Pterygium Excision Surgery Research Articles

Comparison of fibrin glue with sutures for pterygium excision surgery with conjunctival autografts

To compare pterygium excision conjunctival autograft surgery using Tisseel fibrin glue versus Vicryl sutures. Prospective randomized clinical trial. Fifty patients were randomized into either sutured graft or glued graft groups. Twenty-five received standard conjunctival autograft sutured with Vicryl and 25 received surgery with the autograft placed with Tisseel fibrin glue. Outcome measures include surgical time, patient discomfort, pathology, complications and recurrence rates at 3, 6 and 12 months. Patients were followed up at days 1, 7, 14, 30, 90, 180 and 365. The mean surgical time for the glue group was significantly shorter at 12 min compared with the suture group at 26 min (P < 0.001). Postoperative pain was significantly less at day 1 (P < 0.001) and day 2 (P < 0.05) but was not significantly different following these visits. Complications in the glue group included one patient with an absent graft at week 1 that required revision of the graft. At 3 months there were no recurrences in the glue group and two recurrences in the suture group. The 6- and 12-month recurrence rate was unchanged and not significantly different between the glue and suture groups (both 0/24 and 2/23, respectively). Both glued and sutured conjunctival autografting procedures are safe and effective methods for pterygium surgery. The glued autograft recurrence rate at 12 months was similar to that of sutured grafts. Conjunctival autograft with fibrin glue in pterygium surgery decreased surgical time and resulted in less postoperative pain in the first 48 hours but had a higher complication rate.

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 Recurrence After Excision With Conjunctival Autograft: A Comparison of Fibrin Tissue Adhesive to Absorbable Sutures

To evaluate the rate of recurrence after pterygium excision with conjunctival autograft (CAG) using Tisseel fibrin tissue adhesive versus absorbable sutures. Forty-seven eyes of 42 patients who had undergone primary pterygium excision surgery with CAG were retrospectively reviewed. The study group, CAG adhered using Tisseel tissue adhesive (n = 27), were compared with the control group, CAG adhered using absorbable sutures (n = 20). Postoperative courses were followed for 22-36 months after surgery. Rates of recurrence were compared using logistic regression. Recurrence was defined as regrowth of fibrovascular tissue 1 mm past the corneoscleral limbus. The recurrence rate in the Tisseel group was 3.7% compared with 20% in the sutured group (P = 0.035). Recurrence rate in the Tisseel group was comparable to previously reported rates for CAG with sutures in the literature. There was a significant inverse relationship between age and rate of recurrence overall (P = 0.025). There was no difference in time to recurrence between the groups -- with an average time to recurrence of 3.13 months. In a predominantly Southern California population where there is an overall higher rate of pterygium recurrence, Tisseel tissue adhesive may improve surgical outcomes with equal to or lower long-term recurrence rates than previously reported.

Incomitant Esotropia Following Pterygium Excision Surgery

To report the clinical characteristics and treatment of subjects with incomitant esotropia following unilateral pterygium excision. A retrospective review of 6 consecutive patients who developed incomitant esotropia, limited abduction, and diplopia following unilateral pterygium excision surgery. The mean preoperative deviation was 6 prism diopters (PD) (range, 0-25 PD) in the primary position and 13.8 PD (range, 6-25 PD) in the abducting field of the involved eye. Four patients underwent simultaneous surgery on the conjunctiva-perimuscular connective tissue complex and the medial rectus muscle. One subject had conjunctival-perimuscular connective tissue complex surgery alone. Postoperatively, all patients had orthotropia in the primary position and the deviation in the abducting field was improved to 5.2 PD (range, 0-14 PD). Incomitant esotropia is an uncommon but serious complication following pterygium excision surgery. Medial rectus muscle recession combined with scar tissue removal is required to eliminate diplopia in the primary position. Conjunctiva-perimuscular scar tissue removal may suffice to improve diplopia in the abduction gaze position.

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.

Incomitant Esotropia Following Pterygium Excision Surgery

Introduction: Strabismus is an uncommon complication following pterygium excision surgery. Direct trauma to rectus muscles and scarring of the conjunctiva-perimuscular connective tissue complex may result in restriction to abduction, incomitant strabismus, and diplopia. Surgical treatment is challenging because it requires a combination of surgery on the conjunctival-perimuscular connective tissue complex and the medial rectus muscle. Purpose: To report the clinical characteristics and management of subjects with incomitant esotropia following unilateral pterigyum excision.

Transplante de membrana amniótica associado ao transplante de conjuntiva autólogo no tratamento do pterígio primário

To evaluate the effectiveness of amniotic membrane transplantation associated with conjunctival autograft in primary pterygium treatment. We have analyzed, prospectively, 26 patients (14 women and 12 men), from 20 to 60 years old, examined at the Evangelic Hospital Ophthalmology Outpatient Clinic. They were submitted to primary pterygium treatment with pterygium excision surgery, amniotic membrane transplantation and conjunctival autograft, from April to November, 2001. The evaluated aspects were: degree of pterygium, postoperative complications and recurrence. Four cases (15.38%) showed complications, none of them considered serious, conjunctival graft contraction in 2 cases being the most frequent. After a follow-up of 6 months, 24 patients (92.3%) had a successful result and 2 patients (7.69%) had corneal or conjunctival recurrence. Among the patients with complications 50% presented pterygium recurrence (P<0.05). It is a safe surgical procedure with a low degree of recurrence rate. Complications are associated with a greater chance of relapse. This procedure is also an option in cases where there is not sufficient conjunctiva to cover all excised area.

The Effect of Pterygium Surgery on Corneal Topography

The aim of this prospective randomized clinical study was to evaluate the effect of pterygium surgery on the corneal topography using a computerized corneal topography system. Computerized corneal topography was performed on 27 patients with primary pterygium before and after pterygium excision surgery. The topographical changes that occurred following surgery were evaluated using paired and unpaired two-tailed t-test and Pearson coefficient of correlation analyses. Simulated keratometric astigmatism at the central 3 mm and the total mean refractive powers of the whole cornea were measured before and after surgery. Following surgery, flattened or steepened corneal areas were determined. Simulated keratometric astigmatism at 3 mm was found to be 2.30 +/- 2.08 D (0.2 - 7.63) preoperatively and 0.82 +/- 0.74 D (0.06 - 2.79) postoperatively. The difference between these two values was statistically significant (t = -3.46, P = 0.002). Total mean refractive power of the whole cornea was found to be 42.26 +/- 0.63 (40.80 - 43.64) preoperatively and 43.69 +/- 0.88 (41.50 - 44.90) postoperatively and the difference was 1.42 +/- 0.87. There was a statistically significant high difference (t = 28.36, P < 0.001). When preoperative and postoperative corneal topographies were compared, the whole cornea was found steeper at the postoperative period except a little region in the superior nasal quadrant. We believe that corneal topographical changes caused by the pterygium are almost reversible after surgical treatment, and postoperatively the cornea becomes steeper.