Pterygium Surgery Research Articles

A New Approach: Determination of the Safe Surgical Margin in Pterygium Surgery.

In this retrospective study, we aimed to determine the safe surgical limit for excision of pterygium tissue. Therefore, we aimed to prevent excessive or incomplete normal conjunctival tissue excision during surgery in the coming years. Autografted pterygium surgery was performed between January 2015 and April 2016, and the excised pterygium tissue was examined histopathologically. The files of 44 patients, who had not previously undergone any ocular surgery, who did not have an inflammatory disease and who continued to be checked for at least 1 year, were retrospectively examined. The distance (P-DSEM) from the excised pterygium tissue to the surgical excision margin was measured by a pathologist. Postoperative recurrence rates were evaluated according to this value. In this way, the clean surgical margin was determined. The mean age of the participants was 44.77 ± 12.70, and the mean follow-up time was 55.61 ± 16.38 months. Recurrence developed in 5 out of 44 patients (11.4%). The average recurrence duration was 51 ± 13.87 days. Distance to the average surgical margin was 3.88 ± 0.91 mm. The surgical distances of 5 patients with recurrence were 2, 2.5, 2, 3, and 3 mm, respectively. It was determined that recurrence was less as the distance (P-DSEM) from the tissue to the surgical excision margin increased (p = 0.001). We found that the recurrence rate in pterygium surgery was linked to the clean surgical margin. When planning pterygium surgery, we believe that determining the amount of tissue to be excised before surgery will reduce recurrence rates.

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.

A comparative study on the use of fibrin glue versus sutures in pterygium surgery with conjunctivolimbal autograft and its impact on higher-order aberrations

A comparative study on the use of fibrin glue versus sutures in pterygium surgery with conjunctivolimbal autograft and its impact on higher-order aberrations

Results of Fibrin Glue Applied Over the Corneal Surface Immediately After Pterygium Surgery: A Novel Pain Relief Technique.

The aim of this study was to compare the use of fibrin glue on the corneal epitheliectomy site at the end of pterygium surgery versus conventional eye patch regarding pain levels, need for oral analgesic medications, number of days feeling pain, and awakening due to pain after surgery. Forty-eight eyes of 24 patients with bilateral primary pterygium were included in this prospective, randomized, double-masked controlled trial. Each eye of the same patient was randomized to the intervention or control group. The intervention group received 2 drops of fibrin glue in the epitheliectomy site at the end of surgery and an eye patch, whereas the control group was only received an eye patch. Patients returned on the first and seventh days after surgery. Pain intensity (measured using the visual pain analog scale), need for oral analgesics, the number of days the pain lasted, and quality of sleep were assessed during follow-up visits and compared between groups. Comparison analysis accounted for sex, age, pterygium grading, and comorbidities. Visual analog pain scale after surgery was significantly lower in eyes receiving fibrin glue (-1.58; 95% confidence interval: -2.84 to -0.32; P = 0.014). In addition, the intervention group presented a 73% lower chance of using oral analgesics (OR: 0.27; 95% confidence interval: 0.07-0.95; P = 0.041). No difference in the awakenings at night was noted (P = 0.240) nor the mean days of ocular pain in the first week after surgery (P = 0.474). Fibrin glue at the end of pterygium surgery effectively reduces pain and the need for oral analgesics compared with conventional eye patching. This study is the first to describe the results of this strategy.

Результаты амниопластики с применением двухкомпонентного аутофибринового клея при хирургическом лечении птеригиума

The only effective way of pterygium treatment is its removal with defect plasty by different tissues, including amniotic membrane. The choice of fixation method that will ensure maximum efficiency and minimize recurence risk remains actual. Using sutures increases operation time and leads to discomfort of patient in postoperative period. A comparative analysis of effectiveness of surgical treatment using designed by us two-component autofibrin glue and sutures for fixing the amniotic membrane was done. The study included 32 patients, they were divided into 2 groups depending on the method of fixing the amniotic membrane: the 1st group was the main group (22 patients), where the amniotic membrane was fixed with a two-component autofibrin glue, the 2nd group (10 patients) was the control group, where the sutures were used. Before and after surgery all patients underwent biomicroscopy and optical coherence tomography of the anterior segment, the groups were compared by the time spent on the operation, duration of epithelization and rehabilitation, as well as presence of discomfort in postoperative period. The presence of pterygium recurrence in the study groups was assessed during 12-month observation. During our study we found statistically significant differences between groups, which show the advantages of fixing amniotic membrane with two-component autofibrin glue. During 12-month observation one case of recurrence was fixed after using fixation by sutures. This makes possible to choose two-component autofibrin glue as a fixation method of amniotic membrane in pterygium surgery. Keywords: pterygium, autofibrin glue, surgical treatment, amniotic membrane, fixation

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.

Snatching: A modified cosmetic technique in pterygium surgery without using scalpel

To evaluate the cosmetic surgical outcomes of primary corneal pterygia excision using the avulsion (snatching) technique. A prospective, interventional study included twenty-five eyes of 25patients with primary pterygium underwent excision were followed up for at least 6months. In all patients, snatching (modified avulsion) technique was utilised to avulse the pterygium head off the corneal surface and remove any residual fibres by Colibri without need for keratectomy with a scalpel. The study involved 25eyes of 25patients with an average age of 42.5±56.5years. The mean follow-up was 6months. One-week post-op, 8patients (32%) reported they can tell which is the operated eye but looked untouched while 17 (68%) patients reported that the operated eye looked red but is accepted. Twenty patients (80%) reported some discomfort while the remaining 5patients (20%) reported no discomfort. Cornea examination showed a clear cornea in 18eyes (72%), 6eyes (24%) had mild keratitis, and 1 eye (4%) had clouding at the surgical site. Over an average of six months post-op follow-up period, all the patients (100%) reported they cannot tell which eye had the surgery and none (0%) of them reported discomfort. Examination of the cornea was clear in 24 (96%) eyes, but 1 (4%) eye had mild keratitis. Snatching (modified avulsion) technique was found to be effective, safe, and presents decent aesthetic appearance for the management of primary corneal pterygia when safety points are firmly followed.

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.

An unusual case of herpes simplex keratitis presenting as persistent epithelial defect after pterygium surgery

Pterygium is a common conjunctival degeneration and surgical excision is the mainstay of treatment. HSV keratitis after ocular surgery has been attributed to various factors including reactivation of latent infection secondary to surgical trauma to the corneal subepithelial nerve plexus and the modulation of the ocular immune response in the postoperative period caused by steroids. In the current case, the patient had persistent epithelial defect which was non responsive to routine topical lubricant therapy and showed a classical dendritic ulcer pattern upon staining with fluorescein dye. Upon initiation of conventional anti-viral therapy, the patient improved and the epithelial defect was gradually healed. HSV keratitis can rarely present as a non-healing epithelial defect after pterygium surgery and a close follow-up in the post-operative period, timely diagnosis and prompt antiviral therapy plays an important role in achieving a favourable clinical outcome in such cases.

A STUDY ON EFFECT OF PTERYGIUM EXCISSION ON PTERYGIUM INDUCED ASTIGMATISM

Purpose: Methods: To determine the effect of pterygium excision on pterygium induced astigmatism. A statistical comparison of the refractive astigmatism before and after effective pterygium surgery was done on 30 patients who underwent preoperative and postoperative refraction testing. pterygium surgery caused si Results: gnicant improvements in visual acuity, with the rule astigmatism. The corneal astigmatism tended to decrease s Conclusion: ignicantly following pterygium excision with conjunctival limbal autograft transplantation.

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.

Epidemiologic characteristics and the change of surgical methods of pterygium and pseudopterygium from 2013 to 2019 in China: A retrospective analysis

IntroductionPterygium is a common multifactorial external eye disease, which causes various ocular symptoms and negatively affects appearance. The aim of this study was to analyze the epidemiological characteristics and the change of surgical methods of pterygium and pseudopterygium in China from 2013 to 2019. Materials and methodsThis study was a hospital-based nationwide retrospective study to estimate the epidemiologic characteristics and the change of surgical methods of pterygium and pseudopteygium in China from 2013 to 2019. The data was extracted from the Hospital Quality Monitoring System (HQMS) database. The diagnosis was based on the tenth revision of the International Classification of Diseases (ICD-10) code. ResultsOur study included 1,007,800 pterygium and 2,681 pseudopteygium inpatients. From 2013 to 2019, the proportion of pterygium and pseudopterygium patients who underwent surgery, among all ophthalmology inpatients, increased from 3.3% in 2013 to 7.84% in 2019. The male-female ratio of surgically treated pterygium and pseudopterygium is 1:1.8 and 1.6:1 respectively. Among all age groups, the hospitalized pterygium patients who received surgery were mainly 60–69 years old, accounting for 36.53%. The pseudopterygium patients who received surgery were mostly 50–59 years old, accounting for 24.02%. Among the 31 provinces of mainland China, Yunnan Province has the highest proportion of pterygium patients treated surgically (6.40%), while Shanghai has the highest proportion of pseudopterygium patients treated surgically (12.98%). The most common occupation of participants in the study was farmer, accounting for 47.62% and 28.53%, respectively. During the study period, the application of autologous stem cell transplantation increased year by year, and became the first choice for pterygium and pseudopterygium surgery. DiscussionThis study was the first to describe the epidemiological characteristics and surgical methods of hospitalized pterygium and pseudopterygium patients in China. This study provides important information for better diagnosis, treatment and prevention of pterygium and pseudopterygium.

Conjunctival and Limbal Conjunctival Autograft vs. Amniotic Membrane Graft in Primary Pterygium Surgery: A 30-Year Comprehensive Review.

The purpose of this study is to compare the "real-life" effectiveness of amniotic membrane graft (AMG) and conjunctival (CAT) or limbal conjunctival (LCA) autograft in the management of primary pterygium. Human-based studies on primary pterygium surgery that were published between 1993 and 2022 with at least 3months of follow-up were identified, and only those that were retrospective were included. The global recurrence rate of pterygium was assessed for each surgical technique separately. Specific recurrence rates taking into consideration the fixation technique (glue versus sutures) were also measured. 35 real-life retrospective subgroups comprising a total of 3747 eyes were included in the final review. The mean global recurrence rates for CAT, LCA and AMG were 7.61%, 5.50% and 9.0%, respectively. Recurrences were less common for patients who received fibrin glue (5.92%, 2.56% and 3.60%) than for those who received sutures (8.99%, 6.03% and 23.0%) for the three groups, respectively. Surgical techniques combining CAT or LCA with AMG yielded an even lower global recurrence rate (1.83%). AMG seems like a reasonable option that could be considered in primary pterygium surgery, especially when glued to the underlying sclera. Combining AMG with other treatment modalities such as CAT or LCA seems to offer an interesting alternative in terms of recurrence.

Surgical application of Ong speculum in simple limbal epithelial transplantation and pterygium surgery.

Ong speculum is used in glaucoma surgeries such as trabeculectomy to expose the superior part of the globe. The large inferior blade pushes the inferior conjunctival fornix, due to which the eyeball rotates downwards. It has not been used in other anterior segment surgeries before. We used this speculum in simple limbal epithelial transplantation (SLET) and pterygium surgery to expose superior bulbar conjunctiva for harvesting limbal and conjunctival grafts, respectively. As the superior conjunctiva and sclera become exposed, it facilitates the steps of harvesting limbal biopsy and conjunctival graft in SLET and pterygium surgery. This eliminated the need for a superior rectus suture or an assistant who would keep the globe rotated downwards. Its position could also be maneuvered to adjust the site of exposure when dissecting the area of pannus in SLET. Thus, it makes the superior conjunctiva more accessible.

Pterygium surgery with lyophilized versus cryopreserved amniotic membrane graft

To evaluate surgical outcomes (recurrence rate, aesthetics and symptoms) of pterygium surgery with two different amniotic membrane preservation approaches - lyophilized (LAM) and cryopreserved (CAM). Primary pterygium patients were randomized to either LAM or CAM surgery. Demographic data, ocular surface disease index (OSDI), aesthetic grading (1 to 4), recurrences and complications were recorded over a 6-month follow-up period. Twenty-nine patients were recruited. Recurrence at month 6 was detected in 11 cases (37.9%) and was more prevalent with CAM grafts, without reaching statistical significance (P=0.196). Aesthetic outcome grading showed no differences between LAM and CAM at month 6 (P=0.124). Aesthetic results were mostly unsatisfactory (grade 3 and 4) without statistical differences between groups (P=0.514). Baseline OSDI was similar in both groups (P=0.888), and it significantly decreased by the last follow-up visit (P<0.001) for both the LAM and CAM groups. This decrease did not significantly differ between amniotic membrane preservation approach surgery groups (P=0.714). LAM might be considered a legitimate alternative to CAM, showing no inferiority in outcomes, since clinical and aesthetic outcomes were similar for both groups.

FIBRIN GLUE VERSUS AUTOLOGOUS BLOOD FOR FIXATION OF CONJUNCTIVALAUTOGRAFT IN PTERYGIUM SURGERY

Purpose: To compare mean surgical time and graft outcomes following pterygium excision and conjunctival autograft xation using patient's in situ autologous blood or standard brin glue-assisted conjunctival autograft adhesion. Methods: Outcomes of 44 eyes which underwent pterygium excision and conjunctival autograft with autologous blood (group I) were compared with 41 eyes that underwent brin glue-assisted conjunctival autograft (group II). Average time required for surgery and graft behaviour was noted in subsequent follow ups over 3 months. Results were compared between both groups. Results: The two groups were similar regarding age and gender. Mean surgical time required for group II was signicantly higher than that of group I (23.00 ± 1.71 min, group I; 26.37 ± 3.73 min, group II; P-value&lt;0.001). Graft behaviour was analysed by noting incidence of graft edema, graft retraction, subconjunctival haemorrhage and recurrence at the end of 3 months. Incidence of graft edema at day 1, day 3 and day 7 did not differ signicantly between two study groups (P-value&gt;0.05). Postoperatively, subconjunctival haemorrhage was seen in 54.5% and 53.7% cases in group I and group II respectively. At the end of day 21, none of the cases from either groups had any signicant graft edema or subconjunctival haemorrhage. Incidence of graft retraction at day 1 and day 3 was signicantly higher in Group I as compared to Group II (P-value&lt;0.05 for all). However, none of the cases required any intervention for the same. No cases of graft loss or graft granuloma formation were noted in either groups in all the follow-ups. Recurrence rates of 2 cases (4.5%) and 3 cases (7.3%) were seen in group I and group II respectively at the end of 3 months. Conclusion: The technique employing the use of autologous blood for conjunctival autograft xation in pterygium surgery has provided safe and comparable results to brin glue. In terms of recurrence also, autologous blood is not inferior to brin glue in pterygium surgery. Autologous blood can be an excellent replacement for brin glue

Role of polymerase chain reaction-based viral detection in pterygia.

Pterygium is a fibrovascular disease that originates in the conjunctiva and commonly spreads to the corneal surface, thereby posing a threat to eyesight. Despite intensive research, the pathophysiology of this disease remains unclear. Recent research suggests that oncogenic viruses, such as human papillomavirus (HPV), cytomegalovirus, and Epstein-Barr virus (EBV), may play a role in pterygia development. Although there are questions concerning the function of oncogenic viruses in pterygium pathogenesis, existing research shows a lack of consensus on the subject, demonstrating the heterogeneity of pterygium pathophysiology. Therefore, we aimed to simultaneously detect the three common viral pathogens that have been reported in pterygium tissue obtained after excision. Thirty-five tissue specimens of pterygium from patients undergoing pterygium surgery (as cases) were analyzed for evidence of viral infection with multiplex polymerase chain reaction (PCR), and virus-specific real-time quantitative PCR was used for the samples that were detected positive by multiplex PCR. Of the 35 patients, one sample was positive for EBV and two samples were positive for HPV. Further PCR-based DNA sequencing of the HPV PCR-positive product showed identity with HPV-16. Real-time quantitative PCR on samples that showed EBV or HPV positivity did not yield any detectable copy number. Our study results confirmed that PCR positivity could be due to transient flora, but it was not quantitatively significant to conclude as the causative factor of pterygium pathogenesis. However, additional studies with larger sample populations are warranted to fully determine the role of the virus in pterygium.

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 .