Primary Pterygium Surgery Research Articles

Fibrin Adhesive Is Better Than Sutures in Pterygium Surgery

To evaluate the recurrence rate, surgical time, and postoperative pain between conjunctival autografting with sutures and with fibrin adhesive in pterygium surgery. A prospective, randomized, double-blind, clinical trial on the benefits of using fibrin adhesive in place of sutures in pterygium surgery. One hundred seventy-five eyes with primary pterygium were randomized to undergo pterygium surgery with conjunctival autograft transplantation using either fibrin adhesive or sutures. One hundred thirty-seven eyes of 113 patients that were operated on by a single surgeon (V.R.) completed the 1-year follow-up. Sixty-eight eyes were operated with fibrin adhesive and 69 eyes with sutures. Patients were followed up at 1 day, 1 week, 1 month, 6 months, and 1 year after surgery. Pterygium recurrence and postoperative pain was graded by an independent observer (A.L.) masked to the method of treatment. Surgical time was measured with a stopwatch. All patients were followed up for 1 year. There were 3 recurrences (4.41%) in the fibrin adhesive group and 11 recurrences (15.9%) in the suture group. The mean duration required to complete surgery in the fibrin adhesive group was 16.93 +/- 2.85 minutes, whereas that of the suture group was 29.84 +/- 5.65 minutes, which was statistically significant (P < 0.001). The immediate postoperative pain score and week 1 postoperative pain score were significantly lower in the fibrin adhesive group (P < 0.05). No major complications were observed in either group. The use of fibrin adhesive in primary pterygium surgery with conjunctival autografts reduces the recurrence rate, surgical time, and postoperative pain when compared with sutures.

Intraoperative Mitomycin C and Corneal Endothelium After Pterygium Surgery

To determine the effect of mitomycin C (MMC) on the corneal endothelium after primary pterygium surgery. This prospective, interventional, nonrandomized, observer-masked study included 46 consecutive patients (51 eyes) with primary pterygium. The bare sclera technique with 1-minute application of 0.02% MMC intraoperatively was used in all cases. The follow-up period was 3 months. Preoperative and postoperative central corneal specular microscopy was performed. The endothelial cell density, coefficient of variation of cell size, and percentage of hexagonal cells were analyzed, and the corneal thickness was measured. The mean endothelial cell densities preoperatively and 3 months postoperatively were 2382.35 +/- 342.07 cells per square millimeter (range, 1020-3129) and 2385.02 +/- 356.83 cells per square millimeter (range, 1001-3151), respectively (P = 0.96). The mean coefficients of variation of cell size preoperatively and 3 months postoperatively were 34.31 +/- 5.62 (range, 22-49) and 35.29 +/- 7.50 (range, 22-55), respectively (P = 0.17). The mean percentages of hexagonal cells values preoperatively and 3 months postoperatively were 52.98 +/- 7.32 (range, 32-71) and 51.61 +/- 8.98 (range, 32-67), respectively (P = 0.48). The mean pachymetry measurements preoperatively and 3 months postoperatively were 506.65 +/- 36.87 microm (range, 411-583) and 502.08 +/- 41.33 microm (range, 411-593), respectively (P = 0.99). One intraoperative application of 0.02% MMC for 1 minute after primary pterygium surgery does not seem to cause substantial changes in the corneal endothelium at 3 months.

Preliminary Results of Subconjunctival Bevacizumab in Primary Pterygium Excision

Purpose: To evaluate the efficacy of subconjunctival bevacizumab as an adjunctive therapy for primary pterygium surgery. Material and Methods: This randomized prospective clinical study was conducted on 30 eyes of 30 patients. After pterygium excision and accomplishing a rotational conjunctival flap, 15 patients (case group) received 1.25 mg (0.1 ml) bevacizumab, and 15 other patients (control group) received 0.1 ml balanced salt solution subconjunctivally. The main outcome measures were recurrence of pterygia, horizontal length of the corneal epithelial defect, conjunctival erythema, lacrimation and photophobia during the first postoperative week. Results: There were no statistically significant differences regarding age, sex or recurrence risk factors between the two groups (p > 0.05). The pterygia resolved in 13 (86.6%) of 15 eyes in both groups, with a recurrence rate of 13.4% during a mean follow-up period of 8 ± 1.4 months in the case group and 7.4 ± 1.5 months in the control group (p = 0.2). There were no statistically significant differences regarding reduction in refractive astigmatism, improvement in visual acuity, corneal epithelial defects, conjunctival erythema, lacrimation or photophobia between the case and control groups (p > 0.05). Conclusions: A single intraoperative subconjunctival bevacizumab injection had no effect on recurrence rate or early postoperative conjunctival erythema, lacrimation, photophobia or healing of corneal epithelial defects following pterygium excision.

Sutureless and glue free conjunctival autograft in pterygium surgery

Abstract Purpose To review the safety and efficacy of sutureless and glue free conjunctival autografting for the treatment of primary pterygium Methods Retrospective case notes review of 8 consecutive patients undergoing primary pterygium excision performed by a single surgeon over a 1 year period. Excision of the pterygium was followed by reconstruction using suture and glue free conjunctival autograft. Results Mean follow up was 14 months (range 12 to 24). There were no transplant dislocations, failures or recurrences (0 of 8 eyes) after one year. The average operating time was 14+/‐2(SD) minutes. One patient had transient graft oedema. Visual acuity was unaltered in seven patients, one patient with significant pterygium‐induced astigmatism gained 3 Snellen lines. No major complications occurred and all patients approved of their cosmesis at their final visit. Conclusion Sutureless and glue free autologous conjunctival grafting for primary pterygium surgery appears safe and efficacious and may aid in preventing complications attributed to the use of foreign materials.

Excessive granulation tissue at the harvest site following pterygium surgery with conjunctival autograft: a clinicopathological case report

A 31-year-old woman had an uneventful primary pterygium surgery with a conjunctival autograft. Four days following the surgery a red-violet-coloured lesion appeared at the bare autograft harvest site that was excised at postoperative 1 month leaving the autograft site bare again. The lesion recurred in a week. The excision was repeated but this time the sclera was closed by end-to-end suturation of conjunctiva. The lesion did not recur during the 3 months of follow up. Pathological examination revealed the lesion to be composed of granulation tissue composed of an overlying stratified epithelium and underlying marked vascularization, fibroblasts and lymphomonocyte cells. Excessive granulation tissue may form when there is a deviation in wound healing. Removal of the excessive granulation and restoration of the continuity of the surrounding epithelium should be curative.

Effect of Inferior Conjunctival Transposition Flap Surgery for Primary Pterygium

Purpose: To evaluate the efficacy and safety of the inferior conjunctival transposition flap for primary pterygium surgery. Methods: This study reviewed 59 eyes in 59 patients with primary pterygium who were treated with pterygium excision and an inferior conjunctival transposition flap. The inferior conjunctival flap was obtained from lower bulbar conjunctiva and was secured with 8-0 vicryl. Patients were followed-up on the third day after surgery and then at 1, 2, 4 and 12 weeks postoperatively. Results: The mean patient age was 55.6 (ranging from 34 to 74) years. The mean follow-up period was 24.9 (ranging from 12 to 46) months. During the follow-up period, the pterygium recurred in one (1.7%) of the 59 eyes. There were no severe complications except for mild congestion and hemorrhage of the conjunctival flap. Conclusions: Inferior conjunctival transposition flap technique may be considered as a safe and effective method that reduces complications and recurrences after primary pterygium excision.

Fibrin glue versus sutures for attaching the conjunctival autograft in pterygium surgery: a prospective observer masked clinical trial

Aims:To compare the degree of conjunctival autograft inflammation, subconjunctival haemorrhage (SCH) and graft stability following the use of sutures or fibrin glue (FG) during pterygium surgery.Methods:Prospective, observer masked, clinical trial....

Randomised controlled trial on the effectiveness of lidocaine gel vs tetracaine drops as the sole topical anaesthetic agent for primary pterygium surgery

To determine the effectiveness of lidocaine 2% gel vstetracaine 1% drops in primary pterygium surgery. This was a prospective, randomised controlled trial. Forty consecutive patients who had primary pterygium underwent surgical excision of primary pterygium and mitomycin C. Patients were randomised into two groups. Group 1 received tetracaine 1% drops and solcoseryl eye gel (Solco Basel AG, Switzerland). Group 2 received xylocaine 2% gel (lidocaine hydrochloride 2% gel, AstraZeneca, Sweden) topically and normal saline drops 0.9%. Additional tetracaine drops were given to patients who experienced pain preoperatively. The primary outcome was the pain experienced during and after surgery. Immediately after the operation, pain and discomfort scores were assessed by the patients and doctor using a 10-point linear analogue scale. The stages of the operation were divided into the following: stage 1-first incision, stage 2-pterygium body excision, stage 3-conjunctival suturing, and stage 4-immediate postoperative after patching. There was no statistically significant difference in the mean pain scores experienced during pterygium excision (3.03+/-2.35 for the lidocaine group and 3.98+/-2.18 for the tetracaine group). However, for stage 3, there was a statistically significant difference in mean pain scores experienced during closure (P=0.03) (0.47+/-0.84 for the lidocaine gel group and 1.43+/-1.66 for the tetracaine group), with patients of group 2 experienced less pain. The mean number of additional drops required by the eyes in lidocaine gel group was also significantly (0.16+/-0.11) less than the tetracaine group (0.67+/-0.09, P=0.001). Topical administration of lidocaine 2% gel or tetracaine 1 % drops are both effective anaesthetic agents for primary pterygium surgery and mitomycin C. However, lidocaine gel is superior to tetracaine eye drops and its application is more convenient with a less frequent application and a sustained duration of action.

Prospective Study of Primary Pterygium Surgery using Pterygium Extended Removal Followed by Extended Conjunctival Transplantation

To assess the rate of recurrence and complications after primary pterygium removal with the P.E.R.F.E.C.T. for PTERYGIUM (pterygium extended removal followed by extended conjunctival transplantation) technique. A case series study of the P.E.R.F.E.C.T. for PTERYGIUM technique was conducted by 1 surgeon with a 1-year follow-up to assess the recurrence and complication rate. Two hundred fifty consecutive primary pterygium removals. A major modification of conjunctival autograft surgery was used to treat primary pterygia. The recurrence rate and complications after excision of primary pterygia using the P.E.R.F.E.C.T. for PTERYGIUM technique. One patient had a vascularized delle listed as a recurrence from among 250 consecutive patients (0.4%). The mean study follow-up period was 462+/-172 days. No patient lost best-corrected vision. The P.E.R.F.E.C.T. for PTERYGIUM technique results in a near 0% recurrence rate with minimal complications and a good cosmetic appearance.

CONJUNCTIVAL Z-PLASTY FOR PTERYGIUM: COMPARISON WITH CONJUNCTIVAL AUTOGRAFTING

Aim: High recurrence rate is the most common problem after the pterygium excision surgery, and the adjunctive therapies performed to reduce the recurrence rate have severe complications. The aim of this study was to compare the safety and efficacy of conjunctival Z-plasty and conjunctival autograft application in primary pterygium surgery. Methods: Forty two consecutive patients had undergone pterygium excision with either conjunctival autografting or conjunctival Z-plasty randomly. Operation time was recorded for each eye. Mean follow-up time in the autograft group and the Z-plasty group was 18 and 17 months, respectively. Results: Loose graft was observed in 1 (4.7%) patient, tenon’s granuloma in 1 (4.7%) patient, and recurrence in 1 patient (4.7%) in the autograft group. Recurrence was observed in 1 patient (4.7%), and suture releasing in 1 patient (4.7%) in the Z-plasty group. Mean operation time was 36.14 ± 3.8 (range, 30-45) minutes and 16.10 ± 2.0 (range, 13-20) minutes in the autograft group and the Z-plasty group, respectively (p<0.001). Conclusion: Conjunctival Z-plasty is a safe and an effective procedure to reduce the recurrence rate following primary pterygium excision. This method has some advantages over conjunctival autografting technique, such as shorter operation time and easy application.

Human Amniotic Membrane Transplantation With Fibrin Glue in Management of Primary Pterygia

To report the use of fibrin glue for attaching the human amniotic membrane graft with a tuck-in technique after primary pterygium excision. Twelve patients with primary pterygium (grade 2 or 3) underwent pterygium excision. The bare sclera was covered with an oversized human amniotic membrane graft by using fibrin glue for graft adherence. The edges of the graft were tucked underneath the adjacent free margin of conjunctiva on 3 sides. Various parameters such as operative time, patient's postoperative comfort, graft adherence, time of graft epithelialization, and recurrence of pterygium were assessed. The amniotic membrane graft adhered successfully in 11 patients. Average surgical time was 15.5 minutes (range, 13-21 minutes). The postoperative period was generally comfortable. Epithelialization of the graft was rapid, occurring within 7 days in 11 eyes. In 1 patient, the graft was found dislodged partially on the first postoperative day. Eleven eyes showed no recurrence at the end of 1-year follow-up. Use of fibrin glue for attaching human amniotic membrane graft in primary pterygium surgery is effective. It not only reduces the surgical time but also minimizes postoperative discomfort and complications.

Conjunctivolimbal Autograft Using a Fibrin Adhesive in Pterygium Surgery

PurposeTo evaluate the efficacy and safety of fibrin bioadhesive in conjunctivolimbal autograft surgery for primary pterygium.MethodsThirty-six eyes in 34 patients were reviewed with nasal primary pterygium who were treated with pterygium excision with superior conjunctivolimbal transplantation with fibrin bioadhesive. Surgical durations were recorded and the patients were followed up on the first day after surgery and then at 1, 2, 4, 8 and 12 weeks postoperatively. The graft-recipient site attachments were examined and subjective symptoms of patients were recorded at every follow-up examinations.ResultsThe mean patient age was 57.9±10.1 (ranging from 33 to 83) years. The mean follow-up period was 22.05±5.78 weeks. The mean surgery time was 18.04±5.65 minutes. The subjective symptoms (pain, foreign body sensation, tearing and discomfort) disappeared in 23 of 36 eyes (64%) in one week after surgery, and all discomforts subsided within two weeks after surgery in all patients. The conjunctivolimbal autograft was correctly positioned and fixed in 34 of 36 eyes (94.4%) throughout the follow-up period. Graft dehiscence was seen in two eyes (5.6%), one eye was treated with remedial sutures, and the other eye showed a spontaneous healing without remedial sutures. Transient graft edema occurred in four eyes (11.2%) but subsided spontaneously within a month. There were no cases of pterygium regrowth or complications due to the fibrin bioadhesive.ConclusionsThe use of fibrin bioadhesive in conjunctivolimbal autograft surgery in primary pterygium simplifies surgical techniques, shorten surgical duration, and produce less postoperative subjective symptoms. Therefore, the fibrin bioadhesive is a safe and effective tool to attach conjunctivolimbal autograft in primary pterygium surgery.

Efficacy of mitomycin C associated with direct conjunctival closure and sliding conjunctival graft for pterygium surgery

Aims:To evaluate the comparative efficacy of direct conjunctival closure (DCC) and sliding conjunctival graft (SCG), with and without intraoperative mitomycin C 0.02% (MMC) for pterygium surgery.Methods:A comparative study consisting of...

Conjunctival–Limbal Autograft, Amniotic Membrane Transplantation, and Intraoperative Mitomycin C for Primary Pterygium

We evaluated and compared the safety and efficacy of the conjunctival-limbal autograft, amniotic membrane transplantation, and intraoperative application of mitomycin C in 94 patients undergoing primary pterygium surgery and concluded that conjunctival-limbal autografting and amniotic membrane methods were more effective and safer than intraoperative mitomycin C.

Management of Primary Pterygia Using Free Conjunctival and Limbal-Conjunctival Autografts Without Antimetabolites

To report the incidence of recurrence after primary pterygium surgery using either a free conjunctival or limbal-conjunctival autograft without antimetabolites. One hundred eleven eyes of 90 patients underwent pterygium resection; a free conjunctival autograft was used in 88 surgeries and a free limbal-conjunctival autograft in 24; the latter technique was reserved for dark-skinned patients, under age 30, and with a history of recurrent pterygium in the contralateral eye. Mean age was 42.5 years (range, 23-75), and 50% of the patients were male. Mean follow-up was 9 months (range, 3-12). There were 2 recurrences (1.8%), both observed in the third postoperative month. With a good surgical technique, the incidence of recurrence after primary pterygium surgery is very low, making the use of antimetabolites unnecessary.

The cut‐and‐paste method for primary pterygium surgery: long‐term follow‐up

To evaluate the recurrence rate, reoperation rate and side-effects of a novel technique for pterygium surgery. Retrospective study. The study included 461 eyes of 381 patients operated for primary nasal pterygium by the same surgeon between 1994 and 2003 and followed for 23 +/- 20 months (range 6-112 months). Autologous conjunctival grafts harvested at the superotemporal limbus were used to cover the sclera after pterygium excision. Using a retrospective chart review, the outcome after attaching the transplant to the sclera with a fibrin tissue adhesive (n = 325) was compared to the outcome after graft attachment using absorbable sutures (n = 136). Recurrence rate, reoperation rate and complications. The recurrence rate was 5.3% in the glue group and 13.5% in the suture group (p = 0.01). The reoperation rates were 1.2% and 3.3%, respectively (p = 0.31). Complications, such as transient transplant oedema and persistent corneal epithelial defects, occurred equally in both groups. Using a fibrin tissue adhesive instead of sutures when attaching the conjunctival transplant in primary pterygium surgery results in a significantly lower recurrence rate.

5-Fluorouracil as chemoadjuvant for primary pterygium surgery: preliminary report.

To investigate the safety and efficacy of intraoperative application of 5-fluorouracil as an adjuvant in primary pterygium surgery and to evaluate the effect of postoperative subconjunctival 5-fluorouracil injections on the recurrent pterygium. Of 25 consecutive white patients, 28 eyes with primary pterygium underwent pterygium excision with intraoperative application of 5-fluorouracil (25 mg/mL for 3 minutes). The superior and inferior conjunctiva was approximated to cover the scleral bed within 1 mm of the limbus. Recurrence of pterygium was defined as postoperative fibrovascular growth more than 1 mm onto the cornea. Eyes with recurrence less than 2 mm were treated with subconjunctival 5-fluorouracil injections. After a mean follow-up of 14.1 +/- 3.9 months (mean +/- standard deviation), 7 recurrences (25%) were observed. All recurrences were detected within 12 months. In 4 of 7 recurrences, the fibrovascular growths were less than 2 mm. We, therefore, performed subconjunctival 5-fluorouracil injections. In 3 (75%) of 4 recurrences, the fibrovascular growths became atrophic. No serious complications were observed during and after the surgery. However, superficial punctate keratitis, pain, and hyperemia were detected in all patients in the early postoperative period. As a result, of 28 eyes, 4 (14%) had unacceptable cosmetic results and growing recurrences. This study suggests that intraoperative applications of 5-fluorouracil is both efficient and safe in the treatment of primary pterygium. Additionally, postoperative subconjunctival 5-fluorouracil injections may prevent the progression of fibrovascular tissue.

Pterygium Surgery: Conjunctival Rotation Autograft Versus Conjunctival Autograft

To compare the safety and efficacy of conjunctival rotation autograft to conjunctival autograft in primary pterygium surgery. A prospective randomized study was performed of 39 eyes in 31 patients who had undergone pterygium surgery. Nineteen eyes were treated by conjunctival rotation autograft (Group A). Twenty eyes were treated by conjunctival autograft (Group B). Follow up ranged from 8 to 12 months (mean 11 months). Recurrence was defined as postoperative regrowth of 2 mm fibrovascular tissue onto clear cornea in the area of previous pterygium excision. Four eyes were excluded from the study. Delayed wound healing occurred in 11.76% of eyes, and 5.88% of eyes had persistent congestion in Group A. A loose graft was present in 5.55% of eyes, and 5.55% of eyes had dellen formation in Group B. We conclude that conjunctival rotation autograft and conjunctival autograft are both equally effective methods to reduce the recurrence rate after pterygium surgery. Conjunctival rotation autograft can be tried as an alternative attractive procedure for pterygium surgery to reduce the chances of recurrence. However, a larger, randomized, prospective double masked study with more patients and a longer follow up will eventually demonstrate the superiority of one procedure over the other.

Low-Dose Intraoperative Mitomycin-C Versus Conjunctival Autograft in Primary Pterygium Surgery: Long Term Follow-Up

To evaluate and compare the long term safety and efficacy of low-dose intraoperative application of mitomycin-C (0.02%) with conjunctival autograft in primary pterygium surgery. Of 37 consecutive patients 41 eyes with primary pterygium underwent pterygium excision with either intraoperative mitomycin-C (0.02%) (Group I) or conjunctival autografts (Group II) at random. Mitomycin-C (0.2 mg/mL) was applied for 2.5 minutes on the scleral bed under the conjunctiva. Conjunctival autograft was obtained from upper temporal limbus and secured with 10-0 monofilament nylon. The follow-up period ranged from 14 to 54 months (mean 36 months) for mitomycin-C group and 13 to 58 months (mean 38 months) for conjunctival autograft group. Twenty-one eyes underwent pterygium excision with intraoperative mitomycin-C (0.02%) application (Group I) and 20 eyes were treated using conjunctival autograft (Group II). The mean size of the pterygium was 3.80 mm (range 2.6 to 4.8 mm) in the mitomycin-C group and 3.60 mm (range 2.5 to 4.5 mm) in the conjunctival autograft group. Two (9.52%) eyes treated with intraoperative mitomycin-C had delayed epithelial healing of corneoscleral wound and one (4.76%) eye developed pyogenic granuloma. Three (14.3%) of the 21 eyes in Group I and one (5%) of 20 eyes in Group II had recurrence of pterygium (P = 0.3174). All recurrences occurred in patients below 40 years of age (P = 0.0384). We conclude that conjunctival autograft and intraoperative mitomycin-C are both equally effective adjuncts to primary pterygium surgery on long term follow-up. However, future prospective studies with larger numbers of subjects may be carried out to find out the optimum concentration and duration of intraoperative mitomycin-C application.

Comparative study of intraoperative mitomycin C and β irradiation in pterygium surgery

AIMSTo compare the rate of recurrence and complication after surgery for primary pterygium performed by one surgeon using either intraoperative mitomycin C or β irradiation.METHODSA retrospective study was performed of...