Primary Pterygium Excision Research Articles

Long-Term Density Changes in Corneal Layers After Primary Pterygium Excision With Topical Mitomycin-C.

To evaluate the long-term change in average corneal densities at 18 months after primary pterygium excision with topical adjuvant mitomycin-C application, particularly the relationship between anterior and posterior corneal layer densities. Prospective observational case series. Patients were imaged with the Pentacam at 18 months after their surgery. Average corneal densities were the primary outcome and were compared with postoperative weeks 1, 4, and 12 data using paired t test. In all, 31 eyes of 31 patients were recruited. Mean age at time of operation was 62.0 ± 9.4 years. Mean best-corrected logarithm of the minimal angle of resolution visual acuity at 18 months was 0.14. The mean total anterior, central, and posterior average corneal densities were 30.6, 25.9, and 20.5 respectively. Compared with postoperative week 1 data, the anterior layer was reduced by 12.7% (P = 0.0144); however, there was no significant change in the central and posterior layers (P = 0.5353 and 0.0858, respectively). Subgroup analyses did not support the use of a 10- to 12-mm annulus as opposed to total-diameter data, and density reduction effect at 18 months from week 12 and week 1 seemed to be stronger in males (P = 0.0074 and 0.0042, respectively). Anterior corneal scars continued to diminish in density with time. Previous finding of a significant increase in posterior layer density at postoperative week 12 is likely not a result of optical phenomenon caused by a less dense anterior layer. Sex difference in terms of scar remodeling may be present.

A Comparative Study to Evaluate the Outcome of SuturelessGlufree Versus Sutures in ConjunctivalAutograft for Primary Pterygium Excision

A Comparative Study to Evaluate the Outcome of SuturelessGlufree Versus Sutures in ConjunctivalAutograft for Primary Pterygium Excision

Is Suturless and Gluelesslimbal Conjunctival Autograft for Primary Pterygium Surgery Efficient and Safe ?

Aim of the study:evaluate the safety and efficacy of sutureless glue free limbal conjunctival autograft for the management of primary pterygium surgery. Material and method:This prospective,interventional randomized,non comparative study was held at AlZahraaUniversity Hospital between May, 2013 and June, 2015. It included 20 eyes of 17 patients, 12 males(70.6%), and 5 females(29.4%). Their mean age±SD was 52.50±18.31 years (Range:30-75 years). They were presented to the outpatient clinic of Al Zahraa University Hospital with primary pterygium. Inclusion criteria included primary pterygium,non atrophic, with healthy conjunctiva. Exclusion criteria included atrophic pterygium, pseudopterygium, ocular surface pathology, infection, previous limbal surgery or double head pterygium. Surgeries were done under local anesthesia. Simple pterygium excision was done leaving a bare sclera. The size of bare sclera was measured. A conjunctival graft 2 mm larger in width and length than the recipient bed was created from the superior temporal quadrantand was extended to the limbus to include limbal stem cells. The graft was gently moved to the recipient bed with the epithelial side up and keeping the limbal edge toward the limbus.Hemostasis was allowed to occur spontaneously without use of cautery to provide autologous fibrin to glue the conjunctival autograft naturally in position without tension.All patients were followed up after 48 hours, weekly for one month then monthly for 12 months. Results:Pterygia were located nasally in all cases. Pterygia were presented right eye in10(50%) and left eye 10(50%). Mean graft size±SD was 5.5±1.5 millimeter (Range: 5-7 mm). Mean duration of graft fixation ±SD was 10±2.82 minutes (Range:10–12minutes).Mean operative time±SD was 25±1.41 minutes(Range: 24-26 minutes) with good cosmetic outcome in all cases. There was minimal postoperative pain and discomfort, without graft dislocation or dehiscence and without recurrence of pterygia during the follow up period. Conclusion:Sutureless and gluelessconjunctivallimbalautograft following primary pterygium excision is safe,easy,effective and economic technique in primary pterygium surgery.

Corneal Polishing After Pterygium Excision With Motorized Diamond Burr: A Randomized Control Trial.

To evaluate outcomes of motorized diamond burr polishing versus manual polishing after pterygium excision. Dr. Rajendra Prasad Center for Ophthalmic Sciences, New Delhi. A randomized, interventional observer-masked controlled trial. Forty consecutive eyes underwent pterygium excision with fibrin, glue-assisted conjunctival autograft. In group 1 (20 eyes), polishing of the corneal bed was done using a crescent blade, and in group 2 (20 eyes), using a motorized diamond burr. There was no difference in the 2 groups with respect to mean age (P=0.08), gender (P=0.3), preoperative uncorrected visual acuity (UCVA) (P=0.45), best spectacle-corrected visual acuity (BCVA) (P=0.52), spherical equivalent (P=0.5), mean astigmatism (P=0.7), tear function tests like tear break-up time, tear film meniscus height, Schirmer I and II (P=0.6, 0.5, 0.7, 0.9 respectively), pterygium dimension (P=0.4), and conjunctival autograft size (P=0.24). Mean intraoperative surgical time was significantly more in group 1 (16.9 ± 2.85 min) as compared with 12.25 ± 1.88 min in group 2 (P=0.0001). Postoperatively, there was a statistically significant reduction in astigmatism and improvement in UCVA, BCVA, spherical equivalent in all eyes. No difference was found in mean epithelial defect healing time, UCVA, BCVA, astigmatism, tear film break-up time, Schirmer I and II, and tear meniscus height at 6 months between 2 groups; however, significantly better UCVA was found in group 2 at 3 months (P=0.04). Surgically induced astigmatism (SIA) was significantly more in group 2 as compared with group 1 at 6 months (P=0.0006). Motorized diamond burr polishing of the corneoscleral bed during primary pterygium excision in comparison with manual polishing requires significantly lesser surgical time with better UCVA, decreased astigmatism, and greater SIA at 6 months, which indicates greater astigmatic correction.

Fibrin glue versus autologous blood for conjunctival autograft fixation in pterygium surgery

ObjectiveTo compare the outcomes between autologous blood- and fibrin glue–fixated conjunctival autografts in pterygium excision surgery. DesignRetrospective case series. ParticipantsForty eyes of 40 patients who had a primary nasal pterygium excision. MethodsA retrospective comparative case series of 40 eyes (40 patients) that had a primary nasal pterygium excision. All eyes had a conjunctival autograft from the superior bulbar conjunctiva to cover the scleral bed. Twenty eyes (20 patients) had fixation of the autograft using autologous blood (AB), and 20 eyes (20 patients) had fixation using fibrin glue (FG). One year of follow-up data included conjunctival graft stability (graft loss, graft retraction), pterygium recurrence, visual acuity, and postoperative complications. Descriptive and inferential statistics were performed. ResultsIntraoperatively, no complications occurred in either group. Graft loss occurred in 6 patients in the AB group, compared with none in the FG group. Graft retraction occurred in 3 patients in the AB group and 2 patients in the FG group. At 1 year postoperatively, pterygium recurrence occurred in 4 patients in the AB group and 1 patient in the FG group. One patient in the AB group developed a small pyogenic granuloma that resolved by 6 months with conservative management. Visual acuity remained stable in both groups. ConclusionsConjunctival autograft fixation with autologous blood resulted in less stable conjunctival autografts and a higher recurrence rate compared with fixation with fibrin glue.

Monitoring corneal densities following primary pterygium excision with adjuvant topical mitomycin-C application--an observational study of corneal scar changes.

Corneal densitometry is an inherent feature of the Pentacam device. We aim to assess the changes in corneal scar density with serial Scheimpflug images following primary pterygium excision with topical application of mitomycin-C. We recruited patients who underwent primary, single-headed pterygium excision with topical adjuvant mitomycin-C. Scheimpflug images were taken at postoperative weeks 1, 4, and 12, and all patients received topical corticosteroid and antibiotic treatment for at least 4 weeks postoperatively. Corneal scar densities were generated by the software for analysis. Secondary outcome measures included intraocular pressures and pterygium recurrence at the end of 12 weeks. Changes in corneal densities between weeks 12, 4, and 1 were calculated. We recruited 31 eyes of 31 patients, of whom 16 were male patients and 15 were female patients, with 19 left and 12 right eyes. Mean age at operation was 62.0 ± 9.4 years. Mean reduction in density of the anterior 120 μm of cornea was -3.07 [95% confidence interval (CI), -6.600 to 0.460] and -3.455 (95% CI, -6.787 to -0.122) at postoperative 4 and 12 weeks, respectively, and mean reduction percentage was -4.7% (95% CI, -10.7% to 1.3%) and -6.3% (95% CI, -11.8% to -0.7%), respectively. No steroid response or pterygium recurrence was reported. Corneal densitometry is an objective measure to detect scar changes in zones and layers. The overall reduction of density was evident at 12 weeks postoperatively. These results might serve as baseline figures for future studies in assessing modulation of corneal scars over time.

Recurrence After Primary Pterygium Excision: Amniotic Membrane Transplantation with Fibrin Glue Versus Conjunctival Autograft with Fibrin Glue

Purpose: The aim of the present study was to compare the surgical results and recurrence rates of primary pterygium excision with conjunctival autografts versus amniotic membrane grafts fixated with fibrin glue.Materials and methods: In this prospective study, 73 eyes of 65 patients who had undergone conjunctival autograft group (CAG) (n:37) or amniotic membrane group (AMG) (n:36) after pterygium excision were evaluated. Fibrin glue was used for the fixation of grafts in both groups. The patients were followed up for 12 months. Postoperative complications were recorded. The rate of recurrence was defined as the primary outcome measure.Results: In the CAG, partial dehiscence of the graft was observed on the nasal edge on postoperative day 1 in two (5.4%) eyes that healed with secondary re-epithelialization at week 1. Twelve (32.4%) eyes showed a yellowish-orange or hemorrhagic edema of the graft on postoperative day 7 that spontaneously resolved in 1 to 3 weeks. In the AMG, partial dehiscence and folding of the amniotic membrane occurred in two (5.5%) eyes. Two eyes (5.4 %) in the CAG developed corneal recurrence and five eyes (13.8%) in the amniotic membrane graft group developed recurrence; one limbal (2.7%), four corneal recurrences (11.1%) (p = 0.25).Conclusion: Fibrin glue is a safe and effective method for attaching conjunctival or amniotic membrane grafts for wound closure following pterygium surgery. Although the results were not statistically significant, amniotic membrane grafting using fibrin glue seems to have a higher pterygium recurrence rate compared with conjunctival autografting.

Combined conjunctival rotational autograft with 0.02% mitomycin C in primary pterygium surgery: a long-term follow-up study

Background/aimsTo compare the long-term outcomes of primary pterygium surgery with combined conjunctival rotational autograft and mitomycin C (CRA-MMC), mitomycin C alone (MMC) and limbal conjunctival autograft (LCAU).MethodsThe outcomes of primary...

Injection of bevacizumab in the subpterygial tissue at the time of surgical removal against 2 weeks before surgery

Objective The aim of this study was to evaluate the postoperative outcome and the recurrence rate after primary pterygium excision using preoperative subpterygial bevacizumab injection at the time of surgical removal as against 2 weeks before surgery. Background Recurrence after pterygium excision represents a challenge for ophthalmologists and is considered to be the most common postoperative complication. Several techniques have evolved in a trial to overcome the high rate of postoperative recurrence. However, none proved to be totally effective. Patients and methods Forty eyes with primary pterygium were divided into two groups. Group A eyes (included 20 eyes) were operated upon with pterygium excision after subpterygial injection of bevacizumab. Group B eyes (included 20 eyes) were operated upon with pterygium excision 2 weeks after subpterygial injection of bevacizumab. Pterygium regrowth over the cornea for 1 mm or more was considered as a recurrence. Results The follow-up period was 6 months. In group A, recurrence was reported in two (10%) eyes, whereas in group B, recurrence was reported in one (5%) eye. No serious postoperative complications were reported. There was no statistically significant difference between the two groups regarding the recurrence rate and the complication rate. Conclusion Both techniques used in the current study proved to be effective in reducing the recurrence rate after excision of the primary nasal pterygium with minimal postoperative complications. Injection of bevacizumab 2 weeks before had a better effect on decreasing the pterygium vascularity, which minimized bleeding during operation in addition to decreasing the recurrence rate, according to this study.

Topographic changes after excision surgery of primary pterygia and the effect of pterygium size on topograpic restoration.

To assess the effect of pterygium size on time-course change of corneal topography after excision surgery of primary pterygium. Retrospective case series included eyes that underwent excisions of primary pterygium. Pterygium size was graded according to the advancing edge position: less than one third of corneal diameter (grade 1), outside the pupil (grade 2), and within the pupillary area (grade 3). Time-course changes in corneal refractive power, astigmatism, and irregularity (surface regularity and asymmetry indices) in corneal topographies over 12 months postoperatively were compared between the pterygium size grades. Pterygium excision was performed on 562 eyes, consisting of 119, 338, and 105 eyes with grades 1 to 3, respectively. Grade 1 did not change in corneal irregularity, and there was no difference between grades 1 and 2, except for corneal astigmatism at 6 months. Grade 3 showed significantly higher corneal refractive power and irregularity than grade 1 until 3 and 6 months, respectively, whereas corneal astigmatism was higher over 12 months. Topographic changes after primary pterygium excision were associated with pterygium size. Pterygium advancing over the pupillary area required 6 to 12 months for corneal topography restoration, resulting in slow recovery of visual acuity.

One-year results of the triple procedure for primary pterygia

Purpose The aim of this work was to study the effectiveness and potential complications of adjunctive intraoperative mitomycin-C (MMC) application combined with limbal-conjunctival autografting after primary pterygium excision. Patients and methods Fifty-seven eyes of 43 patients with primary pterygia were randomized to receive pterygium excision, followed by either a free conjunctival autograft (control group, n = 27) or an adjunctive intraoperative MMC 0.02% application for 2 min and limbal-conjunctival autograft (triple procedure group, n = 30). All patients were followed for 12 months. Results After 1 year, the recurrence rate was 14.81 and 0% in the control and the triple procedure groups, respectively (P Conclusion Simple excision of pterygium combined with adjunctive intraoperative MMC 0.02% application for 2 min and limbal-conjunctival autografting is a safe and effective way of treating primary pterygia.

Minimally invasive pterygium surgery versus air-assisted dissection technique for excision of primary pterygium

PurposeThe aim of this study was to assess and compare minimally invasive pterygium surgery with air-assisted dissection technique for excision of primary pterygium.Patients and methodsThis prospective randomized comparative study was carried out on 20 eyes of 16 patients with primary pterygium. The cases were randomly divided into two equal groups: group I included 10 eyes in which pterygia were excised with minimally invasive pterygium surgery, and group II included 10 eyes in which pterygia were excised with air-assisted dissection technique. Postoperative examination and follow-up for 3 months were carried out.ResultsThe mean age of the patients was 46.1±3.8 years. Successful dissection was recorded in 80% of cases in group I and in 70% of cases in group II. Recurrence occurred in 10% of cases in each group, with a follow-up duration of 3 months.ConclusionThe minimally invasive pterygium surgery is superior to air-assisted dissection of pterygium as it keeps the tenon capsule intact.

Surgical Outcome of Primary Pterygium Excision with Conjunctival Autograft

Purpose: To investigate the clinical outcomes of primary pterygium excision combined with free conjunctival autograft. Methods: The medical records of 112 patients (129 eyes) who underwent pterygium excision and free conjunctival autograft for primary pterygium were retrospectively reviewed for recurrence and postoperative complications and the outcomes compared with pterygium excision combined with amniotic membrane transplantation, conjunctival flap, or simple conjunctival closure. Additionally, the surgical outcomes were evaluated in relation to the intraoperative use of mitomycin C. Results: Postoperative recurrences were observed in 3 of 129 eyes (2.3%) that received pterygium excision and free conjunctival autograft, 2 of 10 eyes (20.0%) that received pterygium excision with amniotic membrane transplantation, 1 of 10 eyes (10.0%) that received pterygium excision with conjunctival flap and 1 of 12 eyes (8.3%) that received pterygium excision and simple conjunctival closure. Therefore, the recurrence rate was significantly lower in patients with conjunctival autograft than in those without (p = 0.024, Breslow-Wilcoxon test). Additionally, recurrence was observed in 1 of 10 eyes (10.0%) in patients that underwent pterygium surgery when mitomycin C was used intraoperatively and in 2 of 119 eyes (1.7%) without the use of mitomycin C. Conclusions: Pterygium excision combined with free conjunctival autograft is an effective and safe surgical procedure to treat primary pterygium. J Korean Ophthalmol Soc 2015;56(6):856-862

English

AIM: To study the rate of recurrence and complication of primary pterygium surgery among bare sclera resection and bare sclera resection of pterygium with intraoperative mitomycin C To study the efficacy and toxicity of intraoperative use of Mitomycin C in the primary treatment of pterygium MATERIALS AND METHODS: 60 patients with primary pterygium attending the outpatient department of Ophthalmology, M. S. Ramaiah Medical College & Teaching Hospital. RESULTS: 60 patients, majority in the age group of 21-60 years, were randomized in bare sclera group (n=30) and MMC group (n=30). At the end of 6 months, 8 patients had recurrence in bare sclera group while only 1 patient had recurrence in MMC group. The common post-operative complications noted were pain, lacrimation and photophobia. Dellen was present in 1(3.3%) patient in bare sclera group. CONCLUSION: The odds for pterygium recurrence following bare sclera excision of primary pterygium are high. With higher success rates and fewer complications reported with the use of Mitomycin C has become a favored form of adjunctive pharmacological therapy.

Sealing the gap between conjunctiva and Tenon’s capsule in primary pterygium surgery

Objetive: To assess the results of an alternative surgical approach in the excision of primary pterygium by analyzing the rates of recurrence and of intraoperative and postoperative complications. Methods: Retrospective cross-sectional study based reviewing the clinical records of individuals subjected to surgery for pterygium, with conjunctival autograft transplantation, fibrin glue and intraoperative application of mitomycin C. In addition, sealing was performed by suturing the gap between the conjunctiva and Tenon’s capsule. A total of 36 eyes from 35 individuals were subjected to the assessed techniques. The study variables were complications of surgery and recurrence rates during a minimun follow-up period of 6 months. Results: No recurrence occurred during the follow-up period. One graft (2.8%) exhibited partial retraction, but pterygium did not recur. The intraocular pressure increased in one eye (2.8%) and was controlled by clinical methods. Conclusion: Eyes in which a barrier was established between the conjunctiva and Tenon’s capsule by sealing the gap between them showed an absence of recurrence in the sample studied. However, there is the need of a random prospective study with a control group for a more accurate conclusion on the efficacy of the technique

Comparison of conjunctival graft thickness after primary and recurrent pterygium surgery: anterior segment optical coherence tomography study.

Objective:The objective of the following study is to compare the conjunctival graft thickness measured with anterior segment optical coherence tomography (OCT) after primary and recurrent pterygium excision.Design:Prospective, interventional and comparative study.Participants:A total of 20 eyes of 20 patients with primary pterygium (primary group) and 20 eyes of 20 patients with recurrent pterygium (recurrent group) were enrolled.Materials and Methods:All patients underwent pterygium excision with conjunctival autograft transplantation. Conjunctival graft thickness was measured at 1 week, 1 month and 3 months after surgery using the Visante-OCT (Carl-Zeiss Meditec, Dublin, CA, USA). Main outcome measure was the mean conjunctival thickness determined as the mean of three measurements at 1, 2 and 3 mm posterior to the scleral spur.Results:There were no statistically significant differences in age, sex, or laterality between the groups. Mean thickness of the graft in primary and recurrent groups, respectively, was 430 ± 127 μm and 461 ± 178 μm at 1 week after surgery (P = 0.587), 114 ± 19 μm and 162 ± 48 μm at 1 month after surgery (P = 0.001) and 109 ± 15 μm and 107 ± 18 μm at 3 months after surgery (P = 0.726).Conclusion:The findings revealed that conjunctival thickness after primary or recurrent pterygium excision was greatest at 1 week after surgery and continued to decrease for up to 3 months. Mean graft thickness differed significantly between the two groups only at 1 month after surgery.

Comparison of autologous in situ blood coagulum versus sutures for conjunctival autografting after pterygium excision

Our aim was to compare the efficacy and safety of autologous in-situ blood coagulum versus sutures for attaching conjunctival limbal autografts (CAG) among patients undergoing primary pterygium excision over a period of 1year. Thirty-two eyes of 32 patients with primary pterygium were randomly divided in into two groups: group I (16 eyes) underwent CAG with 10-0 monofilament nylon sutures and group II (16 eyes) underwent CAG with patient's own in-situ blood coagulum acting as bioadhesive or fixative followed by bandaging for 48h. Patients were followed up postoperatively on the 2nd day, 1week, 2weeks, 4weeks, and 12months. All the surgeries were done by the same surgeon. Graft success, recurrence rate, operating time, patient comfort, graft retraction or any other complication were studied. The duration of surgery was significantly less (P<0.001) in group II (mean duration 15±2min) than group I (mean duration 67±2min). Postoperative symptoms were fewer for group II than group I. Rate of recurrence was equal in both groups (one patient in each group, 6.25%). But complications regarding graft failure and graft retraction were more common in group II (two patients, 12.5%) than group I (one patient, 6.25%); however, the difference was not statistically significant (Z=0.61). Thus, autologous in-situ blood coagulum is a useful method for graft fixation in pterygium surgery with shorter operating time and less postoperative discomfort.

Comparison of clinical effects of three adjuvant therapeutics to primary pterygium excision

Comparison of clinical effects of three adjuvant therapeutics to primary pterygium excision

Is amniotic membrane transplantation, an adjuvant of choice following excision of primary Pterygium?

Though, Conjunctivo-limbal auto-graft is the most accepted adjuvant to prevent recurrence of pterygium, has its own limitations like difficulty to cover large defect and to preserve for future glaucoma surgeries, necessiating to find an alternative especially, in young patients. The outcomes between amniotic membrane transplantation (AMT) and conjunctivo-limbal auto graft transplantation (CLAT) as an adjuvant following excision of primary pterygia from Jan. 2010 to Dec.2010 were compared. Twenty four patients had AMT and 28 patients had CLAT after pterygium excision and followed for minimum of 12 months; evaluated in terms of recurrence or complications. We had 44% young (<40yrs) with 58% female. Epithelial healing occurred within a week. AMT cases showed 8% recurrence, nil in CLAT but, with 2 cases of pyogenic granuloma. We conclude that, AMT as an adjuvant would be a viable option reserving CLAT for those with recurrence or as a last resort especially, in younger patients.

A comparison between fibrin sealant and sutures for attaching conjunctival autograft after pterygium excision

BackgroundUse of conjunctival autograft following excision of primary pterygium has reduced the recurrence rate. This study evaluates the efficiency of fibrin glue as compared to sutures in attaching the conjunctival autograft with reference to surgical time, post operative comfort and recurrence during follow up. Methods60 patients with primary pterygium were included and divided into two groups. In the first group autograft was secured in place with help of 10-0 polyamide monofilament suture while in second group fibrin glue was used. Both the groups were compared in terms of operative time, post op comfort and recurrence. ResultsThe average surgical time taken was 50.93 ± 4.96 min with suture group and 34.43 ± 4.94 min with fibrin glue group. Pain and foreign body sensation was markedly less with fibrin glue group. At the end of final follow up at 6 months, 3 cases (10%) from suture group and 1 case (3.33%) from fibrin group had recurrence. ConclusionFibrin glue is effective and safe for attaching conjunctival autograft during pterygium surgery. Although more number of recurrences were observed in suture group as compared to fibrin glue group the difference was not statistically significant (p 0.612).