Pterygium Excision Research Articles

A COMPARATIVE STUDY TO EVALUATE THE CLINICAL OUTCOME OF CONJUNCTIVAL LIMBAL AUTOGRAFT AND AMNIOTIC MEMBRANE TRANSPLANT FOR THE TREATMENT OF PRIMARY PTERYGIUM

Aim: The aim of the study was to assess the safety and effectiveness of the conjunctival limbal autograft (CLAG) and amniotic membrane transplantation (AMT). Methods: After a full pre-operative assessment 100 patients with primary pterygium attending the ophthalmology outpatient department of a teaching hospital in Eastern India, fulfilling the inclusion and exclusion criteria were selected for our study. The patients were explained the procedure of the study and possible outcomes. They were divided into two groups. Group A: Where 10-0 nylon was to be used for CLAG after pterygium excision. Group B: Where 10-0 nylon was to be used for AMT after pterygium excision. Results: There was marked improvement in vision postoperatively more in the AMT group than CLAG. In the AMT group: 34% had a visual acuity of LogMAR 0.00, 30% had LogMAR 0.12, 12% had LogMAR 0.18, and 24% had LogMAR 0.30 after the surgery. In the CLAG group: 52% had a visual acuity of LogMAR, 20% had LogMAR 0.12, 22% had LogMAR 0.18, and 6% had LogMAR 0.30 after the surgery. Graft and suture-related complications were more in the CLAG group than in the amniotic membrane (AM) graft group. Conclusion: In the present study, The CLAG group was found to be associated with more discomfort, and more post-operative complications than AMT. AM may provide a basement membrane rich in various growth factors and matrix proteins, which promotes epithelial cell migration, adhesion, and differentiation. It is also believed to have anti-inflammatory and antifibrotic effects and exerts anti-scarring effects through the transforming growth factor-β pathway. AMT may be a superior treatment in primary pterygium due to lower recurrence rate, shorter surgical times, and better visual and cosmetic outcomes.

Conjunctival Autograft with Mitomycin C (MMC) in Primary Pterygium Excision

Purpose: To evaluate role of conjunctival Autograft (CAG) with Mitomycin C (MMC) in primary pterygium excision. Place and Duration of Study: Mughal eye hospital Lahore from 2020 to 2022. Methods: Patients with primary pterygium were operated. Pterygium excision was followed by Mitomycin C (MMC) 0.02% application for 2 minutes under the conjunctiva at base of the pterygium and this was followed by CAG. Patients were followed up at 1 week, 1 month and 2 months to see recurrence and any side effects of MMC. Google sheets were used for recording data of pterygia. Results: A total of 385 eyes of 316 patients with primary pterygium were included in the study. There were 209 males and 107 females. Mean age was 35 years (range 26 to 58 years). Follow up ranged from one month to 2 months. Four eyes (1%) had recurrence. It was noted that blood vessels of recurrent pterygium grew above or below the conjunctival graft on the side which was short. No complication of MMC was observed. There were 2 cases of graft dehiscence due to early breakdown of sutures. Conclusion: Recurrence after pterygium excision can be reduced to minimum by application of MMC with CAG and it is a safe procedure. Recurrence mostly encroaches on the cornea from above or below the conjunctival graft. A large conjunctival graft is thus necessary to cover the pterygium area and prevent recurrence. MMC is safe. Suturing the conjunctival graft provides minimum chances of graft loss.

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

The effect of different pterygium surgery techniques on the ocular surface parameters in different durations: a systematic review and meta-analysis.

To evaluate the effects of different pterygium surgery techniques on ocular surface (OS) in different follow-up periods. PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wan Fang, and China Biology Medicine disc were searched for studies reporting pre- and post-operative OS parameters in pterygium. A total of 33 articles were finally included. Three OS parameters showed relatively consistent changing trends after surgery including ocular surface disease index (OSDI), tear film break-up time (BUT), and score of corneal fluorescein staining (SCFS). They worsened significantly at 1w post-operation and then gradually improved: OSDI and BUT showed obvious improvement in 1m post-operation (SMD = - 0.58, 95%CI = [- 1.04, - 0.13]; SMD = 0.42, 95%CI = [0.06, 0.78]); SCFS was restored to preoperative levels in 3m after surgery (SMD = - 0.54, 95%CI = [- 1.16, 0.07]). Another parameter, Schirmer test without anesthesia (SIT), presented transient increase at 1w post-operation (SMD = 0.87, 95%CI = [0.27, 1.47]) and presented a relatively stable improvement after 1m post-operation (SMD = 0.52, 95%CI = [0.16, 0.89]). All parameters in amniotic membrane graft (AMT) showed better improvement in early stage and they showed non-inferior improvements in the long term compared with conjunctival autograft (CAG). Limbal-conjunctival autograft (LCAG) made excellent improvement to OS in the long term while pterygium excision (PE) showed the worst OS. The type of pterygium (primary and secondary), diabetes mellitus (DM) status, and fixation method had certain effects on the results. OS of pterygium is deteriorated at 1w post-operation then gradually improved to preoperative levels after 1m post-operation. Among various surgery techniques, LCAG had the best improvement to OS which especially displayed in the long-term outcomes.

Conjunctival autograft with fibrin glue in primary pterygium Demographic profile, visual, refractive and surgical outcome

: To compare the pre and post-operative visual, refractive and surgical outcome. It was a prospective interventional study of 56 primary pterygium patients with 12 months follow up. All patients underwent surgery with pterygium excision and conjunctival autograft fixation with fibrin glue without any fixating suture and adjuvant. Pre and post- operative visual acuity, spherical equivalent was compared and surgical outcome were evaluated. All patients were followed up to 12 months. The mean age was 42.43 ±13.38 years with male predominance. Seventy five percent (n=42) patients with normal vision (6/5 to 6/12, according to WHO) became 96% (n=54), 4 week post-operatively. Preoperatively, 42.8% (n=24) patients had spherical equivalent up to 1 D followed by 25% (n=14) Plano, 17.9% (n=10) up to 2 D, 5.4% (n=3) up to 3 D, 3.6% (n=2) had more than 3D which post operatively became 57.1% (n=32) up to 1D, 26.8% (n=15) Plano, 12.5% (n=7) up to 2D and there was no patients more than 2D with pre and post-operative comparison, p value of 0.000. There were no recurrence in 12 months follow up. Fibrin glue is very much effective in reducing recurrence rate and minimizes the complication with a very good visual outcome within 4 week postoperatively if surgery done carefully.

The Impact of A Successful Pterygium Excision on Corneal Astigmatism and Topography

Objective: To determine the impact of successful excision of pterygium on corneal astigmatism and topography.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Feb 2021 to Jul 2021.
 Methodology: All 52 patients of pterygium who underwent surgical excision of the pterygium during the study period were included. The size of pterygium was measured in millimeters. Pre-operative automated keratometry and corneal topography was done, and changes in astigmatism, surface asymmetry index, surface regularity index, uncorrected visual acuity and best corrected visual acuity were measured postoperatively on the 7th day. Paired sample t-test was applied between pre- and post-operative astigmatism, surface asymmetry index, surface regularity index, uncorrected visual acuity and best corrected visual acuity.
 Results: The mean age of participants was 42.02±13.3 years, with 22(42.3%) females and 30(57.7%) males. The male to female ratio is 1.36:1. The highest frequency of cases was noted in the age group, 31-50 years (42%), followed by 18-20 years (21%). Pterygium size was 2.25 to 4.10 mm, with a mean of 3.16±0.54mm. Pain and photophobia were noted in 5 cases. Pre- and postoperative comparison of astigmatism and corneal topography revealed a significant reduction in Surface Asymmetry Index and Surface Regularity Index values (p-value<0.001). Uncorrected Visual Acuity (p=0.002) and Best Corrected Visual Acuity also improved significantly after surgery (p=0.006).
 Conclusions: This study concluded that pterygium excision brings a significant decrease in astigmatism and reversible corneal topography changes.

Outcomes of Fibrin Glue for Graft Fixation in Primary Pterygium Surgery with Conjunctival Autograft

Objective: To evaluate the recurrence rate and postoperative complications of fibrin glue fixation of conjunctival autografts following primary nasal pterygium excision. Materials and Methods: The present study was a retrospective study of all eyes with primary nasal pterygium that underwent pterygium excision with conjunctival autograft transplantation using fibrin glue for graft fixation at Mettapracharak (Wat Rai Khing) Hospital between July 2017 and December 2018. The author analyzed pterygium recurrence rates and postoperative complications such as graft loss, graft displacement or dehiscence, pyogenic granuloma, or any other complications. Results: Fifty-seven eyes of 57 patients were evaluated, of which 43 (75.4%) were female. The mean age was 57.09±1.38 years (range of 34 to 80 years). No serious complications occurred. One eye (1.8%) sustained recurrence in the six months follow-up. All grafts were intact. Graft displacement requiring suturing occurred in three cases (5%). Graft dehiscence was observed in 29.8%, and in all cases epithelialized without intervention. Other postoperative complications included pyogenic granuloma in 3.5%, graft edema, subgraft hemorrhage in 21.1%, and elevation of intraocular pressure over 21 mmHg in 5.3%. Conclusion: Fibrin glue for fixation for conjunctival autografts after primary nasal pterygium excision is safe and effective. The most common complication in the present study was graft dehiscence, which did not require surgical intervention. Keywords: Conjunctival autograft; Fibrin glue; Pterygium recurrence rate; Graft dehiscence

Modified Limbal-Conjunctival Autograft Surgical Technique: Long-Term Results of Recurrence and Complications.

The aim of this study was to report the recurrence and complication rates of a modified limbal-conjunctival autograft surgical technique for pterygium excision. This was a retrospective, single-surgeon, single-operating environment, consecutive case series of 176 eyes in 163 patients with a biopsy-proven diagnosis of pterygium. All patients underwent excision using a 23-gauge needle to "behead" the pterygium head, followed by a limbal-conjunctival autograft including ∼50% of the palisades of Vogt. Outcomes measured included recurrence, defined as any conjunctival fibrovascular growth, and complication rates. Correlations between preoperative patient characteristics, pterygium morphology, and intraoperative factors (width of corneal extension, conjunctival defect, and graft) with postoperative recurrence were examined using logistic regression models. The median age was 59.5 years and 122 eyes (69.3%) had primary pterygium (type I: 17%, II: 37.5%, and III: 45.5%). Kaplan-Meier analysis demonstrated the median pterygium-free follow-up period to be 723 days (range 46-7230 days). Recurrence was observed in 3 eyes of 2 patients (1.7%). No postoperative graft-related complications were observed. Postoperative symptomatology was transient. Age demonstrated a negative correlation with recurrence (odds ratio 0.888, 95% CI, 0.789-0.998, P = 0.046). However, no other correlations with preoperative or intraoperative factors, including whether pterygium was primary or recurrent, were identified (all P > 0.05). This modified limbal-conjunctival autograft technique represents an effective alternative that offers a very low recurrence rate and avoids extensive dissection or antimetabolites, with minimal complications and transient postoperative symptomatology, over a long-term follow-up period. This technique is relatively simple and successful for both primary and recurrent pterygia. Future comparative studies with other surgical techniques may determine which are superior.

Successful Management of Extensively Drug Resistant Pseudomonas aeruginosa-Infectious Scleritis after Pterygium Surgery

ABSTRACT Introduction and purpose We report a case of extensively drug-resistant (XDR) Pseudomonas aeruginosa (PA) scleritis after pterygium surgery. Methods Case report. Results A 58-year-old farmer presented with a 40-day history of severe pain, swelling, and blurred vision after a pterygium excision was performed at another institute. The patient was on multiple medications with no relief. The examination showed a nasally located scleral thinning in his right eye, with ulceration and infiltrates. Microbiology revealed Pseudomonas aeruginosa, which showed intermediate sensitivity to colistin only. The patient was administered topical (0.19%) and intravenous colistin and dexamethasone. There was a rapid reduction in symptoms, and the lesions healed over the next 2 months. Conclusions To the best of our knowledge, this is the first case report of XDR-PA scleritis. We suggest the possibility of evolving drug resistance caused by the iatrogenic use of antibiotics during the early stages of the disease course.

Pterygium Excision with Application of Mitomycin C in Comparison to Sub-Pterygium Injection of Avastin without Excision

Pterygium Excision with Application of Mitomycin C in Comparison to Sub-Pterygium Injection of Avastin without Excision

Surgical Time and Postoperative Symptoms Study in Pterygium Excision and Amniotic Membrane Graft Using Celularity Triple Layer Dehydrated Amniotic Membrane.

To evaluate a novel sutureless glueless technique using a triple-layer dehydrated amniotic membrane (TLDAM) for pterygia excisions in surgical time, postoperative pain, epiphora, irritation, and FBS. Twenty eyes with pterygia underwent excision with mitomycin C. The conjunctival defect was closed with TLDAM placed on the dried scleral bed with the edges of the amniotic membrane tucked under the edges of the conjunctival defect. Surgical times were measured from injection of lidocaine to final placement of bandage contact lens. After a bandage contact lens was placed, the eye was patched until POD1. Patients graded self-administered questionnaires to rate pain, FBS, irritation, and epiphora on a scale of 1-5 (1-none; 5-severe) at POD1 and POW1. Surgical times ranged from 6:55 to 12:00, with mean of 8:29. Compared with a previous study of sutureless glueless methodology, the difference in mean surgical time was 11.9 (p < 0.0001). Mean questionnaire scores were as follows: POD1 pain 1.8, FBS 2.3, irritation 1.0, and epiphora 2.6; POW1 pain 1.5, FBS 1.6, irritation 1.6, and epiphora 1.6. Compared to previous studies, this technique showed significantly improved pain at POD1 (p=0.0086, p<0.0001, p<0.0001, p<0.0001) and POW1 (p=0.0002, p=0.0016, p<0.0001). Significant improvement in irritation and FBS was noted at POD1 and POW1. See Table 1 for full analysis. The sutureless glueless technique using TLDAM is a safe and effective technique compared to current standard methods. There appears to be a significant benefit regarding surgical time and postoperative pain, irritation, epiphora, and FBS compared to previous studies.

Comparison of efficacy and safety of sutureless glue-free versus suture technique for autogenous conjunctivolimbal grafting in primary pterygium excision

To compare the efficacy and safety of sutureless glue-free versus suture technique for autogenous conjunctivolimbal grafting in primary pterygium excision. A prospective observational study was conducted in thirty consecutive patients of primary progressive pterygium after taking their informed written consent and ethical clearance in a tertiary eye care centre of Northern India. Patients were randomly divided equally into group “A” and “B” each constituting fifteen patients. Group A patients underwent suture technique and group “B” patients underwent sutureless technique for conjunctivolimbal graft placement. Comparison of both groups was done in terms of intraoperative time, postoperative symptoms and recurrence over a period of one year. Data was compiled and entered into Microsoft Excel software and SPSS version 21.0 was used for data analysis.The mean duration of surgery was 42 min and 30 min in group A and B respectively and this difference was found to be statistically significant (p=0.0001). On 1 postoperative day, pain and foreign‐body sensation was present in 12 patients in group A, while only 1 patient of group B had these symptoms and this difference was statistically significant (p = 0.00014). Postoperative hyperaemia was seen in 8 patients of group A and 6 patients of group B which was statistically insignificant (p = 0.564). Only two patients in group A had conjunctival chemosis while no patients in group B developed chemosis, and the difference was statistically insignificant (p = 0.964). Subconjunctival haemorrhage was seen in 2 patients of Group A and 1 patient of Group B which resolved over a period of 2-3 weeks. Conjunctivolimbal graft was found to be more stable in group A while it was misplaced in 1 patient of group B and the difference was statistically insignificant (p = 1.000). Only 1 patient of group A developed suture related complication i.e suture granuloma. Over a period of 1 year follow up, only 1 patient of group A had recurrence of pterygium.Sutureless glue-free technique is a time saving, cost effective and better surgical modality in comparison to conventional suture technique for autogenous conjunctivolimbal grafting in primary pterygium resection.

The influence of pterygium on corneal densitometry evaluated using the Oculus Pentacam system.

To assess the effect of pterygium on corneal densitometry (CD) values. One hundred and nine patients (155 eyes) with primary pterygium were divided into a severe pterygium group (79 eyes) and a mild-to-moderate pterygium group (76 eyes) according to pterygium severity. Among them, 63 patients had monocular pterygium; and 25 patients (38 eyes) underwent pterygium excision combined with conjunctival autograft follow-up. A Pentacam anterior segment analyzer was used to obtain the CD values and corneal morphological parameters, including central corneal thickness (CCT), flat-axis keratometry (K1), steep-axis keratometry (K2), corneal astigmatism, irregular astigmatism, and spherical aberration. CD was subdivided into four concentric radial regions based on corneal diameter and three layers according to depth. CD values at 0-12 mm of the anterior 120 μm layer, 0-10 mm of the center layer and full thickness, and 2-6 mm of the posterior 60 μm layer were significantly higher in eyes affected by pterygium than in the contralateral unaffected eyes (all P < 0.05). CD values were significantly higher in the severe pterygium group than in the mild to moderate pterygium group (all P < 0.05). Corneal astigmatism, irregular astigmatism, K1, K2, CCT, and spherical aberration correlated with CD values in eyes with pterygium (all P < 0.05). CD values at 6-10, 0-12 mm in the anterior 120 μm layer and full thickness, 10-12 and 0-12 mm in the center layer were significantly decreased 1 month after pterygium surgery compared with those before surgery (all P < 0.05). Patients with pterygium had increased CD values, particularly in the anterior and central layers. CD values were correlated with pterygium severity grading and corneal parameters. Pterygium surgery partially reduced the CD values.

Comparison of the outcome of 0.02% mitomycine C versus limbal conjunctival autograft after primary pterygium excision.

Objective: is to compare the outcomes of mitomycin 0.02% intra-operatively and limbal conjunctival autograft after excision of primary pterygium. Methodology: Randomized controlled trial (RCT) was conducted at Opthalmology department Shalamar medical and Dental College, Lahore from October 2021 to September 2022 in duration of 1 year. A total of 62 patients enrolled in study. Patients were divided into two groups MMC and LCAG. Main variables of study were laterality of pterygium, size of pterygium cross limbus, preoperative and post operative BCVA and proportion of pterygium recurrence in both groups. SPSS version 24 was used for data analysis. Results: Laterality were right for 48.4% patients in Group MMC and 58.1% for Group LCAG, (p=0.445). The average Size of pterygium cross limbus, Preoperative and postoperative BCVA of both the groups were almost equal, (p&gt;0.050). The recurrences at 3, 6 &amp; 9 months and after 1 year in Group MMC was 12.9%, 6.5%, 16.1%, 9.7%, 45.2% which is greater than Group LCAG 9.7%, 9.7%, 3.2%, 6.5%, 29% respectively, but the difference was statistically insignificant, (p=0.526). Conclusion: Limbal conjunctival autograft is more successful in prevention of recurrence after excision of primary pterygium as compare intraoperative application of mitomycin-c. But simple excision and LCAG or MMC both are acceptable in terms of minor difference in recurrence rate, surgeon’s skill and preferences of local practice are main risk factors.

Incidence and risk factors of steroid-induced ocular hypertension following pterygium excision with conjunctival autograft

Background: Topical steroids are used to reduce post-operative inflammation after ocular surgery with the potential risk of ocular hypertension, glaucoma and blindness. There is a paucity of published data globally and locally on steroid-induced ocular hypertension (SiOH) post pterygium excision(PE) with conjunctival autograft (CAG). Objective: We aimed to determine the incidence and risk factors of SiOH post-PE with CAG in Korle-Bu Teaching Hospital, Accra, Ghana. Methods: In this prospective observational study, the demographic and clinical data of patients undergoing PE with CAG were collected and analyzed. Post-operative intraocular pressures (IOP) were measured on days 1, 7, 14, 28, and 42. The cumulative incidence of SiOH (proportion of the increase in IOP ≥10mmHg at six weeks compared to baseline) and mean change in IOP from baseline were computed. Risk factors of SiOH were determined using a multiple logistic regression model. The Kaplan-Meier survival curve was used in estimating the median time to develop SiOH. Results: Overall, 101 patients participated in this study with a mean age of 46.8±11.9 years. The majority (65.3%, n= 66/101) of participants were females. The mean pre-operative IOP in the study eyes was 15.3±3.0 mmHg. The overall mean post-operative IOP was 18.6±2.8 mmHg (p= 0.001). The overall incidence of SiOH six weeks post-PE with CAG was 32.7% (95% confidence interval (CI)= 23.7-42.7%). Male sex was the only independent factor associated with the development of SiOH [odds ratio (OR) = 3.3; 95% CI = 1.1-9.7; p= 0.032]. The median time to develop SiOH was 42 days (95% CI= 37.1-46.9 days, p= 0.022). Conclusion: The study showed that SiOH post-PE is a common complication with an overall six-weeks post-excision incidence of 32.7%. Males are more likely to develop SiOH after PE with CAG. Patients undergoing PE with CAG should be closely monitored postoperatively to prevent complications associated with prolonged raised IOP.

Suture and glue-free autologous graft for pterygium surgery

Of various techniques of pteryium surgeries to prevent recurrence, conjunctival limbal auto graft has been the most successful adjuvant since the studies have shown the role of limbal stem cell deficiency (LSCD) as pathology of pterygium. The most common method of auto-graft fixation post pterygium excision is suturing; with drawbacks of prolonged operating time and postoperative discomfort. Replacing sutures with tissue adhesives may shorten the operating time, improve postoperative comfort; however, the major concern of the commercial fibrin glue is the cost and the potential risk of transmission of infection.To study, 1. The efficacy and complications of suture free and glue free conjunctival-limbal auto-graft for the management of pterygia, 2. The outcome of surgeries by two different qualified surgeons Prospective, interventional case study of 108 consecutive cases of pterygia that had excision with conjunctival-limbal auto-grafting without using glue or sutures. The operated eye patched for a day and followed up on day 1, 3 and 7, 6 weeks and 6 months; watched for hemorrhage beneath the graft, graft retraction, chemosis, recurrence or any other complication. The mean age of the patients was 40.7 years (range, 25 – 68 years) with female preponderance (60.2%) and nasal pterygia in 65.7 %. Not a single graft was dislodged and none had recurrence in the follow up period of 9-20 months. Graft retraction occurred in 7 cases (6.5%) and one patient had sub-graft hemorrhage which lasted for nine days. 76.9% had no discomfort even in immediate post-operative period. The results were comparable among patients of both the surgeons.Suture- and glue-freelimbal conjunctival auto-grafting following pterygium excision is a safe, effective and economical option for the management of both primary and recurrent pterygium. Learning curve is short and consistently similar results possible in different hands.

Multi-drug resistant Klebsiella-induced corneal ulcer following pterygium surgery: a case report

BackgroundManagement of pterygium is dependent on the grading of pterygium and its clinical presentation (inflamed or quiescent), and surgical excision is the final choice of treatment for the pterygium extending beyond the limbus. Infectious keratitis is one of the most commonly reported complications in recent years. To the best of our knowledge, Klebsiella keratitis after pterygium surgery has not been described in the current literature. Here, we report a patient with corneal ulcer formation following pterygium surgical excision.Case presentationA 62-year-old woman presented with complaints of pain, blurred vision, photophobia and redness in her left eye for a month. She had a history of pterygium surgical excision two months ago. Slit-lamp examination showed conjunctival congestion, a central whitish corneal ulcer with a central epithelial defect, and hypopyon. Corneal scraped sample revealed multidrug resistant (MDR) Klebsiella pneumonia and the strain was found to be sensitive to cefoxitin and ciprofloxacin. Intracameral cefuroxime (1 mg/0.1 mL) injection, fortified cefuroxime ophthalmic suspension (50 mg/mL) and moxifloxacin ophthalmic suspension (0.5%) were successfully administered to control the infection. Since residual central stromal opacification remained persistent, final visual acuity did not improve beyond finger counting at two meters.ConclusionsKlebsiella keratitis is a rare and sight-threatening complication following pterygium excision. This report emphasizes the importance of close follow-up examination following pterygium surgeries.

Morphology of pterygium

This article details the morphology of pterygium, eastern regional eye care program in eastern Nepal, surgical steps for pterygium removal, amniotic membrane transplantation, procedure pterygium excision with conjunctival autograft.

Doubt flap technique in pterygium surgery

Background: A pterygium is a triangular fibrovascular sub-epithelial ingrowth of degenerative bulbar conjunctival tissue over the limbus onto the cornea. The mainstay of treatment is surgery with more measures to decrease the recurrence rate. Pterygium doesn’t need intervention unless there is an extension of the lesion towards the center of the cornea and it encroaches on the visual axis, or is symptomatic in terms of redness and discomfort. Objective: To present a new surgical technique for managing primary pterygium. We aim to find a more effective method than the one previously used. We wanted to demonstrate and prove that this technique has low recurrence rates. Patients and Methods: A Hospital-based interventional case series study, sampling done by simple random sampling from the outpatient departments. The study was conducted in the ophthalmology department of Erbil teaching hospital in Erbil city for eight months from August 2021-April 2022. In the current study 40 patients with pterygium were operated that they were attending the ophthalmology department in this hospital. Results: The result revealed 3 cases of recurrence of 7.5% out of 40 cases using a dual flap technique as a new approach for treating pterygium in the follow-up of 3 months, in which the mean ± SD of age was 46.3 ± 10.537 years. Twenty four cases were female, and 16 were male; all of the lesions were nasally located pterygium. In the sample we used in the study 5 patients had had pterygium excision using other techniques in the past at least once, and neither of them recurred utilizing this approach. Conclusion: The double flap is a proper alternative technique in pterygium surgery; this new procedure, dual conjunctival flap with 7.5% recurrence rates and provides safe and comparable results to current methods.

Doubt flap technique in pterygium surgery

Background: A pterygium is a triangular fibrovascular sub-epithelial ingrowth of degenerative bulbar conjunctival tissue over the limbus onto the cornea. The mainstay of treatment is surgery with more measures to decrease the recurrence rate. Pterygium doesn’t need intervention unless there is an extension of the lesion towards the center of the cornea and it encroaches on the visual axis, or is symptomatic in terms of redness and discomfort.&#x0D; Objective: To present a new surgical technique for managing primary pterygium. We aim to find a more effective method than the one previously used. We wanted to demonstrate and prove that this technique has low recurrence rates.&#x0D; Patients and Methods: A Hospital-based interventional case series study, sampling done by simple random sampling from the outpatient departments. The study was conducted in the ophthalmology department of Erbil teaching hospital in Erbil city for eight months from August 2021-April 2022. In the current study 40 patients with pterygium were operated that they were attending the ophthalmology department in this hospital.&#x0D; Results: The result revealed 3 cases of recurrence of 7.5% out of 40 cases using a dual flap technique as a new approach for treating pterygium in the follow-up of 3 months, in which the mean ± SD of age was 46.3 ± 10.537 years. Twenty four cases were female, and 16 were male; all of the lesions were nasally located pterygium. In the sample we used in the study 5 patients had had pterygium excision using other techniques in the past at least once, and neither of them recurred utilizing this approach.&#x0D; Conclusion: The double flap is a proper alternative technique in pterygium surgery; this new procedure, dual conjunctival flap with 7.5% recurrence rates and provides safe and comparable results to current methods.