Pterygium Excision Research Articles

Astigmatic change after pterygium excision with autologous limbal conjunctival graft

Background: Pterygium induces a significant amount of astigmatism. Pterygium excision with conjunctival limbal autograft results in significant reduction in astigmatism by inducing a reversal of pterygium induced corneal flattening thereby improving the vision.
 Objectives: The aim of this study was to investigate the amount of corneal astigmatism in patients with pterygium before and one month (4 weeks) after surgery. 
 Methodology: The prospective observational study was conducted in 31 patients who underwent pterygium excision with limbal autograft in Kathmandu Medical College Teaching Hospital during the study period of 12 months duration. Patients with recurrent pterygium, pseudopterygium, history of ocular trauma, history of ocular surgery, corneal scarring were excluded from the study. After surgery, patients were followed for four weeks. Findings were recorded in the proforma and statistical analysis was done in SPSS version 19. 
 Results: Pterygium was seen in all age groups with majority being in the active age range of 41-50 yrs. Females were most commonly affected. Significant difference in corneal astigmatism was noted postoperatively with a p value being 0.01.
 Conclusion: The technique of pterygium excision with limbal conjunctival autograft not only reduces the chances of recurrence but also helps in reducing the induced corneal astigmatism which is responsible for decreased vision in patients with pterygium.

Clinical demographics of pterygium excision and prevalence of conjunctival intraepithelial neoplasia: a 15-year review.

To find clinical demographics of pterygium surgery and prevalence of conjunctival intraepithelial neoplasia (CIN) in pterygium specimen. This is a retrospective, institutional study. The records of patients who had received pterygium excision from 2000 to 2014 were reviewed. Patients after complete ophthalmic "examinations", surgical procedures, and pathological reports were enrolled. Surgical procedures, pathology, external eye photography, prevalence of CIN in specimen, and demographic data were described. Of 1787 pterygium cases, 928 were male and 859 were female. The mean age was 65.19 ± 14.21years. Of these 1787 cases, 1435 (80.3%) cases had primary pterygium excision, while the others (n = 352; 19.7%) had pterygium excision for recurrence. Four cases presented CIN within pterygium tissue (0.22%). The mean age of pterygium patients with CIN was 57.75 ± 7.80years. In stratified data, our patients who received primary and secondary pterygium excision were found prevalent in the eighth (28.2%) and seventh (26.1%) decade, respectively. Twelve percent of patients who underwent secondary pterygium excision had a recurrence and required another surgery. Patients requiring amniotic membrane transplantation (AMT) during primary pterygium excision were significantly younger (median, 58years) than those (median, 67years) without the assistance of AMT (p < 0.001). Similarly, AMT was utilized in younger patients (median, 56years) during secondary pterygium excision, compared to those without AMT (median, 64years) (p = 0.001). CIN combined with pterygium is very rare. However, the possibility of the development of ocular surface squamous neoplasia in pterygium tissue should not be ignored. Meticulous pathological investigation of the surgical samples is important.

Anterior segment optical coherence tomography-guided transepithelial phototherapeutic keratectomy for scarring of the central cornea following pterygium excision.

To report the outcomes of patients undergoing anterior segment optical coherence tomography-guided transepithelial phototherapeutic keratectomy (ASOCT T-PTK) for central corneal scarring after pterygium excision. The charts of 11 eyes of 10 patients that underwent ASOCT T-PTK following excision of visual axis-involving pterygia were retrospectively reviewed from a single private practice institution. The visual outcomes and corneal topographic findings were evaluated 4±1mo after pterygium excision and 6±2mo after transepithelial phototherapeutic keratectomy (T-PTK). All 11 eyes tolerated both the pterygium excision and T-PTK procedure well without any significant intraoperative or postoperative complications. Uncorrected distance visual acuity (UDVA) and manifest refraction corrected distance visual acuity (CDVA) improved after pterygium excision (P=0.03 and P=0.05, respectively). The UDVA and CDVA improved further after T-PTK (P=0.004 and P=0.002, respectively). The topographic surface asymmetry index, topographic surface regularity index, and topographic projected visual acuity significantly improved after T-PTK (P=0.0092, P=0.0022, and P=0.0002, respectively). None of the subjects lost any lines of CDVA, developed recurrence of pterygia or required keratoplasty during the postoperative period. ASOCT T-PTK can provide excellent visual and anatomic outcomes in patients with central corneal scarring after excision of visual axis-involving pterygia.

Comparison between limbal stem cell versus dry amniotic membrane transplantation in treatment of primary pterygium

Abstract Background Pterygium is a degenerative disorder of the conjunctiva which leads to encroachment of bulbar conjunctiva onto the cornea. This invasion causes irritation of ocular surface, irregular astigmatism and loss of visual acuity.surgical treatment of pterygium is directrd towards excision, prevention of recurrence and restoration of ocular surface integrity. A myriad of techniques have been described for achieving these goals. Tha main complication of these procedures is the recurrence rate, which has been estimated as high as 30%_70%. Purpose to compare the efficiency of limbal stem cell transplantation versus dry amniotic membrane transplantation in treatment of pterygium. Patients and Methods The study carried out at ophthalmology department, Ain shams university and included 20 eyes which were classified into two groups; first group included 10 eyes of patients underwent pterygium excision with amniotic membrane transplantation. Second group included 10 eyes of patients underwent pterygium excision with limbal stem cell transplantation. Results the mean follow up duration was 1-3 months in both groups. On comparing recurrence rate between the studied groups which occurred only in the first group in two eyes 20%, there is no statistically significant difference found between the studied groups as regard recurrence. But it was statistically significant better with limbal conjunctival autografting. Graft rejection was not detected in the two groups during follow up period. There was no statistically significant difference found between the studied groups as regard clinical stability and graft rejection. Conclusion Limbal stem cell transplantation proved to be better than amniotic membrane transplantation in treatment of pterygium. As it is more effective in prevention of pterygium reccurence as well as it is of lower cost and better availability than amniotic membrane.

Application of 3g/L sodium hyaluronate eye drops combined with corneal bandage contact lens in the early stage after pterygium excision surgery

Application of 3g/L sodium hyaluronate eye drops combined with corneal bandage contact lens in the early stage after pterygium excision surgery

The Effect of Pterygium Surgery on Corneal Topography

Abstract Objective To evaluate the effect of pterygium surgery on corneal topography by comparing wave front analysis before and one month after the surgical treatment. Methodology Fifty eyes of forty-one patients were included in this study. Twenty five male and sixteen female patients seeking pterygium surgery were recruited from the Ophthalmology Department Outpatient Clinic in Sohag Teaching Hospital during the period from July 2017 to May 2018. All eyes underwent pterygium excision with conjunctival autograft. Results In this study we found a highly statistically significant improvement in the mean uncorrected visual acuity from 0.44±0.21SD preoperatively to 0.62±0.18SD postoperatively (p &amp;lt; 0.001) and a highly statistically significant difference in the mean logMAR visual acuity as it was decreased from 0.43±0.28 SD preoperatively to 0.34±0.23 SD postoperatively (p &amp;lt; 0.001). Also, there was a highly statistically significant improvement in mean of manifest refractive astigmatism from -4.08±3.28 SD preoperatively to -1.46±1.40 SD postoperatively (p &amp;lt; 0.001). We also found a highly statistically significant improvement in the mean cycloplegic astigmatism from -4.00±3.01 SD preoperatively to -1.39±1.33 SD postoperatively (p &amp;lt; 0.001) and also there was a highly statistically significant improvement in the mean topographic astigmatism from -5.17±4.08 SD preoperatively to -2.20±2.31 SD postoperatively (p &amp;lt; 0.001). We also found a highly statistically significant improvement in the mean of ISV (Index of Surface Variance) from 76.22±36.86 SD preoperatively to 33.56±15.02 SD post operatively (p &amp;lt; 0.001) and also there was a highly statistically significant improvement in the mean IHD (Index of Height Decentration) from 0.042±0.027SD pre-operatively to 0.023±0.036 SD post operatively. Conclusion There was a highly statistically significant difference in the mean logMAR visual acuity and a highly statistically significant improvement in the mean uncorrected visual acuity. A highly statistically significant improvement in both refractive and topographic astigmatism after one month of the surgery was noted also. Here were also a highly statistically significant improvement in ISV and IHD that indicate improvement after pterygium removal. Recommendations Patient with pterygium that inducing astigmatism will benefit from surgical removal of the pterygium.

Fibrin Glue Versus Autologous Serum for Conjunctival Autograft Fixation in Pterygium Surgery

Purpose: To compare the outcomes of conjunctival autograft fixation using autologous serum vs fibrin glue to cover the bare sclera in pterygium excision surgery.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: The study was conducted in Ophthalmology Department of CMH Kharian from April 2018 to November 2018.&#x0D; Material and Methods: Forty patients with primary pterygium were selected by convenient sampling technique. Patients with recurrent Pterygia and moderate to severe dry eyes, keratitis or secondary to trauma were excluded. The patients were divided into two groups, group A treated with fibrin glue and group B treated with autologous serum technique. All patients underwent pterygium excision under topical anaesthesia. The conjunctival autograft was removed from superior temporal bulbar conjunctiva to cover the scleral bed produced by pterygium excision. Post operatively the patients were followed-up for three months to assess the fixation or otherwise. Data was noted and analysed by using SPSS version 23.&#x0D; Results: The graft was taken-up nicely in most of the cases. The patients were followed up for three months after surgery. The frequency of graft lost in Group A and Group B was noted as n = 8 (40%) and n = 1 (5%), respectively (p = 0.008). The only other complication was recurrence of pterygium which was n = 5 (25%) and n = 3 (15%), in Group A and Group B, respectively (p = 0.429). No case of infection was noted.&#x0D; Conclusion: Fixation of conjunctival autograft with autologous serum is a safe and effective method and potential alternative of fibrin glue technique.

Corneal Reinnervation and Sensitivity Recovery after Pterygium Excision.

Purpose To evaluate changes in corneal sensitivity and subbasal nerve density after pterygium excision. Methods This prospective trial included 22 eyes with nasal primary pterygium and 18 controls. Corneal sensitivity was evaluated using a Cochet–Bonnet esthesiometer in the nasal, superior, temporal, inferior, and center quadrants of the cornea before surgery and 10 days, 1 month, and 3months after surgery. The central cornea was analyzed using in vivo confocal microscopy (IVCM) before surgery and 1 and 3 months after surgery. Subbasal nerve density and other nerve parameters were analyzed using NeuronJ. Nerve tortuosity was evaluated and graded in individual IVCM scans. The tear film break-up time (TBUT) test and Schirmer's test were performed before surgery, as well as 1 and 3 months after surgery. All the same tests were performed in the controls. Results All affected eyes showed a significant increase in corneal sensitivity in the nasal corneal quadrant after surgery when compared with preoperative data (F = 37.3; P < 0.01). Compared with controls, pterygium patients demonstrated decreased corneal subbasal nerve density (P < 0.01). Compared with controls, pterygium patients demonstrated decreased corneal subbasal nerve density (P < 0.01). Compared with controls, pterygium patients demonstrated decreased corneal subbasal nerve density (P < 0.01). Compared with controls, pterygium patients demonstrated decreased corneal subbasal nerve density (F = 37.3; P < 0.01). Compared with controls, pterygium patients demonstrated decreased corneal subbasal nerve density (P < 0.01). Compared with controls, pterygium patients demonstrated decreased corneal subbasal nerve density (F = 37.3; P < 0.01). Compared with controls, pterygium patients demonstrated decreased corneal subbasal nerve density (Conclusion Pterygium patients demonstrated deteriorated corneal subbasal nerve fibers when compared with healthy controls in terms of nerve length, nerve trunks, and nerve branches. Therefore, pterygium excision improves corneal sensitivity and increases corneal subbasal nerve density.

Femtosecond Laser-assisted Preparation of Conjunctival Autograft for Pterygium Surgery

Femtosecond laser-assisted conjunctival autografts (CAG) preparation was recently proposed. This study reports the outcomes of the first clinical trial on the use of laser to prepare CAG in pterygium surgery, and to compare the outcomes with those of manual technique. Forty eyes undergoing primary pterygium excision with laser-assisted CAG transplantation were prospectively included (L group). Two historical matched cohorts whose CAGs were prepared manually were compared (n = 78 eyes by the same experienced surgeon, M group; n = 78 eyes by trainees; TM group). We found the laser-created CAGs had only 11 μm deviation from the targeted thickness. The best-corrected visual acuity improved, and the astigmatism significantly decreased after surgery, with comparable efficacy across 3 groups. The 1-year recurrence rate was 2.5%, 3.8% and 7.7% in the L, M and TM groups, respectively (P = 0.12). There was no significant difference between the L and M groups in the complication rate (5.0% and 1.3%, respectively), surgical time (19.4 ± 5.1 and 19.1 ± 6.2 minutes, respectively), and postoperative discomfort scores (0.1 ± 0.3 and 0.2 ± 0.3, respectively), but these outcomes were significantly less favorable in the TM group. The results of this first comparative clinical trial suggest that femtosecond laser-assisted CAG preparation can be considered as an alternative technique for CAGs preparation.

Pattern of Ophthalmic Procedures Performed at a New Peripheral Eye Clinic in a Semi-urban Area in Port Harcourt, Nigeria - A 5 Year Review

Aim: A number of ophthalmic procedures are essential in the management of ocular disorders and are an integral part of ophthalmic practice all over the world. &#x0D; As different therapeutic methods evolve, some ophthalmic procedures have become outdated and some have been modified or replaced by various forms of laser therapy, leading to an increase in uptake of ophthalmic procedures in this country. Also though our patients still prefer non-surgical therapy, when surgery is performed, the results are much improved leading to greater patient satisfaction. This is a result of the use of more sophisticated and expensive surgical equipment and better surgical techniques. The ophthalmic procedures analyzed here were carried out in a general ophthalmic clinic without any subspecialty affiliation.&#x0D; Methodology: This is a retrospective review of ophthalmic procedures carried out in a specialist facility over a five year period. Information on age, sex and type of ocular procedure was retrieved from case notes of patients and entered into excel sheets. Data was exported from excel sheets for statistical analysis.&#x0D; Results: A total of 111 patients had Ophthalmic procedures over the 5 –year period under review with a mean age of 56.7±18.5 years and age range from 7 to 89 years. Sixty-three of the patients (56.8%) were males while forty-eight (43.2%) were females (M:F = 4:3). The commonest ophthalmic procedure carried out was cataract extraction which accounted for 48.6% of cases followed by yag laser capsulotomy (19.8%) and pterygium excision (18%). No surgical or laser procedures for glaucoma were performed during this period.&#x0D; Conclusion: Ophthalmic procedures are a very important mode of treatment of eye disorders. The most common procedure performed in our study was cataract extraction and more males than females underwent both cataract surgery and pterygium excision while more females had laser capsulotomy.

Comparison of Conjunctival Autograft Technique Using Autologous Blood as Glue Versus Suture Technique in Pterygium Surgery

Aim: To compare the post-operative inflammation, surgical time and complications in conjunctival autografting with oozed autologous blood versus sutures in primary pterygium surgery.&#x0D; Study Design: Prospective interventional study.&#x0D; Place and Duration of Study: Department of Ophthalmology, CIMS, Bilaspur (C.G), India. (Jan 2017-May 2018).&#x0D; Methodology: 80 eyes of 80 patients (25 to 75 years) presented with primary pterygium up to grade 3 were included in this prospective interventional study presented in eye OPD, CIMS, Bilaspur (CG). All the procedures and post-operative evaluation was done by the same surgeon. All the patients were divided into two groups on alternate basis. 40 patients received conjunctival autografting with oozed autologous blood (CAGb) and 40 patients received sutures (CAGs). These two groups were then compared for post-operative inflammation, surgical time and complications (day 1, day 5, 2 weeks, 1 month and 3 month).&#x0D; Result: Total 80 patients were evaluated after surgery. Progressive pterygium was observed in more than 50% cases in both groups. Post-operative inflammation and discomfort was significantly lower in CAGb group compared to CAGs group (P&lt;.001). Mean surgical time was also significantly less in CAGb group (11.6±2 min) compared to CAGs group (21.6±3min) (P&lt;.001). In CAGb group 5% patients had graft displacement while none in CAGs group. Granuloma formation was higher in CAGs group (12.5%) compared to CAGb group (7.5%). Subgraft haemorrhage was 10% in CAGb and 17.5% in CAGs group. Dellen formation was seen in 3 patients in CAGb and 4 patients in CAGs. Recurrence rate was higher in suture group (5/40 in CAGs vs 1/40 in CAGb).&#x0D; Conclusion: Our study concludes that placement of conjunctival autograft with oozed autologous blood as adhesive after pterygium excision is an effective, less inflammatory and less time consuming approach, with significantly lower rates of post-operative complications. This can be used as a better alternative to suture technique.

Pterygium: new insights

Pterygia are common conjunctival degenerations with well-documented risk factors but an unclear pathogenesis. Better understanding of the pathogenesis of pterygium could lead to improved surgical outcomes and decreased postoperative recurrence. Currently, pterygium excision with conjunctival autograft remains the preferred surgical technique to decrease pterygium recurrence. Many adjuvant therapies have been used in pterygium surgery to varying degrees of success. Topical cyclosporine, an immunosuppressive medication, in conjunction with conjunctival autograft was found to be most successful in decreasing pterygium recurrence according to a recent meta-analysis. Other adjuvant therapies such as mitomycin-C (MMC), 5-fluorouracil (5-FU), and beta-irradiation have also been used, though usage of these may cause multiple adverse effects. Recent research indicates that interactions between mouse double minute 2 (MDM2) and p53 could play a role in the occurrence of pterygium. Nutlin, anMDM2 antagonist, was found to have significantly less toxicity in conjunctival cells when compared with MMC on laboratory analysis of pterygium samples.

Karakteristik Klinis Kasus Pterygium di Rumah Sakit Dr. Kariadi

Introduction and Objective: Pterygium is a fibrovascular tissue growth of conjunctiva. The aim of this study was to report the clinical characteristic of pterygium cases in dr. Kariadi Hospital Semarang. Method: This is a retrospective study of pterygium patients medical records who went to surgery in Ophthalmology Department of Kariadi Hospital Semarang, from March 2012 to April 2017. The data of patient age, gender, occupation, laterality, site of pterygium, visual acuity, type of surgery, recurrences, and complications were collected. Descriptive statistics analysis was used to analyzed demographic and clinical profile of patient. Result: Seventy-six patients were included in this study consist of 61.8% were female and 31.2% were male. The mean age was 46.04 ± 12.76 years (range 18-65 years). Most of the patients were housewife (30.3%) and private worker (25%). Fifty-six percent of patients have unilateral pterygium and mostly on nasal site (90.79%). Twenty-five percent of patients underwent excision with limbal-autograft. Five patients (13.9%) have recurrences, therefore overall recurences rate was 13.9%, in which three patients (17.6%) without graft recurrence occured at first year treatment and two patients (9.5%) with graft recurrence occured at third year treatment. Most patients have best corrected visual acuity between 6/6 to 6/18 before and after treatment (40.7% and 55.26% respectively). Complications were recurrence (6.58%), post-operative refractive disorders (5.26%). Conclusion: pterygium patients mostly were housewife with unilateral and located on nasal site. Recurence rate of pterygium excision with conjungtivo limbal-autograft was smaller than bare sclera technique in which occured at 3 year of post operation.

Glue Free and Suture Free Conjunctival Autograft in Pterygium Excision:A North Indian Perspective

Aim: To study postoperative outcome &amp; related complications of Glue free and suture free conjunctival autograft in pterygium excision in Haryana-A North Indian state. Materials and Method: The present study was conducted at the Department of Ophthalmology, MMIMSR, Mullana (Maharishi Markandeshwar Deemed to be University) in the time period extending between December 2017 and January 2019. 50 eyes of patients of either sex with primary pterygium were selected and pterygium was excised &amp; sutureless &amp; glue free conjunctival autograft was done with patient’s own blood fibrin. Parameters such as mean operating time, presenting complaints, grade, complications &amp; recurrence were observed on postoperative Day 1, Day7, 2 weeks, 1 month, 2 month, 3 month &amp; 6th month. Results: The mean age of the study population was 48.82 + 11.13 years... Out of 50 eyes only 1 (2%) had conjunctival cyst, 2 (4%) graft edema and 3 (6%) had graft displacement, 1(2%) had graft lost, 1(2%) had graft rejection &amp; 1(2%) had recurrence at 6 month follow up. The mean operation time was 24.88 minutes. Regarding type of the pterygium, out of 50 patients 9(18%) were grade 1, 26(52%) were grade 2, 11(22%) were grade 3 and 4(8%) were grade 4. Conclusion: Conjunctival autograt using patients own blood technique is a safe, cheaper, effective, with less surgical time &amp; has minimal postoperative discomfort.

Comparative Study to Evaluate the Outcome of Sutures Versus Sutureless in Attachment of Conjunctival Autograft for Pterygium Excision

Background: Suturing of conjunctival graft is a traditional technique for pterygium excision surgery. Owing to its many disadvantages &amp; complications many newer techniques like autologous fibrin glue have been introduced &amp; accepted as an alternative method of graft adhesion. Methodology: The present study was conducted at the Department of Ophthalmology, MMIMSR, Mullana (Maharishi Markandeshwar Deemed to be University) in the time period extending between December 2017 and January 2019. 100 eyes of patients of either sex with primary pterygium were selected and divided into 2 groups of 50 each in Group 1- patient underwent conjunctival auto graft with 10-0 ethilon sutures while in Group 2 suture less conjunctival auto graft was done with patient’s own blood fibrin. Results: Parameters such as mean operating time, presenting complaints like pain, watering, burning and foreign body sensation, complications &amp; recurrence were compared between the two groups on postoperative Day 1, Day 7, 2 weeks, 1 month, 2 month, 3 month &amp; 6th month. Statistical significant difference (p&lt;0.01) was found between the suture and sutureless surgery for pterygium in relation to post-operative discomfort grading. There was a significant difference (t = 22.149, p = 0.001) in the duration of surgery for GROUP I surgery. Conclusion: Conjunctival auto graft with autologous serum is a safe and fast method. It is equally effective as conventional sutured autograft technique. Post operative discomfort is significantly less in this method. It also prevents suture related complications.

Sutureless and Glue-free Conjunctival Autograft in Pterygium Surgery: A Case Series

Foreign materials used in ocular surface surgery may lead to local complications such as discomfort, scarring, or infection. Plasma-derived products such as fibrin glue may produce possible hypersensitivity reactions whereas the risk of viral transmission remains. We describe a simple method of achieving conjunctival autograft adherence during pterygium surgery avoiding potential complications associated with the use of fibrin glue or sutures. Pterygium excision with limbal conjunctival autografting without using glue or sutures was performed in all the patients followed by bandaging for 24 hours. The patients were followed up post operatively on 2nd day, 1 week, 1 month, 3 month and 6 months. They were examined for haemorrhage, wound gape, graft shrinkage, chemosis, graft dehiscence, recurrence or any other complications. Total 100 cases were included in this case series. Patient age in ranged from 23 to 78 years (mean 50. 08 ± 12.76 years). Surgical Time was (in Minutes) from 20-28; mean &amp; SD 23.76 ± 1.89. Total graft dehiscence occurred in 1 eye (1%), graft retraction in 12 eyes (12%) and recurrence was seen in 1 eye (1%). At 3 month postoperatively, the gain in uncorrected visual acuity ranged from 2-3 line in Snellen chart in 13 eyes. No other complication was noted. This simple technique for pterygium surgery may prevent potential adverse reactions encountered with the use of foreign materials and in this case series provided safe and comparable results to current methods.&#x0D; TAJ 2019; 32(2): 56-61

Complications and Recurrence after Pterygium Excision using Mitomycin C Eye Drops versus Sutureless and Glue Free Conjunctival Autograft: A Prospective Study

Introduction: Recurrence is the most common problem with pterygium excision. Various adjunctive methods have been described to decrease the recurrence rate of pterygium. Mitomycin C (MMC) and limbal Conjunctival Autograft (CAG) are most commonly used methods to reduce its recurrence. Aim: To compare the recurrence rate of pterygium and the complications with MMC eyedrops after bare sclera pterygium excision versus sutureless and glue free CAG. Materials and Methods: Total 104 eyes were divided into two groups (A and B) of 52 eyes each. Group A patients underwent bare sclera excision of pterygium followed by 0.01% MMC eye drops BD (twice a day) for five days and Group B patients had sutureless and glue free CAG using oozing blood as tissue adhesive after pterygium excision. The patients were followed-up postoperatively on day 1, day 3, day 7, one month, three months, six months and one year. All the patients were examined for recurrence and complications. Statistical analysis was done by using Statistical Package for the Social Sciences (SPSS) version 16 and student’s t-test was applied for comparison. Results: A total of 104 eyes of 92 patients were divided into two groups (A and B) of 52 each. The mean age of Group A was around 45 year and group B was around 43 years and the difference was statistically insignificant (p&gt;0.05). Total three patients had recurrence in one year of follow-up in group A, out of which first case appeared before the end of 1st month, second before the completion of 3rd month and the third case at the last follow-up. In group B only one case presented with recurrence at 6th month follow-up. The difference between the recurrences in both the groups was statistically insignificant (p&gt;0.05). Short term complications were observed in five patients in group A. One patient had corneal thinning; one had scleral thinning, two patients presented with avascular sclera and one patient with granuloma. In group B, 18 patients with graft retraction, eight with graft oedema, five with sub-conjunctival graft haemorrhage and one with granuloma were observed. All these complications resolved by the time. Long term complications were not observed in any patient of both the groups. Conclusion: This study concluded that the use of MMC eye drops (0.01%) BD or glue free and sutureless CAG after pterygium excision is safe and effective treatment modalities for pterygium.

Recurrence of Pterygium after Pterygium Excision with Stem Cell Graft and Amniotic Membrane Graft: A Comparison.

Study objectiveThe objective of this study was to compare pterygium excision with amniotic membrane graft and that with stem cell graft in terms of pterygium recurrence, using a quasi-experimental study design. This study was conducted at the department of ophthalmology at Nishtar Hospital, Multan, Pakistan from January to September 2019.Methodology and resultsA total of 214 patients who presented to the outpatient section at the department of ophthalmology were included in this study. A lottery method was used to divide the patients into two equal groups: A and B. Patients in group A underwent pterygium excision with amniotic membrane graft, and patients in group B underwent pterygium excision with stem cell grafts. Follow-ups were planned for the third day, the second week, the first month, the third month, and the sixth month postoperatively. Frequency and percentage were calculated for qualitative variables and for quantitative data. Mean and standard deviation were calculated, and a p-value of <0.05 was considered significant. Postoperative complications (i.e., graft edema, hemorrhage, and recurrence) in group A were observed as n = 0 (0%), n = 11 (10.3%), and n = 15 (14%), respectively. Postoperative complications (i.e., graft edema, hemorrhage, and recurrence) in group B were observed as 15%, 3.7%, and 12.1%, respectively. Statistically, the difference for graft edema was significant (p = 0.000).ConclusionStem cell grafting after pterygium excision was not associated with any major complications postoperatively. Stem cell grafting is better in terms of cosmetic appearance and has less recurrence rate as compared to amniotic membrane transplantation.

21G Needle-Assisted Pterygium Excision (21-GNAP): A Novel Safe Approach

Aim: To determine surgical efficacy of 21G needle-assisted pterygium excision. Method: A pictorial review of pterygia excised at different levels of maturity and diverse clinical history using a 21G hypodermic needle and a colibri. Ten pterygia were excised of which grade 3 were six and grade 2 were four. Nine cases were primary pterygia and a case was recurrent. The author was the only surgeon. Result: Cases reviewed showed minimal or no residual pterygial tissues post-operatively. Pterygial beds had smooth corneal optical surfaces, there were no perforations or undue corneal “guttering” from irregular cuts, no exuberant tissue formation like pyogenic granuloma or recurrence at 6 weeks of follow-up. Overall, slit lamp images were comparable with conventional “grab and cut” with surgical blade or scissors. Conclusion: 21G Needle-Assisted Pterygium (21-GNAP) excision is cheap, safe, and easy-to-learn new modality of excising all forms of pterygial and ocular surface masses.

Carnitine analysis in pterygium.

The aim of the present study was to measure the free carnitine and acylcarnitine levels in pterygium tissue and normal conjunctival tissue at the metabolomics level using tandem mass spectrometry. In this prospective, clinical randomized study, pterygium tissues and normal conjunctival tissues taken during pterygium excision with autograft were compared regarding their free carnitine and acylcarnitine profiles. After tissue homogenization, carnitine levels were measured using tandem mass spectrometry. The data were statistically analyzed with the Wilcoxon signed-rank test. Pterygium and normal conjunctival tissue samples from a single eye of 29 patients (16 females, 13 males; mean age, 54.75 ± 11.25 years [range, 21-78 years]) were evaluated. While the free carnitine (C0) level was significantly high in the pterygium tissue (p<0.001), acylcarnitine levels were significantly high in some esterized derivatives (C2, C5, C5:1, C5DC, C16:1, C18, methylglutarylcarnitine) (p<0.05). No statistically significant difference was determined for the other esterized derivatives (p>0.05). That the carnitine levels in pterygium tissue were higher suggests that acceleration of cell metabolism developed secondary to chronic inflammation and the premalignant characteristics of pterygium tissue. High carnitine levels may also effectively suppress the apoptosis process. The data reported in our study indicate that further, more extensive studies of the carnitine profile could help clarify the pathogenesis of pterygium.