Recurrent Pterygium Research Articles

Interleukin-17 and its correlation with vascular endothelial growth factor expression in ocular surface pathologies: a histologic study.

Interleukin-17 (IL-17), a cytokine that was recently associated with various inflammatory processes, was evaluated in ocular surface inflammatory pathologies, namely pterygium and inflamed juvenile conjunctival nevus (IJCN). Its expression was examined in correlation with vascular endothelial growth factor (VEGF) expression. Expression of IL-17 and VEGF was immunohistochemically evaluated in 50 pterygia and 9 IJCN specimens. The pattern of IL-17 and VEGF expression was studied as well as the correlation between the 2 cytokines. Interleukin-17 was expressed in all IJCN samples and in 84% of pterygia (Fisher exact test, p<0.002). In pterygium, it was expressed mainly in the basal layer of the epithelial cells, in the perivascular tissues, and in the vascular endothelial cells. In IJCN, it was mainly expressed in the inflammatory infiltrate. In normal conjunctival epithelium, it was barely detected and was positive in only 11%. Vascular endothelial growth factor was expressed in all IJCN samples and in 92% of pterygia (Fisher exact test, p<0.002). It was expressed in the surface epithelial layers of the pterygium and in the vascular endothelium. In IJCN, it was again seen in the vascular endothelial cells and in the inflammatory infiltrate. Vascular endothelial growth factor expression was noted in 67% of normal conjunctival sections. The present study describes the expression of IL-17 in pterygium and in IJCN. These findings provide new insights into pterygium and IJCN pathogenesis. Interleukin-17 blockade may have a potential role in management of pterygium and IJCN or preventing pterygium recurrence.

Corneal Wavefront Aberrations After Primary and Recurrent Pterygium Surgery.

To evaluate the effect of primary and recurrent pterygium surgery on corneal wavefront aberrations. This prospective and interventional study included the 47 eyes of 47 patients with primary pterygium (primary group) and 41 eyes of 41 patients with recurrent pterygium (recurrent group). All patients underwent pterygium excision with conjunctival autograft transplantation. Corneal wavefront aberrations were measured using Sirius corneal topography and aberrometry system (Costruzione Strumenti Oftalmici, Florence, Italy) before surgery and at 3 and 12 months after surgery. The main outcome measures were root mean square values of total wavefront error (WFE), higher-order aberrations (HOAs), coma, trefoil, and spherical aberrations. Corneal wavefront aberrations were not significantly different between the primary and recurrent groups at baseline (P>0.05). Total WFE, HOA, trefoil, and coma decreased significantly in both primary and recurrent groups at postoperative 3 and 12 months compared with preoperative measurements (P<0.05). The mean spherical aberration was not significantly changed at 3 and 12 months compared with preoperative measurements (P>0.05). Total WFE, HOA, trefoil, and coma were significantly higher in the recurrent group than in the primary group at postoperative 3 and 12 months (P<0.05). Pterygium surgery can significantly reduce corneal wavefront aberrations, including total WFE, HOA, trefoil, and coma in eyes with primary or recurrent pterygium. However, postoperative corneal aberrations were higher in the recurrent group than in the primary group.

Bare sclera resection followed by mitomycin C and/or autograft limbus conjunctiva in the surgery for pterygium: a Meta-analysis.

To evaluate the recurrence and complications after bare sclera resection (BSR) combined with mitomycin C (MMC) treatment and/or autograft limbus conjunctiva (ALC) in the surgery for pterygium. Meta-analysis was used to evaluate the differences in patient outcomes between BSR of pterygium with or without MMC and/or ALC. All included studies were randomized trials of patients with pterygium who received BSR followed by MMC and/or ALC in the surgery. The recurrence of pterygium and other complications resulting from different treatments were extracted for analysis. Thirteen studies met the inclusion criteria. The recurrence of pterygium with intraoperative (IO) MMC was higher than that with ALC (OR=2.38, 95% confidence interval 1.45-3.91, I (2)=29%). Postoperative MMC resulted in an incidence of recurrence similar to that of ALC (OR=0.66, 95% confidence interval 0.30-1.42, I (2)=0%), and IO MMC treatment in combination with ALC produced similar patient outcomes to ALC alone (OR=0.41, 95% confidence interval 0.16-1.01, I (2)=16%). Other complications such as punctate epitheliopathy, scleral thinning and ischemia, irritation and persistent epithelium defect, were more common in patients in the MMC group as compared to those treated with ALC. The recurrence of pterygium with BSR followed by ALC is lower than that of BSR followed by MMC, and the incidence of other complications is lower. While ALC is a more effective strategy for treating pterygium, the quality of the ALC transplant should be considered when the patient has a history of glaucoma.

Prevention of Recurrent Pterygium with Topical Bevacizumab 0.05% Eye Drops: A Randomized Controlled Trial

PurposeWe assessed the efficacy and tolerability of topical bevacizumab 0.05% when used as an adjunctive therapy after excision of primary pterygia. MethodsThis randomized double-masked study included 22 patients (22 eyes) with primary pterygia who underwent pterygium surgery with the use of the bare sclera technique. After pterygium excision, 22 patients were randomized to receive the topical bevacizumab 0.05% (12 eyes) or the placebo (10 eyes) with the use of the block of four randomization method. Topical bevacizumab and placebo were applied in the respective groups 4 times daily for 3 months. Follow-up evaluations for recurrence by slit-lamp photography were conducted once monthly. Ocular and systemic adverse events were assessed every 2 weeks during the 3 months of treatment. The slit-lamp photographs were masked and analyzed. The primary and secondary outcomes were the differences in the pterygial recurrence rates between the groups and adverse events at 3 months, respectively. Corneal recurrence was defined as recurrent fibrovascular tissue invading the cornea; conjunctival recurrence was defined as either recurrent vessels or fibrous tissue in the excised area without corneal invasion. FindingsAll 22 patients completed follow-up at 3 months after the start of the trial medications. After 3 months of treatment, 1 patient (8.33%) and 3 patients (30.00%) from the bevacizumab and placebo groups, respectively, had a corneal recurrence. No significant (P = 0.293) differences were found between the groups as determined by Fisher’s exact test. However, conjunctival and corneal recurrences were found in 4 (33.33%) and 9 (90.00%) patients, respectively, in the bevacizumab and placebo groups, a difference that reached significance (P = 0.01). No significant adverse events developed. ImplicationsTopical bevacizumab, as an adjunctive treatment after pterygium excision, was well tolerated. The trend for recurrence was lower in the topical bevacizumab group. ClinicalTrials.gov identifier: NCT01311960.

In vitro study of cyclosporine A 0.05% on primary and recurrent pterygium fibroblasts.

To compare the cyclosporine 0.05% exposure effect on fibroblasts from primary and recurrent pterygium. Primary culture of fibroblasts from primary and recurrent pterygium was performed until the third passage, which was exposed to cyclosporine 0.05% in a group and the other remaining unexposed (control group), in triplicates. After 3, 6, 12, and 17days of exposure the viable cell counting was performed by hemocytometer. The results were statistically analyzed using the technique of analysis of non-parametric variance model for repeated measures with three factors. There was a significant reduction in both fibroblast proliferation, in primary as in the recurrent pterygium cultures exposed to cyclosporine when compared not exposed cultures, with statistical significance (P<0.05). Comparing primary and recurrent pterygium that received the drug, there was no significant difference in cell proliferation in relation to primary or recurrent pterygium. Cyclosporine 0.05% is effective in inhibiting fibroblast proliferation in culture, both in primary and as in recurrent pterygium.

Fibrin glue versus autologous blood for conjunctival autograft fixation in pterygium surgery

ObjectiveTo compare the outcomes between autologous blood- and fibrin glue–fixated conjunctival autografts in pterygium excision surgery. DesignRetrospective case series. ParticipantsForty eyes of 40 patients who had a primary nasal pterygium excision. MethodsA retrospective comparative case series of 40 eyes (40 patients) that had a primary nasal pterygium excision. All eyes had a conjunctival autograft from the superior bulbar conjunctiva to cover the scleral bed. Twenty eyes (20 patients) had fixation of the autograft using autologous blood (AB), and 20 eyes (20 patients) had fixation using fibrin glue (FG). One year of follow-up data included conjunctival graft stability (graft loss, graft retraction), pterygium recurrence, visual acuity, and postoperative complications. Descriptive and inferential statistics were performed. ResultsIntraoperatively, no complications occurred in either group. Graft loss occurred in 6 patients in the AB group, compared with none in the FG group. Graft retraction occurred in 3 patients in the AB group and 2 patients in the FG group. At 1 year postoperatively, pterygium recurrence occurred in 4 patients in the AB group and 1 patient in the FG group. One patient in the AB group developed a small pyogenic granuloma that resolved by 6 months with conservative management. Visual acuity remained stable in both groups. ConclusionsConjunctival autograft fixation with autologous blood resulted in less stable conjunctival autografts and a higher recurrence rate compared with fixation with fibrin glue.

Outcome of Conjunctival Autograft in Pterygium Surgery

This Prospective study is designed to investigate the efficacy of conjunctival autograft in surgical management of primary pterygium. The study was conducted at Tairunnessa Memrial Medical College and Hospital, Targach, Board bazar,Tongi, Gazipur and Kushtia General Hospital from July 2012 to June 2013. Fifty eyes with primary pterygia were selected for the study.Ptergium was graded depending on the extent of corneal involvement. We excluded the patients with recurrent pterygium, double headed pterygium, dry eye and history of previous intraocular surgery from our study. The mean patient age at the time of surgery was 41.9±8.1 years ranged from 30 to 60 years.The excision of pterygium with conjunctival autograf was done under peribulbar anaesthesia using 8-0 virgin silk.Then the patients were followed up for 12 months. The excision of pterygium with conjunctival auto graft was done by applying same technique. All grafts were intact during the follow up period. There is recurrence in three patients that becomes evident within first three month. Conjunctival autograft is a effective surgical technique for the treatment of pterygium.It is safe and uncomplicated procedure and prevents the recurrence of pterygium. It also reduces the risk of granuloma formation, scleral thinning and necrosis.Medicine Today 2014 Vol.26(2): 75-77

Clinical analysis of risk factors contributing to recurrence of pterygium after excision and graft surgery.

To find the risk factors related to the reproliferation of the pterygial tissue after excision and graft surgery. Charts of 130 eyes of 130 patients who had pterygial excision from March 2006 to April 2011 were reviewed. Preoperative pterygium morphology, surgical methods, and adjunctive treatments were statistically analyzed for their relationship with recurrence. During the follow-up period, recurrence was observed in 20 eyes (15.4%). None of the preoperative morphologic features were affected the rate of the recurrence. However, an age < 40y [P =0.085, odds ratio (OR) 3.609, 95% confidence interval (CI) 0.838-15.540] and amniotic membrane graft instead of conjunctival autograft (P =0.002, OR 9.093, 95% CI 2.316-35.698) were statistically significant risk factors for recurrence. Multivariate analysis revealed that intraoperative mitomycin C (MMC) (P=0.072, OR 0.298, 95% CI 0.080-1.115) decreased the rate of recurrence. Younger age is a risk factor for reproliferation of pterygial tissue after excision and amniotic membrane transplantation (AMT) are less effective in preventing recurrence of pterygium after excision based on the comparison between conjunctival autograft and AMT. Intraoperative MMC application and conjunctival autograft reduce recurrence.

Sealing of the Gap between the Conjunctiva and Tenon Capsule to Improve Symblepharon Surgery

To report the surgical outcome of "sealing the gap" in treating symblepharon caused by various etiologies other than recurrent pterygium. Retrospective, interventional case series. Sixteen eyes of 14 patients with pathogenic symblepharon were consecutively operated by conjunctival recession, sealing the gap between recessed conjunctiva and Tenon capsule with a running 9-0 nylon suture, and covering of the bare sclera with amniotic membrane. For severe symblepharon where there was conjunctival shortening, oral mucosa graft was added. Outcome measures include ocular surface inflammation, fornix reformation, and restoration of ocular motility. The underlying causes of symblepharon included Stevens-Johnson syndrome (n= 6), chemical burn (n= 5), ocular cicatricial pemphigoid (n= 1), thermal burn (n= 1), following excision of conjunctival squamous cell carcinoma (n= 1), conjunctival scarring following exposed buckle (n= 1), and immune dysregulation (n= 1). Twelve eyes (75%) had an average of 1.6 ± 0.9 previous surgeries. Before surgery, ocular motility restriction was significantly correlated with the severity of symblepharon. During the follow-up period of 17.1 ± 13.6months, 13 eyes (81.3%) achieved complete success, 2 eyes (12.5%) achieved partial success, and 1 eye with immune dysregulation had failure (6.3%). There was no correlation between the success rate and the severity of symblepharon. After surgery, the ocular motility and inflammation were significantly improved. Visual acuity had improved in 2 of 15 eyes. Sealing the gap between the conjunctiva and Tenon capsule is an important step in the surgical management of pathogenic symblepharon. This method not only avoids the use of mitomycin C, but also creates a strong barrier to prevent recurrence, restore ocular surface integrity, reform a deep fornix, and regain full ocular motility.

Recurrence and complications of pterygium extended removal followed by extended conjunctival transplant for primary pterygia.

To study the recurrence rate and complications after primary pterygium removal using pterygium extended removal followed by extended conjunctival transplant. Sixty-eight eyes of 57 consecutive patients with primary pterygia underwent pterygium removal using pterygium extended removal followed by extended conjunctival transplant between April 2010 and October 2014. The follow-up period lasted for at least 36 months after the procedure. No recurrences were reported after a mean follow-up period of 40.0 ± 5.7 months (minimum of 36months). One case (1.4%) developed Tenon granuloma at the donor site 2 weeks after surgery, and it was surgically removed. Transient graft swelling was observed in 22% of the cases, and transient diplopia was observed in 17.6%. Both graft swelling and diplopia resolved gradually in all cases during the early postoperative period. Loss of corrected distance visual acuity was not reported. Pterygium extended removal followed by extended conjunctival transplant is an effective technique for primary pterygia and resulted in a 0% recurrence rate with minimal intraoperative and postoperative complications.

Observation on the effect of transplantation of autologous limbal epithelial stem cell for the treatment of pterygium

Objective To observe the clinical effect and complications of autologous limbal epithelial stem cell transplantation in the treatment of pterygium. Methods Eighteen eyes of 18 cases with pterygium were treated with corneal limbal stem cell transplantation. The vitality of grafts and recurrence of pterygium were observed. Results The follow-up time was 1 year. The pterygium recurred in one eye and the recurrent rate was 5.6%. No serious complications happened. Conclusion Autologous limbal epithelial stem cell transplantation is a better method for the treatment of pterygium. Intraoperative careful operation can bring better cosmetic effect. Key words: Limbus, corneal; Cells, stem; Grafting; Pterygium

Monitoring corneal densities following primary pterygium excision with adjuvant topical mitomycin-C application--an observational study of corneal scar changes.

Corneal densitometry is an inherent feature of the Pentacam device. We aim to assess the changes in corneal scar density with serial Scheimpflug images following primary pterygium excision with topical application of mitomycin-C. We recruited patients who underwent primary, single-headed pterygium excision with topical adjuvant mitomycin-C. Scheimpflug images were taken at postoperative weeks 1, 4, and 12, and all patients received topical corticosteroid and antibiotic treatment for at least 4 weeks postoperatively. Corneal scar densities were generated by the software for analysis. Secondary outcome measures included intraocular pressures and pterygium recurrence at the end of 12 weeks. Changes in corneal densities between weeks 12, 4, and 1 were calculated. We recruited 31 eyes of 31 patients, of whom 16 were male patients and 15 were female patients, with 19 left and 12 right eyes. Mean age at operation was 62.0 ± 9.4 years. Mean reduction in density of the anterior 120 μm of cornea was -3.07 [95% confidence interval (CI), -6.600 to 0.460] and -3.455 (95% CI, -6.787 to -0.122) at postoperative 4 and 12 weeks, respectively, and mean reduction percentage was -4.7% (95% CI, -10.7% to 1.3%) and -6.3% (95% CI, -11.8% to -0.7%), respectively. No steroid response or pterygium recurrence was reported. Corneal densitometry is an objective measure to detect scar changes in zones and layers. The overall reduction of density was evident at 12 weeks postoperatively. These results might serve as baseline figures for future studies in assessing modulation of corneal scars over time.

Nasal Mucosa Graft and Lamellar Keratoplasty as Treatment in Recurrent Pterygium

Aim: We propose the use of lamellar keratoplasty associated with nasal mucosal graft for the reconstruction of the ocular surface in multiple recurrent pterygium. Methods: Our patient had undergone four operations of nasal pterygium excision on the right eye, using different surgical procedures: simple excision, excision plus conjunctival autograft, removal plus amniotic membrane graft, excision plus mucosa oral graft plus mitomycin C. All the procedures failed. Given the need for sizeable graft to reconstruct the lower fornix symblepharon, we decided to take a nasal mucosa graft. We also proposed an eccentric lamellar keratoplasty in order to restore corneal thickness and transparency. Results: Twenty months after surgery, the fornices were preserved, donor cornea was transparent and there were no signs of recurrence

Identification of human papillomavirus in pterygium.

The purpose of this study was to evaluate the involvement of human papillomavirus in the pathogenesis of primary and recurrent pterygium in northern Israel. A retrospective study examined 100 randomly chosen pterygium specimens with solar elastosis, from 100 patients who underwent pterygium surgery during 2012-2013 at the Emek Medical Center. All the specimens were analysed for evidence of human papillomavirus infection by immunohistochemistry. Human papillomavirus was not detected in any of the 100 pterygia samples by immunohistochemistry. These used samples were taken from 100 patients with mean age of 51.5 years and a primary: recurrent ratio of 8.09:1. We conclude from our study that human papillomavirus infection does not appear to be an important pathogenic factor of pterygium in Israel.

Recurrence After Primary Pterygium Excision: Amniotic Membrane Transplantation with Fibrin Glue Versus Conjunctival Autograft with Fibrin Glue

Purpose: The aim of the present study was to compare the surgical results and recurrence rates of primary pterygium excision with conjunctival autografts versus amniotic membrane grafts fixated with fibrin glue.Materials and methods: In this prospective study, 73 eyes of 65 patients who had undergone conjunctival autograft group (CAG) (n:37) or amniotic membrane group (AMG) (n:36) after pterygium excision were evaluated. Fibrin glue was used for the fixation of grafts in both groups. The patients were followed up for 12 months. Postoperative complications were recorded. The rate of recurrence was defined as the primary outcome measure.Results: In the CAG, partial dehiscence of the graft was observed on the nasal edge on postoperative day 1 in two (5.4%) eyes that healed with secondary re-epithelialization at week 1. Twelve (32.4%) eyes showed a yellowish-orange or hemorrhagic edema of the graft on postoperative day 7 that spontaneously resolved in 1 to 3 weeks. In the AMG, partial dehiscence and folding of the amniotic membrane occurred in two (5.5%) eyes. Two eyes (5.4 %) in the CAG developed corneal recurrence and five eyes (13.8%) in the amniotic membrane graft group developed recurrence; one limbal (2.7%), four corneal recurrences (11.1%) (p = 0.25).Conclusion: Fibrin glue is a safe and effective method for attaching conjunctival or amniotic membrane grafts for wound closure following pterygium surgery. Although the results were not statistically significant, amniotic membrane grafting using fibrin glue seems to have a higher pterygium recurrence rate compared with conjunctival autografting.

Mitomycin C-associated scleral stromalysis after pterygium surgery.

To describe complications after use of mitomycin C (MMC) as a surgical adjuvant in pterygium surgery. This is a retrospective chart review of patients presenting to a tertiary referral center over a 7-year period with a diagnosis of scleral stromalysis after previous pterygium removal. Sixteen eyes of 15 patients were identified with scleral stromalysis after pterygium surgery with the use of adjuvant MMC. Three eyes were excluded because of insufficient chart information or previous beta-irradiation treatment. Twelve of 13 eyes underwent surgical treatment for primary pterygium, and 1 eye was treated for recurrent pterygium. Time from initial pterygium surgery to presentation ranged from 1 month to 10 years. Dosage and routes of MMC administration included 0.02% intraoperative application to either the bare sclera or Tenon capsule with a range of 30 seconds to 3 minutes or topical administration 4 times daily for 2 weeks. In some cases, the dose and route of MMC administration were unknown. Four of 13 patients (31%) required a scleral patch graft with 1 patient (8%) requiring multiple patch grafts. Use of MMC in various forms and concentrations can cause devastating complications including scleral stromalysis. Scleral stromalysis may present anywhere from months to years after application. We suggest that MMC should be used with extreme caution when used as a surgical adjuvant for pterygium surgery. Patients must be urged to continue long-term follow-up after MMC use because of the potential for future anterior segment complications.

Conjunctival metaplasia after pterygium excision and limbal autograft.

To investigate the changes of conjunctival epithelium in the pterygium and donor graft sites after pterygium excision and limbal conjunctival autograft. This study included 16 eyes of 15 patients who underwent pterygium excision and limbal conjunctival autograft. Epithelial impression cytology specimens of both the pterygium and donor graft were obtained preoperatively and at months 1, 3, and 6, at the pterygium and donor graft sites, respectively. In each specimen, changes in the conjunctival epithelium, including the nucleus-to-cytoplasm (N/C) ratio and goblet cell density (GCD), were evaluated. Morphologic changes in the cells and nuclei were also evaluated. Preoperatively, both N/C ratio and GCD were significantly higher in specimens from the pterygium than in those from the donor site. At both sites, GCD decreased rapidly at 1 month after surgery and then gradually recovered. No significant difference in GCD was found between the two sites at 1, 3, and 6 months postoperatively. Although there was no significant difference in the N/C ratio at 1 and 3 months, the N/C ratio at the pterygium site was significantly greater than that at the donor site at 6 months. At 6 months postoperatively, changes suggesting squamous metaplasia, including elongation of the cells and pyknotic changes in the nuclei, were noted in five samples (31.3%) from the pterygium site but not in any of the samples obtained from the donor site. Conjunctival epithelial metaplasia may return after pterygium removal, which may be associated with the high rate of pterygium recurrence.

Effect of Bevacizumab on Human Tenon's Fibroblasts Cultured from Primary and Recurrent Pterygium.

The purpose of this study was to compare the inhibitory effect of bevacizumab on human Tenon's fibroblasts (HTFs) cultured from primary and recurrent pterygium. Cultured HTFs were exposed to 2.0, 5.0, 7.5, and 15.0 mg/mL concentration of bevacizumab for 24 hours. The 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide and lactate dehydrogenase leakage assays were then performed to assess fibroblast metabolism and viability. The matrix metalloproteinase (MMP), procollagen type I C terminal propeptide (PIP), and laminin immunoassays were performed to examine extracellular matrix production. Changes in cellular morphology were examined by phase-contrast and transmission electron microscopy. Both metabolic activity and viability of primary and recurrent pterygium HTFs were inhibited by bevacizumab in a dose-dependent manner, especially at concentrations greater than 7.5 mg/mL. Both types of HTFs had significant decreases in MMP-1, PIP, and laminin levels. Distinctly, the inhibitory effect of bevacizumab on MMP-1 level related with collagenase in primary pterygium HTFs was significantly higher than that of recurrent pterygium. Significant changes in cellular density and morphology both occurred at bevacizumab concentrations greater than 7.5 mg/mL. Only primary pterygium HTFs had a reduction in cellular density at a bevacizumab concentration of 5.0 mg/mL. Bevacizumab inhibits primary and recurrent pterygium HTFs in a dose-dependent manner, especially at concentrations greater than 7.5 mg/mL. As the primary HTFs produces larger amounts of MMP-1 compared to recurrent HTFs, significant reduction in MMP-1 level in primary pterygium HTFs after exposure to bevacizumab is likely to be related to the faster cellular density changes in primary pterygium HTFs.

The Effect of Limbal Autograft in Recurrence of Pterygium

Background: Assessing the effect of limbal autograft shifting in recurrence of pterygium. Methods: This single-center study was carried out in a tertiary health facility. A review of data on consecutive patients who underwent pure limbal autografts shifting after pterygium resection was done. In all the cases, the pterygia extended at least 3 mm beyond the limbus. The resected each limbal grafts included a width of 1.5 mm and a length of 2 or 3 mm of limbus and a depth of 250 μm. Schmer test was performed at the eighth month postoperatively. Pterygium recurrence was accepted endpoint of the study. One patient had recurrent pterygium, whereas the others had primary pterygium. Patients with other ocular surface diseases or ocular pathology and, patients who discontinued follow-up visits were excluded from the study. Results: The study included 10 patients, with 5 males and 5 females. Median age of the patients was 40 (25 - 70). Follow-up was conducted for a minimum of 8 months for patients with recurrence and at least for 16 months for non-recurrent cases. Recurrence was observed in 6 patients out of 10, in one patient, atypia was reported and excluded from the study. Four recurrent patients experienced decreased levels of tears. The rest one patient with recurrence had not any tear abnormality. The remaining 4 patients responded well to the surgery. Because of the high recurrence rate, it was decided to terminate the study. Conclusions: Limbal autografts shifting alone is not an appropriate treatment for primary pterygium because of the high recurrence rate.

A study of recurrence of pterygium_ following pterygium excision with conjunctival autograft

A study of recurrence of pterygium_ following pterygium excision with conjunctival autograft