Recurrence Of Primary Pterygium Research Articles

Comparison between Limbal Autograft Transplantation and Subconjunctival Bevacizumab Injection in Lowering Recurrence of Primary Pterygium

Comparison between Limbal Autograft Transplantation and Subconjunctival Bevacizumab Injection in Lowering Recurrence of Primary Pterygium

Effect of a Topical Nonsteroidal Anti-Inflammatory Drug (0.1% Pranoprofen) on VEGF and COX-2 Expression in Primary Pterygium.

Purpose: To evaluate the effect of a topical nonsteroidal anti-inflammatory drug (0.1% pranoprofen) on the expression of VEGF and Cox-2 in primary pterygium.Methods: This was a prospective, randomized study. Between January 2019 and April 2020, 120 patients diagnosed with primary pterygium were enrolled and randomly divided into three groups before operation: 1) 40 patients in group 1 received topical pranoprofen 0.1% four times daily for 4 weeks, 2) 40 patients in group 2 received topical fluorometholone 0.1% four times daily for 4 weeks, and 3) patients in group 3 did not receive treatment. For each group, the age, sex, eye type, best-corrected visual acuity (BCVA), intraocular pressure (IOP), duration of onset, combined systemic diseases, and the results regarding vascular endothelial growth factor (VEGF) and cyclo-oxygen-ase-2 (COX-2) in postoperative pterygial tissues were evaluated in detail.Results: There were no significant differences regarding age, sex, eye type, combined systemic diseases, duration of onset, IOP, and BCVA within the three groups (p > 0.05). The reduction of VEGF and CoX-2 expression of pterygial vascular endothelial cells in group 1 were statistically significant compared to group 2 and group 3 (p < 0.05). There were significant correlations between COX-2 and VEGF expression of pterygial tissues within the three groups (p < 0.05).Conclusion: The present findings suggested that the topical pranoprofen 0.1% could reduce the expression of VEGF and COX-2 in primary pterygium. We confirmed that treatment with pranoprofen offers advantages in early intervention and has therapeutic potential in reducing the postoperative recurrence of primary pterygium patients.Clinical Trial registration: The study was registered with the Chinese Clinical Trial Registry. (http://www.chictr.org.cn/index.aspx, Registration Number: ChiCTR2100047726).

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

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

Preoperative subconjunctival combined injection of bevacizumab and mitomycin C before the surgical excision of primary pterygium: clinical and histological results

PurposeThe aim of this study was to detect the clinical and histological effects of preoperative subconjunctival injection of both bevacizumab and mitomycin C (MMC) 1 month before the surgical excision of primary pterygium using a bare sclera technique.Patients and methodsA total of 20 patients with primary pterygium underwent subconjunctival combined injection of 0.1 mL of MMC (0.1 mg/mL) and 0.1 mL of bevacizumab (1.25 mg/0.1 mL) 1 month before bare sclera excision of the pterygium. The excised pterygium tissues were examined histologically and immunohistologically by CD31 staining, and the patients were followed up clinically for at least 2 years. The excised pterygia of two patients without preoperative injection were used for histological comparison.ResultsClinically, there were no intraoperative or postoperative complications. No recurrence was noted during the follow-up period. Histologically, the previously injected pterygia showed a decreased number of epithelial cells and stromal fibroblasts. The latter were rounded or oval and swollen rather than spindle shaped, and some were degenerating or apoptotic. Collagen and elastic fibers were degenerated, distorted, and decreased in density, while blood capillaries were obliterated. There was a significant decrease in CD31-positive cells in previously injected pterygia.ConclusionPreoperative subpterygium combined injection of bevacizumab and MMC is safe and effective in reducing the postoperative recurrence of primary pterygium. Histological and immunohistological changes in the form of decreased fibrovascular activity and degeneration of the extracellular matrix and nerve axons were noted.

Conjunctival Autograft Alone or Combined With Adjuvant Beta-Radiation? A Randomized Clinical Trial

To evaluate the effectiveness and safety of postoperative low single-dose of beta-irradiation (β-RT) in pterygium comparing conjunctival autograft (CAG) surgery with CAG plus adjuvant β-RT in a randomized clinical trial. This trial was designed as a prospective, randomized, single-center study. Surgery was performed in all cases according to the CAG technique. One hundred and eight pterygia were postoperatively randomized to CAG + β-RT or CAG alone. In the case of β-RT, a (90) Sr eye applicator was used to deliver 10 Gy to the sclera surface at a dose rate of between 200 and 250 cGy/min. After treatment, both an ophthalmologist and a radiation oncologist performed the follow-up examinations. The accumulated data were analyzed using a group sequential test. Between February 2008 and September 2008, 116 eyes with primary pterygium were operated on according to the trial protocol. Adjuvant treatment was performed within 24 h postoperatively. Eight patients were lost to follow-up, resulting in 108 patients who could be analyzed. At a mean follow-up of 18 months (range, 8-33), in the 54 eyes randomized to receive CAG + β-RT, 5 relapses occurred compared with 12 recurrences in the 54 eyes in CAG, for a crude control rate of 90.8 % vs. 78%; p = 0.032, respectively. The treatment complications as hyperemia, total dehiscence of the autograft and dellen were significantly more frequent in the CAG (p < 0.05). The arm of β-RT resulted in better cosmetic results and improves of symptoms than CAG. A low single-dose of β-RT of 10 Gy after CAG surgery was a simple, effective, and safe treatment that reduced the risk of primary pterygium recurrence, improved symptoms after surgery, resulting in a better cosmetic effect than only CAG.

Topical Cyclosporin A and Mitomycin C Injection as Adjunctive Therapy for Prevention of Primary Pterygium Recurrence

The authors evaluated the results of topical cyclosporin A 1% and injected mitomycin C 0.01% use as adjunctive therapy for prevention of primary pterygium recurrence. Eighty eyes of 76 consecutive patients who had pterygium excision surgery in a prospective, interventional clinical trial received conjunctival autografting combined with an immediate postoperative 0.1-cc injection of 0.01% mitomycin C in caruncula were randomized into two groups: those who received postoperative topical application of cyclosporin A and those who did not. The recurrence rate in patients who received topical application of postoperative cyclosporin A was 7.5% (3 of 40) compared with 17.5% (7 of 40) for patients who did not receive topical application of postoperative cyclosporin A (P = .31). An unexpected and significant finding in women was that those who received cyclosporin A had no recurrences (0 of 26), whereas those who did not receive cyclosporin A did (6 of 25; 24%) (P = .03). Intracaruncular mitomycin C 0.01% and topical cyclosporin A 1% combined with conjunctival autograft is useful in reducing pterygium recurrence.

Pterygium: Its Treatment with Beta Therapy

To evaluate the effectiveness and safety of postoperative low single-dose of beta-irradiation (β-RT) in pterygium comparing conjunctival autograft (CAG) surgery with CAG plus adjuvant β-RT in a randomized clinical trial.This trial was designed as a prospective, randomized, single-center study. Surgery was performed in all cases according to the CAG technique. One hundred and eight pterygia were postoperatively randomized to CAG + β-RT or CAG alone. In the case of β-RT, a (90) Sr eye applicator was used to deliver 10 Gy to the sclera surface at a dose rate of between 200 and 250 cGy/min. After treatment, both an ophthalmologist and a radiation oncologist performed the follow-up examinations. The accumulated data were analyzed using a group sequential test.Between February 2008 and September 2008, 116 eyes with primary pterygium were operated on according to the trial protocol. Adjuvant treatment was performed within 24 h postoperatively. Eight patients were lost to follow-up, resulting in 108 patients who could be analyzed. At a mean follow-up of 18 months (range, 8–33), in the 54 eyes randomized to receive CAG + β-RT, 5 relapses occurred compared with 12 recurrences in the 54 eyes in CAG, for a crude control rate of 90.8 % vs. 78%; p = 0.032, respectively. The treatment complications as hyperemia, total dehiscence of the autograft and dellen were significantly more frequent in the CAG (p < 0.05). The arm of β-RT resulted in better cosmetic results and improves of symptoms than CAG.A low single-dose of β-RT of 10 Gy after CAG surgery was a simple, effective, and safe treatment that reduced the risk of primary pterygium recurrence, improved symptoms after surgery, resulting in a better cosmetic effect than only CAG.

Comparison of Mini-Flap Technique and Conjunctival Autograft Transplantation without Mitomycin C in Primary and Recurrent Pterygium

Aims: Our purpose was to compare postoperative results of pterygium surgery between mini-flap technique and conjunctival autograft transplantation without application of mitomycin C. Methods: This is a retrospective, comparative and observational study. Forty-one eyes underwent conjunctival autograft transplantation without mitomycin C between March 1999 and December 2001 and 49 eyes with pterygium received conjunctival mini-flap without mitomycin C by the same surgeon between January 2002 and February 2004. The main outcome measurement was postoperative recurrence. Results: The recurrence rate in those with primary pterygium was 4.7% (2 of 43) in the mini-flap group and 17.6% (6 of 34) in the conjunctival autograft group. In the patients with recurrent pterygium, recurrence was observed in 1 of 6 cases (16.7%) in the mini-flap group and 1 of 7 cases (14.3%) in the conjunctival autograft group. Overall, the conjunctival mini-flap group without use of mitomycin C had a significantly lower rate of recurrence (6.1%) than the conjunctival autograft transplantation group without mitomycin C (17.1%) (p = 0.042). Conclusion: The mini-flap technique without use of mitomycin C in pterygium surgery is safe and effective in reducing the postoperative recurrence of primary pterygium compared to the conjunctival autograft technique.

Comparison of Three Methods for the Treatment of Pterygium: Amniotic Membrane Graft, Conjunctival Autograft and Conjunctival Autograft plus Mitomycin C.

Objective: To compare three techniques combined with excision in the treatment of primary and recurrent pterygium: amniotic membrane transplantation, conjunctival autograft, and conjunctival autograft plus mitomycin C. Materials and Methods: Forty-nine eyes of 49 subjects (30 primary, 19 recurrent pterygium) were included in this study. Combined with excision, 25 eyes (18 primary, 7 recurrent pterygium) were treated with conjunctival autografts (Group 1), and 16 eyes (12 primary, 4 recurrent pterygium) were treated with amniotic membrane transplantation for the closure of the defect (Group 2). In 8 eyes (all recurrent pterygium) low-dose mitomycin C (0.02%) was applied topically to the defect area and a conjunctival autograft was applied thereafter (Group 3). The three groups were compared with regard to the recurrence of pterygium and the defect area requiring treatment. Results: The number and percentages of recurrence seen in groups 1, 2 and 3 were as follows: 4 (16%), 4 (25%), and 0(−), respectively. For the treatment of primary pterygium cases, amniotic membrane closure and conjunctival autograft closure were comparable in effectiveness (p > 0.05). In the treatment of recurrent pterygium, there was no significant difference between the three techniques (p > 0.05). Amniotic membrane closure and conjunctival autografts were equally effective for the treatment of both primary and recurrent pterygium (p > 0.05). The graft size was significantly larger in the cases with recurrent pterygium (p = 0.016). Conclusions: Amniotic membrane closure and conjunctival autografts seem to be equally effective in the prevention of recurrence of primary pterygium. Conjunctival autografts combined with mitomycin C are as effective as the above two techniques to prevent recurrence in the treatment of recurrent pterygium. Due to the larger area of subconjunctival fibrosis, a larger defect area is created after the excision of pterygium tissue and a larger graft is needed to close this defect in recurrent pterygium. This factor can guide the surgeon during the planning of the surgery to choose the most appropriate technique for closure of the defect.

Combined ‘symmetrical conjunctival flap transposition’ and intraoperative low‐dose mitomycin C in the treatment of primary pterygium

To introduce a new technique of conjunctival reconstruction after primary pterygium excision, and to evaluate the efficacy of combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C application in preventing recurrence of primary pterygium. In a prospective, non-comparative case series, 43 eyes of 41 consecutive patients with primary pterygium were studied. In all patient eyes, after excision of pterygia, 0.02% mitomycin C was applied topically for 2 min over the exposed scleral surface and "symmetrical conjunctival flap transposition" was performed to reconstruct the conjunctival defect. The main outcome measures were pterygium recurrence or any complications related with surgery or mitomycin C. The mean age of the patients was 47.5 +/- 12.4 years (range 30-70 years). Among the 38 patients who were not lost to follow up, three patient eyes (7.5%) had grade 1, 24 eyes (60.0%) had grade 2 and 13 eyes (32.5%) had grade 3 pterygium. The mean follow up was 12.2 +/- 5.7 months (range 7-28 months). No recurrence or sight-threatening complications were encountered in any patient eye throughout the follow-up period. Combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C application may be an effective surgical alternative in preventing recurrence of primary pterygium. Although the procedure seems to be free from severe complications, surgeons and patients should be well aware of the risk of late radiomimetic complications of mitomycin C. Comparative, randomized trials with more number of patients and longer follow up are required to further establish the safety and efficacy of this treatment strategy.

Conjunctival Autografting Combined With Low-Dose Mitomycin C for Prevention of Primary Pterygium Recurrence

To compare the clinical outcome of pterygium surgery combining intraoperative mitomycin C (MMC) with a free conjunctival autograft, with three other methods of pterygium surgery, including intraoperative MMC alone, conjunctival autograft alone, and bare sclera without adjunctive treatment. Interventional, randomized and in part nonrandomized, prospective, comparative study. setting: A university medical center department of ophthalmology. One hundred and twenty patients underwent pterygium excision surgery. These patients were divided into four treatment groups. In group 1 (30 patients), MMC, 0.2 mg/ml, was applied for three minutes. In group 2 (30 patients), conjunctival autografting was performed. Group 3 (30 patients) received sodium chloride 0.9% only, and group 4 (30 patients) underwent conjunctival autografting combined with one minute application of MMC, 0.2 mg/ml. Recurrence rates and complications. Pterygium recurred in two patients (6.6%) in group 1, in four patients (13.3%) in group 2, in 14 patients (46.6%) in group 3, and in none of the patients in group 4. chi(2) analysis revealed a significantly lower recurrence rate in group 4 compared with group 2 (P = .038) and with group 3 (P < .0001). Epithelialization of the wounds was complete within 14 days of surgery. No complications were demonstrated in any of the study groups except for one case of minor melting of the flap in group 4. This study indicates that pterygium excision with a free conjunctival autograft combined with intraoperative low-dose MMC is a safe and effective technique in pterygium surgery.

Comparison between the Role of Intraoperative Mitomycin C and Doxorubicin in Preventing the Recurrence of Primary Pterygium

Purpose: The purpose of this study was to compare the role of intraoperative mitomycin C (MMC) and doxorubicin in preventing the recurrence of primary pterygium. Materials and Methods: Fifty-six patients including 22 males and 34 females in the age range of 22–55 years (mean age 38.1 years ± 10.7) having primary pterygium of progressive type were randomly divided into two groups. The first group of patients was treated with intraoperative MMC (0.02% for 3 min) and in the second group intraoperative doxorubicin (0.02% for 3 min) was used. The patients were regularly followed until 1 year postoperatively for examining visual acuity, wound condition, adverse events and recurrence of pterygium. Results: The mean age of patients of MMC group was 37.4 ± 11.0 years and of doxorubicin group was 38.8 ± 10.8 years (difference statistically not significant). All these patients had pterygium on the medial side of cornea. The side effects experienced by our patients from the use of these agents were conjunctival hyperemia, conjunctival necrosis, corneal epithelial defect, subconjunctival hemorrhage, episcleritis, increased pain, foreign body sensation, lacrimation, irritation, diminution of vision and photophobia. Recurrence was seen in 4 patients of MMC group (14.3%) and 3 patients of doxorubicin group (10.7%) (difference statistically not significant; χ² = 0.16, p = 0.68). The recurrence of pterygium was not associated with age of patients, laterality of eye involved, amount of encroachment of pterygium over cornea, width of pterygium, preoperative complaints and postoperative adverse events. Conclusions: The two antimitotic agents, MMC and doxorubicin, when used intraoperatively along with primary pterygium excision, had a comparable role both in terms of adverse events and prevention of recurrence of pterygium.

Prevention of pterygium recurrence by postoperative single-dose β-irradiation: a prospective randomized clinical double-blind trial

Purpose To affirm the effectiveness and complication rate of postoperative single-dose β-irradiation (RT) with 90Sr in the case of primary pterygium in a clinical trial. Pterygium is a benign disease of the supporting orbital tissue that can cause impairment of visual function. Depending on the technique used for surgery, recurrence is described in up to 70% of cases—a reason to combine the initial treatment with radiotherapy or chemotherapy. Methods and materials This trial was designed as a prospective, randomized, multicenter, double-blind study. Surgery was performed in all cases according to the bare sclera technique. Ninety-one patients with 96 pterygia were postoperatively randomized to either β-RT or sham RT. In the case of β-RT, a 90Sr eye applicator was used to deliver 2500 cGy to the sclera surface at a dose rate of between 200 and 250 cGy/min. Sham RT was given using the same type of applicator without the 90Sr layer. After treatment, both an ophthalmologist and a radiation oncologist performed the follow-up examinations. The accumulated data were analyzed using a group sequential test. Results Between February 1998 and September 2002, 96 eyes with primary pterygium were operated on according to the trial protocol. Additional treatment was performed within 24 hours postoperatively. Ten patients were lost to follow-up, resulting in 86 patients who could be analyzed. In the 44 eyes randomized to receive β-RT, 3 relapses occurred compared with 28 recurrences in the 42 eyes that received sham RT, for a crude control rate of 93.2% vs. 33.3%, respectively. At a mean follow-up of 18 months, major treatment complications had not been observed. Conclusion Single-dose β-RT after bare sclera surgery is a simple, effective, and safe treatment that reduces the risk of primary pterygium recurrence.

Conjunctival Rotation Autograft for Primary Pterygium

Purpose: To evaluate the safety and effectiveness of conjunctival rotation autograft technique in preventing the recurrence of primary pterygium. Methods: In this prospective study, 24 eyes of 24 consecutive patients with primary pterygium were evaluated. Conjunctival rotation autograft technique, which involved the removal of the underlying fibrovascular pterygium tissue and replacement of the original epithelium over the bare sclera with a 180° rotation was performed in all eyes. Results: Patients were 34–70 years of age (mean, 52.8; SD = 10.5). During the mean follow-up of 15.9 months (range, 12–23 months; SD: 4.0), 4 recurrences (16.6%) were observed. Neither intraoperative nor postoperative complications were encountered except for recurrences and 3 suture openings, which were re-sutured postoperatively without further complications. Conclusion: Conjunctival rotation autograft technique appears to be effective and safe in preventing the recurrence of primary pterygium. A prospective randomised trial comparing conjunctival rotation autografting with other adjunctive procedures in addition to simple pterygium excision is required to determine its effectiveness.