Pterygium Excision Surgery Research Articles

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.

RIPK3 and RIPK1 gene expression in pterygium: unveiling molecular insights into pathogenesis.

Pterygium, characterized by the abnormal proliferation of epithelial cells, matrix remodeling, vascularization, and lesion migration, is a prevalent ocular surface disease involving the growth of fibrovascular tissue on the cornea. Despite the unclear underlying causes of pterygium, numerous investigations have indicated the involvement of cell death pathways in the regulation of cell cycle dynamics. Consequently, the objective of this study was to assess the expression levels of necroptosis markers in individuals diagnosed with pterygium, aiming to shed light on the potential role of necroptosis in the pathogenesis of this condition. This study aimed to investigate the expression patterns of receptor-interacting serine/threonine kinase 3 (RIPK3) and receptor-interacting serine/threonine kinase 1 (RIPK1) genes in pterygium tissues. 41 patients undergoing pterygium excision surgery were recruited. Resected pterygium samples and normal conjunctival tissues were collected, and RIPK3 and RIPK1 mRNA levels were measured using quantitative real-time PCR. Our findings reveal that the expression of RIPK3 is significantly increased in samples obtained from individuals with pterygium. However, no significant alterations were observed in the expression of RIPK1 in these samples. Results showed significantly higher RIPK3 expression in pterygium tissues compared to controls. Moreover, increased RIPK3 levels correlated negatively with pterygium recurrence rates. These findings suggest RIPK3 may play a protective role against pterygium recurrence through necroptosis.

A prospective comparative study of conjunctival autograft (CAG) with dry amniotic membrane graft (AMG) transplantation in pterygium excision surgery

: Pterygium is a wing-shaped, fibrovascular proliferation of the bulbar conjunctiva which crosses the limbus and causes encroachment over the cornea. It is mainly treated by surgical excision. Management options for pterygium include conjunctival autografting, and the use mitomycin C, amniotic membrane graft, 5-fluorouracil, anti-vascular endothelial growth factor (anti-VEGF) agents, and β-irradiation along with excision, to avoid recurrence.: To compare the efficacy and safety of conjunctival autograft (CAG) transplantation and dry amniotic membrane graft (AMG) transplantation in pterygium excision surgery.: Prospective comparative study.: The study was done on 43 eyes of 43 patients. CAG was transplanted on 23 patients & dry AMG was transplanted on 20 patients. All patients were followed up on day 1, day 7, 1 month and 6 months post operatively. On each visit pterygium recurrence, graft retraction, necrosis and visual outcomes were noted from all the patients.: Fisher exact test.: 28(65%) were males while 15(35%) were females. Most of the patients were <40 years of age. During the follow up period, best corrected visual acuity of 3(7%) patients remained same and improved in 40(93%) patients. CAG group had 2(8.69%) while dry AMG group had 4(20%) recurrences (p value = 0.39, non-significant).: Although both the groups showed low recurrence rate but recurrence rate was more in dry AMG group as compared to conjunctival autograft group.: AMG is not always the best option for treating pterygium, but in some situations—such as those with extensive pterygium, conjunctival scarring etc.—it may be more advantageous for the patient.

Comparison of Keratometric Change Following Various Conjunctival Autografting Techniques in Pterygium Surgery.

Aim To compare the postoperative keratometric changes and duration of surgery for different techniques of conjunctival autografting in pterygium surgery. Methods Patients with primary pterygium attending the outpatient department and having appropriate indications for surgery were enrolled. Preoperative ophthalmic examination included visual acuity assessment, refraction, keratometry, slit lamp, and fundus evaluation. Pterygium excision surgery with conjunctival autografting was performed on all patients using one of the four different techniques, namely, sutures, fibrin glue, and the autologous bloodand bridge techniques. Duration of surgery was recorded for all patients. Postoperatively, all patients were followed up on Day 1, Day 7, and Months 1, 3, and 6. Duration of surgery, keratometric changes, and recurrence rates were analyzed in all four groups. Results Sixty-eight eyes of 66 patients completed the study protocol. There was a significant reduction in astigmatism after the autologous blood graft technique (P value 0.0055) and the glue technique (P value < 0.0001). The success rate of the autologous and glue technique was 90%. The glue technique was found to be more time efficient (mean duration 20.40 minutes) than other techniques. Conclusion After pterygium excision, conjunctival auto grafting using either autologous blood or glue plays a significant role in reducing pterygium-induced astigmatism and recurrence rates with the added advantage of a shorter operative time.

Observing the factors affecting fibrovascular regrowth after pterygium excision and comparing the efficacy and complications of conjunctival autograft with sutures versus fibrin glue.

Aim: To observe the factors affecting fibrovascular regrowth after pterygium excision and to compare the efficacy and complications of conjunctival autograft with sutures versus fibrin glue. Materials and methods: 65 consenting patients with primary pterygium attending the outpatient department having appropriate indications for surgery were enrolled. Data was collected using personal interviews. Routine pre-operative ophthalmic examination was done, including visual acuity assessment, slit lamp examination, and fundus evaluation. Pterygium excision surgery was done on all patients using either Fibrin Glue or 10-0 nylon sutures. Patients were followed up at weeks 1, 4, 12, and 24 and any complications were duly noted. Results: The fibrin glue group showed milder postoperative discomfort, symptoms, and signs compared to the suture group. Pyogenic granuloma (3.12%), corkscrew vessels (6.25%), and subconjunctival hemorrhage (24.99%) were more common in the fibrin glue group. FVG not crossing the limbus was observed in 6.25% of glue cases and 9.09% of suture cases, more in fleshy and large pterygia, while age and gender did not alter the incidence of FVG. No recurrences were observed in any group. Conclusion: The incidence of fibrovascular regrowth (FVG) was not affected by age, gender, smoking, and surgical technique, but was positively correlated with length and grade of pterygium. The complication rate between the two groups was not found to be statistically significant. Despite causing severe postoperative discomfort and requiring prolonged surgical time, suture-assisted pterygium surgery is a cost-effective method still being used with long-term outcomes similar to fibrin glue.

Changes in tear film function in patients after pterygium excision surgery done under topical anaesthesia with and without conjunctival autograft – A protocol for a randomized interventional study

Background: Pterygium is an extra-ocular disorder related to progressive subepithelial growth of degenerative conjunctival tissue over the cornea. There are multifactorial causes that lead to the growth of pterygium. The tear film becomes unstable due to the degenerative growth of the conjunctiva. The tear film is divided into three different layers. The lipid layer is secreted by the meibomian gland, which is the exterior layer exposed to the environment and prevents tears from drying out too rapidly. The lacrimal gland releases the middle layer, the aqueous layer, which provides oxygen to the corneal epithelial layer. The goblet cells secrete mucus, the innermost layer that makes the corneal epithelium hydrophilic. Due to uneven wettability brought on by the progression of pterygium, the tear film becomes unstable and may damage the ocular surface. It has been found that pterygium excision increases tear film stability. According to a study, the incidence of pterygium in central rural India is 12.9%. Incidence increases with age, gender, and occupation. Methods: The patients with pterygium will be divided into two groups for the pterygium excision surgery: Group 1 consists of patients in which conjunctival autograft will not be done after pterygium excision, and Group 2 consists of patients in which conjunctival autograft will be done after pterygium excision. Preoperatively and postoperatively, visual acuity was assessed in all the patients on day 1, 4 weeks, and 8 weeks on follow-up. Tear film evaluation was done through Tear film Break Up Time (T-BUT) and Schirmer’s Test in patients preoperatively and postoperatively on day 1, 4 weeks, and 8 weeks follow up. CTRI Registration: REF/2023/07/071130 (30/07/2023) Protocol version: v1 dated 7/08/2023

Use of Cryopreserved Amniotic Membrane During Pterygium Excision: Health Economic Analysis.

To determine the health economic opportunity cost or gain associated with performing pterygium excision surgery using the TissueTuck technique with cryopreserved amniotic membrane (AM) instead of conjunctival autograft (CAU). We performed a literature review to determine the average surgical duration of pterygium surgery using CAU with fibrin glue or sutures to calculate the average time saved with the TissueTuck technique. Such time savings was then used to determine the opportunity revenue gain per national average Medicare reimbursement if adjusted to the average surgical duration of cataract surgery. The time savings achieved using the TissueTuck technique over CAU with fibrin glue is 8.9 min per procedure, which can be applied to additional MSICS or phacoemulsification procedures to generate an opportunity revenue gain of $1167 or $762 per 2022 National Average Medicare reimbursement, respectively. After subtracting the current list cost of AmnioGraft (ie, $645), the opportunity gain is $522 or $117 if the time saving is applied to the above procedures, respectively. Alternatively, the time savings achieved by using the TissueTuck technique over CAU with sutures is 23.4 min per procedure, which can be applied to additional MSICS or phacoemulsification procedures to generate an opportunity revenue gain of $3068 and $2004 per TissueTuck procedure or $2423 or $1359 when accounting for the list cost of AmnioGraft, respectively. The TissueTuck surgical technique using cryopreserved AM for pterygium takes less time, has lower recurrence rates, and provides an opportunity gain compared to pterygium excision with CAU.

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 .

Comparison of Conjunctival Autograft Versus Bare Sclera Technique as Treatment Modalities for Primary Pterygium

Background: Pterygium is a fibrovascular conjunctival growth within the palpebral fissure extending onto the corneal surface. Recurrence is a common post-op complication of pterygium excision surgery, with various rates depending on the techniques used for its excision. Objective: Comparison of conjunctival autograft versus bare sclera technique as treatment modalities for primary pterygium. Material &amp; Methods: This study was done in the Department of Ophthalmology of tertiary care hospital. In a prospective randomized controlled trial a sample size of 102 eyes with primary pterygium were allocated into two equally sized groups (51 patients in each): Group A underwent pterygium excision by bare sclera method, Group B underwent pterygium excision followed by conjuctival autograft. Both groups were analyzed and compared, for recurrence and complications with a mean follow-up time of 3 months. Result: Pterygium recurrence was detected in 16 (31.37%) patients using bare sclera technique (group A) and in 4 (7.84%) patients using conjuctival autograft technique (group B), that reveal a statistically significant difference (p = 0.003) Conclusion: Both surgical techniques are effective for pterygium excision but there is a statistically significant difference (p = 0.003) of pterygium recurrence between both techinques. Pterygium excision with conjuctival autograft should opt for better results in terms of recurrence as well as other complications. Bare sclera technique can be opted for preserving conjunctiva in case of glaucoma or scaring but at the expense of pterygium recurrences. Keywords: Pterygium, conjunctival autograft technique, bare sclera, recurrence.

Sandwich (Amnion/Conjunctival-Limbal Autograft/Amnion) Transplantation for Recurrent Pterygium with Restrictive Strabismus

(1) Background: This study aimed to evaluate the clinical outcome of Sandwich (Amnion/Conjunctival-Limbal Autograft/Amnion) transplantation for recurrent pterygium with restrictive strabismus. (2) Methods: This retrospective study included 11 eyes in 11 patients diagnosed with recurrent pterygium with restrictive strabismus who received sandwich transplantation. The outcomes were measured by pterygium recurrence, best-corrected visual acuity, esotropia (prism diopters), and treatment complications. (3) Results: Eleven patients (six males, five females) had a mean age of 60.5 (range 36-80) years. The previously received pterygium excision surgery number was 1.8 ± 1.02 (range 1-4). The mean follow-up period was 19.9 ± 8.41 (range 12-36) months. All patients had a restriction of abduction in the previously operated eye, causing esotropia in the primary position. Pre-operative esotropia was 17.2 (range 10-30) prims diopter (PD). Five eyes (45.5%) had symblepharon before surgery. All patients were orthotropic until the last follow-up. Symblepharon was released in all eyes. Free ocular motility was present in all eyes. No donor site scar formation, scleral melt, or corneal ulcer was noted. (4) Conclusions: Sandwich transplantation for recurrent pterygium with restrictive strabismus is safe and effective.

Histopathology-based diagnosis of Mooren’s ulcer concealed beneath the pterygium on eye

ABSTRACT Mooren’s ulcer (MU) is a chronic and painful ulcerative keratitis that is difficult to diagnose, especially when concealed beneath the pterygium, which is a common, benign, wedge-shaped, fleshy tissue growth of the conjunctiva extending onto the cornea. The coexistence of MU and pterygium is extremely rare. A 41-year-old man presented with a 2-month history of unprovoked redness, pain, and blurred vision in the right eye. Corneal epithelial defects around the pterygium head were noted upon slit-lamp examination and fluorescein staining. The patient was initially misdiagnosed with a corneal epithelial defect and pterygium. The initial treatments with anti-inflammatory and corneal epithelial growth promotion tear agents failed. Anterior segment optical coherence tomography (AS-OCT) showed corneal stromal lysis thinning, and in vivo confocal microscopy (IVCM) revealed marked inflammatory cell infiltration and stromal degeneration. We suspected the pathology was an immune-related or tumor-related corneal ulcer. The MU concealed beneath the pterygium was diagnosed by histopathological examination of a biopsy specimen that presented typical localized loss of the corneal epithelium and Bowman’s layer, stromal degeneration, and inflammatory cell infiltration. Finally, we performed lamellar keratoplasty (LKP) combined with pterygium excision surgery. The patient recovered with no complications or recurrence during the 1-year follow-up period. Few cases of MU concealed beneath the pterygium have been reported. It is beneficial to rule out the pathological changes concealed beneath the pterygium, combined with multiple means of examination such as slit-lamp examination, AS-OCT, and IVCM. A histopathological examination should be performed to establish a diagnosis.

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

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

Cryopreserved Amniotic Membrane Using the TissueTuck Technique: A Sutureless Approach for Pterygium Surgery.

The purpose of this study was to evaluate the clinical outcomes of the TissueTuck technique in the management of pterygium. This was a single-center, retrospective review of patients with primary or recurrent pterygium that underwent surgical excision followed by application of cryopreserved amniotic membrane (AM) using the TissueTuck technique. All patients underwent surgery between January 2012 and May 2019. Patient profile, surgical time, complications, and rates of pterygium recurrence were analyzed. A total of 582 eyes of 453 patients (328 female patients; 65.1 ± 13.9 years) were included for analysis and initially presented with primary (92%) pterygium. The average duration of pterygium excision surgery was 14.7 ± 5.2 minutes (median: 14, range: 4-39 minutes) with mitomycin C administration in 257 (45%) eyes. At the last follow-up of 30.2 ± 22.2 months (median: 24.5, range: 3-94 months), BCVA significantly improved from logMAR 0.23 at baseline to logMAR 0.19 ( P < 0.0001). Recurrence rate was 2.3% but only 0.7% (2/274) in those cases with primary, single-headed pterygium without mitomycin C treatment. Other postoperative complications in that cohort included granuloma (7.9%), scarring (3.8%), and diplopia in extreme lateral gaze (2.5%). The AM remained secured to the ocular surface throughout the postoperative period. The TissueTuck surgical technique with cryopreserved AM can be performed in minimal time and result in a low recurrence and complication rate after pterygium surgery.

Comparison of surgical techniques for recurrent pterygium

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

A case of resistant scleral thinning following uneventful pterygium surgery: A case report and a literature review.

IntroductionWe describe the management of a scleral thinning after uneventful pterygium surgery, it is an uncommon complication; in addition, we have reviewed similar published cases in the literature.Presentation of caseA 48-year-old woman presented with thinning sclera in the first week after pterygium excision surgery. Conservative treatment was the first line in the management. There was no improvement for two weeks, so we decided to do a rotational flap. We put a scleral dellen diagnosis by excluding other etiologies. The condition was successfully managed, the thinning sclera healed completely. Scleral and conjunctival re-surfacing was observed.Clinical discussionScleral dellen is an early and rare postoperative complication after pterygium surgery. The diagnosis is confirmed after excluding other causes of scleral thinning. The exact pathophysiology of it is not determined yet, many authors described probable explanation in their published cases. We did a comprehensive review of similar cases with their management.ConclusionsScleral dellen is uncommon complication after pterygium surgery, its diagnosis depends on exclusion. The management can be conservative. However, if no progression was detected do not hesitate going for surgical closure.

Α Novel Sutureless Pterygium Excision Surgery Using Human-Derived Dehydrated Amniotic Membrane

There are many surgical techniques available for the management of pterygium. Excision with limbal conjunctival autograft is currently the most popular surgical procedure and has been shown to have low recurrence rate and fewer complications. The fixation of limbal conjunctival autograft is performed with either sutures or fibrin glue. The use of sutures results in longer operating time and intense postoperative irritation and epiphora. We describe a new technique for pterygium excision using a human amniotic membrane-derived dry matrix (Omnigen®; Nottingham, UK: Nu-Vision Biotherapies). The use of Omnigen instead of conjunctival autograft in pterygium surgery is a new promising technique and results in shorter operation time, easier graft fixation, reduction in complications, and less postoperative discomfort. This is a simple technique for pterygium surgery with dry amniotic membrane matrix and without the need for anchoring limbal sutures or an assistant holding the graft whilst it is glued in place.

A study on stability of conjunctivo limbal autograft with autologous serum in pterygium excision surgery

Pterygium surgery has evolved a lot with newer technigues to help create better postoperative outcomes, to make the surgery time less consuming, to have fewer complications and to provide more better postoperative comfort to the patient. Our study is based on one of this new techniques of Conjuctivo Limbal Autograft with autologous serum which is comparatively less time consuming compared to its is precedessors and is a sutureless and glueless technique. The aim of the study is to find the safety, efficacy and relation of stability of intraoperative grafts (graft fixation)with their postoperative outcomes. We found that intra operative stable grafts to provide good results postoperatively having major displacement of only 1.15%.thus making this technique a faster, stable and economical technique for the patients and the doctors.

Efficacy of autologous fibrin glue versus sutures in reducing astigmatism following pterygium surgery

AIM: To evaluate the astigmatic changes before and after pterygium surgery and to study the effect of autologous fibrin glue over sutures in terms of efficacy in reducing corneal astigmatism. SETTINGS AND DESIGN: Randomized controlled trial. SUBJECTS AND METHODS: Forty-four patients with primary pterygia were taken up and divided as follows: Conjunctival autograft with autologous fibrin glue as Group 1 (n = 22) and autograft with 8-0 vicryl sutures as Group 2 (n = 22). All patients were preoperatively assessed for visual acuity, anterior, posterior segments, and Keratometric values using Bausch-Lomb keratometer on postoperative day 1, 7, 1 month, and 3 months. STATISTICAL ANALYSIS: Mann–Whitney test was performed to compare the median keratometric astigmatic changes preoperatively and postoperatively between the groups. P &lt; 0.05 was considered statistically significant. RESULTS: 50.5 was the mean age and 14.81 standard deviation (SD) in Group 1 and 48.86 was the mean and 13.23 SD in Group 2. Group 1 had 40.9% males and 59.1% females, Group 2 had 54.5% males and 45.5% females. The preoperative keratometric values significantly decreased postoperatively in both groups and the median postoperative keratometric value was significantly reduced in Group 1 (0.5) as compared to Group 2 (1.25). Pterygium excision using autologous blood was more effective in reducing corneal astigmatism. CONCLUSION: Pterygium excision surgery reduces corneal astigmatism and thus improves visual acuity. Autologous blood is better option to attach the conjunctival autograft than sutures in reducing astigmatism.

Postoperative Outcomes of Pterygium Excision Surgery with Autograft Using Autologous Blood Versus Conventional Sutures

Introduction: Pterygium is an extremely common ocular condition believed to be occurring due to proliferation and overgrowth of abnormal epithelial and fibrovascular tissue onto the cornea. They are characterized by cellular proliferation, neovascularization, and inflammation. Ultraviolet rays (UVR) induced elastoid degeneration of subepithelial connective tissue, genetic alteration associated altered cytokine expression plays an important role in the pathogenesis of pterygium. The recent treatment entities include conjunctival autograft with good results. The most commonly used means of fixating conjunctival autografts is by sutures or fibrin glue.&#x0D; Aim: This study aimed at comparative assessment of postoperative outcomes of pterygium excision surgery with autograft using autologous blood versus conventional sutures.&#x0D; Methods: Forty post-operative cases of pterygium excision surgery with conjunctival autograft were enrolled in the study and serially followed up. The study included two groups of 20 patients each. Group-A included cases of pterygium excision with autograft using autologous blood, and Group-B included cases of pterygium excision with autograft and sutures. Post-operatively, patients were examined on the 1st, 7th and 30th day to document the graft loss. Graft stability was also assessed on day 1 in both groups. Final comparisons were documented in terms of graft edema, stability and recurrence. Also suture related complications like foreign body sensation, watering, discomfort, granuloma formation and suture abscess were assessed in follow-up.&#x0D; Results: Group-B (suture group) revealed better graft stability whereas displacement of graft was documented in six cases of Group-A. Graft edema was reported in 10 cases from Group A and 7 cases from Group B. On the 30th day, all patients of both groups presented with similar findings. However, subjective discomfort was reported to be more in group-B as compared to group-A during each follow-up.&#x0D; Conclusion: Issue of graft displacement was a critical challenge with autologous blood group (Group A) patients compared to suture-related complications in group B. Looking towards the evidence of less remarkable complications and almost similar outcomes, the surgeons dilemma on pterygium management still persists.

Lyophilized amniotic membrane graft for primary pterygium surgery: preliminary results.

The aim of this study was to investigate the tolerability, safety and efficacy of new lyophilized amniotic membrane (LAM) presentation for ocular use. A prospective case-series cohort of four patients with primary nasal pterygium which undergone excision and LAM implantation was evaluated for complications and clinical outcomes. Surgical manipulation of LAM was also assessed. LAM was stiff and easy to manipulate as well as no tearing occurred during surgery or suturing. Ocular comfort was checked and similar among those patients with LAM glued or sutured. After 12months, there were no issues about tolerability or adverse events. Lower cosmetic outcomes (recurrence) were stated in 3 patients. Our study showed that LAM could be an effective alternative to cryopreserved amniotic membrane for graft after pterygium excision surgery. Its main advantage, storage at room temperature, can make it of immediate availability. Further studies comparing clinical outcomes of pterygium surgery with cryopreserved amniotic membrane versus LAM would confirm the benefits of the last.