimbal graft placement. Comparison of both groups was done in terms of intraoperative time, postoperative symptoms and recurrence over a period of one year. Data was compiled and entered into Microsoft Excel software and SPSS version 21.0 was used for data analysis.The mean duration of surgery was 42 min and 30 min in group A and B respectively and this difference was found to be statistically significant (p=0.0001). On 1 postoperative day, pain and foreign‐body sensation was present in 12 patients in group A, while only 1 patient of group B had these symptoms and this difference was statistically significant (p = 0.00014). Postoperative hyperaemia was seen in 8 patients of group A and 6 patients of group B which was statistically insignificant (p = 0.564). Only two patients in group A had conjunctival chemosis while no patients in group B developed chemosis, and the difference was statistically insignificant (p = 0.964). Subconjunctival haemorrhage was seen in 2 patients of Group A and 1 patient of Group B which resolved over a period of 2-3 weeks. Conjunctivolimbal graft was found to be more stable in group A while it was misplaced in 1 patient of group B and the difference was statistically insignificant (p = 1.000). Only 1 patient of group A developed suture related complication i.e suture granuloma. Over a period of 1 year follow up, only 1 patient of group A had recurrence of pterygium.Sutureless glue-free technique is a time saving, cost effective and better surgical modality in comparison to conventional suture technique for autogenous conjunctivolimbal grafting in primary pterygium resection.

Comparison of the outcome of 0.02% mitomycine C versus limbal conjunctival autograft after primary pterygium excision.

Objective: is to compare the outcomes of mitomycin 0.02% intra-operatively and limbal conjunctival autograft after excision of primary pterygium. Methodology: Randomized controlled trial (RCT) was conducted at Opthalmology department Shalamar medical and Dental College, Lahore from October 2021 to September 2022 in duration of 1 year. A total of 62 patients enrolled in study. Patients were divided into two groups MMC and LCAG. Main variables of study were laterality of pterygium, size of pterygium cross limbus, preoperative and post operative BCVA and proportion of pterygium recurrence in both groups. SPSS version 24 was used for data analysis. Results: Laterality were right for 48.4% patients in Group MMC and 58.1% for Group LCAG, (p=0.445). The average Size of pterygium cross limbus, Preoperative and postoperative BCVA of both the groups were almost equal, (p>0.050). The recurrences at 3, 6 & 9 months and after 1 year in Group MMC was 12.9%, 6.5%, 16.1%, 9.7%, 45.2% which is greater than Group LCAG 9.7%, 9.7%, 3.2%, 6.5%, 29% respectively, but the difference was statistically insignificant, (p=0.526). Conclusion: Limbal conjunctival autograft is more successful in prevention of recurrence after excision of primary pterygium as compare intraoperative application of mitomycin-c. But simple excision and LCAG or MMC both are acceptable in terms of minor difference in recurrence rate, surgeon’s skill and preferences of local practice are main risk factors.

Autologous fibrin glue versus sutures for conjunctival autograft in primary pterygium: a randomized clinical trial.

To describe and compare the autologous fibrin glue and traditional sutures for conjunctival graft attachment in patients undergoing primary pterygium excision surgery. A randomized clinical trial included patients who underwent pterygium surgery with conjunctival autologous graft (CAG). Using randomization, a single-trained surgeon performed graft fixation with autologous glue or sutures. The glue was prepared immediately before the surgery, using the patient's blood components. After centrifugation, the plasma was collected and enhanced with calcium gluconate. Postoperative assessments were performed on Days 1, 7, 21, 30 and 180. The study evaluated postoperative edema and pain and complications. The mean surgical time was compared. Recurrence of the pterygium was assessed 6months postoperatively. The study evaluated 61 eyes. Thirty-three eyes underwent pterygium surgery using the glue technique, and 28 underwent the traditional suture technique. Fifty-one patients (83.60%) had successful graft adhered to at the end of follow-up. Ten patients (10/33) lost their graft in the glue group, and only 69.70% maintained graft presence in the fourth week versus 100% of the patients in the suture group (p = 0.001). Pain scores were lower in the glue group, and clinical edema was significantly higher. There was no significant difference in graft retraction or the presence of granuloma, necrosis or postoperative infection. Autologous fibrin glue is an affordable option for CAG fixation in particular contexts where commercial fibrin glue is unavailable, and it could offer advantages compared to sutures. A higher graft loss rate was observed and might be related to topical anesthesia, and improvements to the technique are needed. gov Identifier: NCT04151017. https://clinicaltrials.gov/ct2/show/NCT04151017?term=20170467&draw=1&rank=1 .

Primary Pterygium Excision with Amniotic Membrane Grafting among Rural Eye Patients in Bangladesh

Objective: Since treatment of pterygium by topical and systemic medications is not effective, surgical treatment remains the only way to resolve the problem. This study was therefore aimed to evaluate the outcome of primary pterygium excision with amniotic membrane graft among patient with eye diseases in rural Bangladesh. Methodology: This study was conducted at the Pangsha Eye Hospital of District Rajbari among a total 280 pre-selected eye patients having primary pterygium over the period of 7 years (January 2012-June 2019). Surgical excision was performed with transplantation of preserved amniotic membrane on to the bare sclera. Every patient was followed up for at least next 6 months. Results: The results were evaluated in terms of recurrent pterygium growth and related complications. Of total 280 patients, pterygium was excision both of 138 (49.29%) being male and 142(50.71%) being female with mean ages of 43.36±10.88. The pterygium extended on to the corneas for 4.76±1.4 mm (range 3 to 8) mm. Only 11(4%) eyes demonstrated recurrent pterygium. Seven of them were male and 4 were female which was managed by second grafting leading to complete resolution. Of various complications, mild hematoma was observed in 3 cases, and, in 2 cases were had mild sclera dryness in bare scleral area after pterygium excision which were managed by topical steroid and artificial tear. Conclusion: Findings of this study yielded that primary pterygium excision with amniotic membrane transplantation is remains a safe and effective surgical technique with minimum recurrence rate. The Journal of Ad-din Women's Medical College; Vol. 11 (1), Jan 2023; p 4-13

Pterygium excision with rotational conjunctival flap - a simple and effective method

Purpose: To find out the effectiveness of rotational conjunctival flap in pterygium excision by analyzing intra/postoperative complications and recurrence rates. Study Design: Interventional case series Place and Duration of study: Al-Baseer Eye Hospital, Karachi from October 2019 to May 2022. Methods: All patients who had primary pterygium excision with rotational conjunctival flap in the hospital were included. Data collection was done using medical records regarding patient’s age, sex, laterality and location of pterygium, intra-operative and post-operative complications. Patients were examined for recurrence at or more than 3 months follow-up. For data analysis, IBM SPSS Statistics 23 was used. Results: A total of 36 patients underwent pterygium excision with rotational conjunctival flap under topical anesthesia by a single surgeon. Mean age at the time of surgery was 52.85±12.66 years. Male : female ratio was 5:4. Ninety four percent were nasally located. Major intraoperative complication (corneal perforation) occurred in one patient. Post-operative significant flap congestion was noted in 2 (5.5%), while partial flap retraction and sub-conjunctival hemorrhage was seen in 1 (2.7%) patient. Twenty six patients completed at least 3 months follow-up. Two (8%) patients had recurrence of mild-moderate degree within 6 months of surgery. Conclusion: Pterygium excision with conjunctival rotational flap is simple and effective method in selected patients. Harvesting, positioning and suturing of flap can be carried out single handedly. The method requires less surgical expertise, and has good post-operative results.

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.
 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.
 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%).
 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.
 Conclusion: Primary pterygium excision with conjunctival autograft has a low recurrence rate consistent with previously published reports.

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.

Conjunctival Autograft versus Combined Amniotic Membrane and Mini-Simple Limbal Epithelial Transplant for Primary Pterygium Excision.

PurposeTo compare outcomes of conjunctival autograft (CAG) and combined amniotic membrane with mini-simple limbal epithelial transplant (mini-SLET) after primary pterygium excision.MethodsAll consenting adults with primary pterygium were included in this study. After pterygium excision, patients were randomized to receive either CAG or mini-SLET and both grafts were held in place with fibrin glue. The patients were followed-up at days 1, 3, 7, 14, and 30 and subsequently at the third, sixth, and ninth months. The recurrence rate was considered as the primary outcome measure whereas the operating time, postoperative symptoms, and surgical complications were considered the secondary outcome measures.ResultsThe study comprised of 264 eyes of 264 patients, of which 233 (88%) completed the nine months of follow-up. Of these, 118 (51%) received CAG and 115 (49%) received mini-SLET. The groups were comparable at baseline. Recurrence of pterygium was seen in two (1.6%) eyes in the CAG group and three (2.6%) eyes in the mini-SLET group (P = 0.68). Operative time for mini-SLET (20.33 1.28 min) was significantly higher than that for CAG (12.01 1.26 min) (P 0.001). Graft displacement was observed in one case in group II (P = 0.999). The Lim Bon Siong (foreign body sensation, lacrimation, pain, and irritation) score in the CAG group was statistically significant for all four symptoms at days 1 and 3; however, at day 7, foreign body sensation, pain, and irritation scores were significantly higher for the CAG group.ConclusionIn this study, the overall recurrence rate was very low and comparable between mini-SLET and the established technique of CAG after performing the primary pterygium excision. Despite a longer surgical time, mini-SLET appears to be a viable option for the management of primary pterygium.

Minimally Invasive Primary Excision and Primary Closure versus Primary Closure Using Mitomycin C to prevent Pterygium Recurrence

Objective: This study aimed to present a surgical technique in which we performed minimal excision and primary closure, which may reduce the recurrence rate, especially without using time-consuming graft procedures. Materials and Methods: Data from primary pterygium excision performed from 2013 to 2019, were retrospectively analyzed from the patient's electronic database. Patients who underwent only primary closure constituted Group 1, patients who underwent primary closure using mitomycin C as adjuvant therapy constituted Group 2. After the pterygium detached from the cornea with the help of blunt dissection, only the cap of the pterygium was resected with a Westcott scissor by vertical incision on the vascular and avascular region border. The primary closure involved a complete closure of the defect in the limbal surface by suturing the pterygium's head. Results: The study comprised a total of 31 patients, including 12 participants in Group 2 and 19 in Group 1. The average age of all subjects was 58.7 ± 9.4 years. The average postoperative follow-up time of groups was 29.2 ± 20.1 months and 30.0 ± 21.9 months, respectively(p = 0.88). Recurrence was observed in 4 (12.9%) of all patients during follow-up. While recurrence occurred in 10.5% of patients in group 1, recurrence was observed in 16.7% of patients in group 2. When the groups were compared in terms of recurrence, no statistically significant difference was observed (p=0.62). Conclusions: This minimal excisional and maximum physiological pterygium surgery is simple, fast, and safe in primary pterygium. It also has a relatively acceptable recurrence rate.

Primary Pterygium Surgery: An Alternative Method Utilizing Conjunctival Tissue Over Thepterygium Itself Retaining its Own Vascular Supply

ntroduction: The gold standard management of pterygium is pterygium excision with conjunctival autograft utilizing the superior bulbar conjunctiva, but its preservation is essential for future glaucoma surgery. Aim/Objective: The aim of this study is to find out the outcome and complications of primary pterygium excision utilising the conjunctival tissue over the pterygium itself to cover the bare area retaining its own vascular supply and to preserve the superior bulbar conjunctiva for future uses. Materials and Methods: In this retrospective non-comparative study, 42 eyes with primary pterygium underwent pterygium excision utilising conjunctival tissue over the pterygium itself maintaining its original position and retaining its vascular supply for the period of 2018-2020. Methodology: In this technique two conjunctival incisions were given, one at the neck of the pterygium and other at 5-5.5 mm away from the limbus. The underlying fibrovascular tissue was separated and removed. Conjunctival tissue was placed in its normal position over the bare sclera maintaining its own vascular supply. Results: Mean age of the study population was 44.86 ± 11.68 years. Mean follow-up period was 12.62 ± 3.96 months. No recurrence was detected in the follow-up periods. The main two complications were subconjunctival injection and graft edema which were 100% and 33.33% respectively. Conclusion: This study results provide that utilization of the conjunctival tissue over the pterygium itself with retaining its own vascular supply can be a useful alternative technique for the management of primary pterygium and thus the superior bulbar conjunctiva can be preserved for future uses.

Evaluation of outcome of primary pterygium excision combined with different techniques

To compare different techniques combined with excision in treatment of primary pterygium: Amniotic membrane transplant [AMG], Limbal-conjunctival autograft [CLAG], and mitomycin c with limbal-conjunctival autograft.[MMC+CLAG]: A prospective comparative study was performed in tertiary hospital on 105 patients satisfying the inclusion and exclusion criteria. Combined with excision, 35 eyes each were treated with AMG transplantation [Group 1] and CLAG [Group 2] for closure of defect. In 35 eyes low-dose mitomycin -C [0.02%] was applied on bare sclera for 1 minute and a CLAG was applied thereafter [Group 3]. Patients were followed up for 9 months.Study was conducted from June 2018 to April 2020 on patients of age 26 to 72 years with mean age of 46.3 ± 10 years with 42[40%] male and 63[60%] female. A statistically significant change [ paired t test, p<0.001] was noted in K-horizontal value pre- and post- pterygium surgery. Change in K-vertical pre- and post- surgery was not statistically significant [paired t test, p<0.58]. Pterygium recurred in 3 patients [8.6%] in group 1, 1 patient [2.9%] each in group 2 and 3. Other postoperative complications include graft displacement [5.7%], graft oedema [6.7%] and congestion [9.5%]. A minor case of scleral melting was noted in one patient [2.9%] in group 3. Pterygium excision followed by CLAG and MMC+CLAG are an effective way of reducing recurrence. However close monitoring is required for use of adjuvant MMC.AMG can be reserved in patients with bilateral pterygium, severe limbal stem cell loss and in need of glaucoma surgery.

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.