Treatment Of Pterygium Research Articles

Comparison of Superior and Inferior Limbal Conjunctival Autograft Transplantation in Primary Pterygium Surgery: A Retrospective Analysis

Introduction: Conjunctival autografting is the cornerstone of pterygium treatment. The most typical way to harvest the conjunctival graft is superior. Nonetheless, it is not always possible to harvest a graft from the superior bulbar conjunctiva, which could impact the functionality and result of a subsequent filtering procedure [1]. This study aims to compare the effectiveness of superior conjunctival autografting and inferior conjunctival autografting without using glue or sutures. Methods: This was a prospective observational study conducted in the Department of Ophthalmology, Pabna Medical College Hospital, Pabna, Bangladesh during the period from January 2019 to December 2020. In our study, we included 200 eyes of 198 patients with primary pterygium who underwent surgical procedures in Pabna Medical College Hospital. Results: A total of 200 cases were included in this case series. 100 of them underwent superior limbal conjunctival autograft transplantation (Group A) and 100 of them underwent inferior limbal conjunctival autograft transplantation (Group B). There was one eye with recurrence in both groups, which was not statistically significant; there were two eyes with graft dehiscence in group B and one eye with graft dehiscence in group A. Graft retraction was not statistically significant in 12 cases in group A and 10 cases in group B. The inferior conjunctival autografting techniques are great alternatives with similar results and no increased risk of serious problems in cases where the superior conjunctiva must be maintained. Conclusion: Our findings show that suture-less and glue-free superior or inferior limbal conjunctival autograft is safe, cost-efficient, and successful.

Key Clinical and Histopathological Features of a Pterygium-Like Induced Lesion in a Rabbit Model.

Surgery is the definitive treatment for pterygium; therefore, reliable animal models are required for translational research. The goal of this investigation was to establish a standardized preclinical model of pterygium-like lesion. A subconjunctival injection of fibroblasts (NIH3T3) and extracellular matrix was administered to 22 New Zealand rabbits. Clinical evaluation was assessed at different points, the severity of the lesion was scored according to four grades and correlated with the area of hyperemia and the histopathological findings on day 23. Thirteen of 22 eyes (60%) developed pterygium-like lesions after 7days and progressed through different grades. Initially, grade 3, characterized by an elevated and fleshiness conjunctiva with tortuous hyperemia, was evident on day 7. By day 15, lesion decreased to grade 2, with less elevation and hyperemia. Subsequent improvement was noted, with grade 1 on day 18. Finally, day 23 was marked by a white‒yellow lesion, classified as grade 4. The area of hyperemia increased from grade 2 to grade 3 (P < 0.05) and decreased from grade 3 to grade 4 (P ≤ 0.05). Histopathological analysis revealed a tendency toward increasing inflammation at grades 2, 3, and 4. There was a correlation between clinical features and the degree of inflammation. Subconjunctival injection of NIH3T3 and extracellular matrix induces a pterygium-like lesion that progresses across four grades, beginning with an acute inflammatory process that evolve a chronic form. This study provides a replicable model for simulating pterygium. The development of a standardized preclinical model of pterygium to evaluate new pharmacological or surgical treatments.

A Simplified Treatment Algorithm for the Management of Primary Double-headed Pterygium

Abstract Aim: To study different methods in the management of primary double-headed pterygium and to propose a simplified treatment algorithm for its surgical management. Methods: A retrospective study was performed on 335 eyes. All the surgeries were carried out under subconjunctival infiltrative anaesthesia. In Group I, patients underwent excision of pterygium with a horizontal conjunctival autograft (CAG). Patients in Group II underwent a vertical split CAG with limbal orientation, while in Group III, limbal orientation was not maintained. In Group IV, patients underwent conjunctival tissue graft from pterygium and conjunctival autografting. Results: Recurrence was observed in five of the 96 eyes in Group I (5.2%) and among 12 of the 99 eyes in Group II (4.04%). Recurrence was observed in three out of 87 eyes (3.45%) in Group III, and four out of 53 eyes (7.5%) in Group IV. All four groups had low and comparable recurrence rates. The follow-up period for all patients was extended for a minimum of 6 months, with mean follow-up durations of 16.79 months in Group I, 18.30 months in Group II, 17.28 months in Group III and 14 months in Group IV. Conclusion: Outcomes of horizontal and vertical split conjunctival autografting with/without limbal orientation and conjunctival tissue from pterygium with conjunctival autografting were studied. All these methods had low and comparable rates of recurrence and are therefore effective in the surgical treatment of double-headed pterygium.

DIFFERENT CONJUNCTIVAL AUTOGRAFT TECHNIQUES FOR PTERYGIUM SURGICAL EXCISION, A CASE SERIES

Abstract&#x0D; Introduction : Pterygium is a wing shaped fibrovascular growth that extends from the conjunctiva onto the cornea. There are many techniques available for pterygium removal, from simple excision to excision and repair of the defect with modified techniques.&#x0D; Case Illustration : 1. A 50-year-old woman presented with a grade II pterygium in both of her eyes. She was undergone sliding flap pterygium excision for her right eye. Case 2. A 32-year-old man presented with a grade II pterygium in his left eye. He was then undergone rotational flap pterygium excision for his left eye. Case 3 A-55-year-old woman presented with a grade II-III double head pterygium. She was later undergone modified conjunctival autograft double head pterygium excision for his left eye.&#x0D; Discussion : Surgical management is the gold standard for pterygium treatment. Indications for pterygium excision include decreased visual acuity due to astigmatism, obstruction of visual axis, repeated irritation and cosmetics. Surgical techniques for excision of the pterygium include bare sclera excision, tissue grafting using conjunctival graft, membrane transplantation amnion and limbal- conjunctival autograft. There are several choices of conjunctival graft techniques after pterygium excision, such as conjunctival sliding flap, conjunctival rotational flap, and modified conjunctival autograft. Modified conjunctival autograft technique was performed for double head pterygium management. The technique consisting of horizontally modified conjunctival autograft and vertically modified conjunctival autograft.&#x0D; Conclusion : The choices of surgical excision techniques for pterygium depends on the grades of the pterygium and operator’s preference.

Current possibilities for the diagnosis and treatment of pterygium

Pterygium is a common inflammatory-proliferative disease characterized by the invasion of degeneratively altered fibrovascular tissue into the cornea. This literature review analyzes the etiological factors and pathogenetic concepts of its development, describes modern methods of diagnostics and surgical treatment of pterygium, and pays particular attention to the assessment of structural and functional changes in the cornea occurring during the growth of pterygium and after its excision.

Regenerative medicine in pterygium surgery

Aims/Purpose: Pterygium is a frequently occurring eye condition that arises due to excessive cellular growth, resulting in the development of abnormal fibrovascular growth of the conjunctiva. Despite the improvement of surgical techniques, preventing postoperative recurrence continues to be a significant challenge. At present, pterygium excision using conjunctival autograft is the preferred surgical method, however there is no universally accepted technique to completely eliminate the risk of pterygium recurrence. Plasma rich in growth factors (PRGF) is an autologous blood product rich in proteins and growth factors which can be rapidly obtained from patient blood. Clinically, it is an affordable treatment with potentially broad spectrum of applications in ophthalmology especially in the treatment of complex corneal disorders. The aim of this study was to evaluate the efficiency of autologous platelet‐rich plasma in the treatment of advanced pterygium and to compare it to conjunctival autograft technique.Methods: A total of 26 patients (31 eyes) with advanced pterygium were included in this study. Mean BCVA was 0.7. Patients were divided into 2 groups according to the surgical technique used: PRGF group (16 eyes) and conjunctival autograft group (15 eyes). All patients underwent excision of pterygium followed by closure of the bare sclera either by PRGF or conjunctival autograft. Solid PRGF was either just placed on the corneal surface or sutured with 2 nodes of 10–00 nylon suture at conjunctiva. If necessary, the procedure was repeated. All patients had corneal OCT scan and photo before the treatment and during the follow up. Patients were followed at 2, 6, 12 and 18 months after the procedure.Results: The mean surgery time was shorter in PRGF group (15.0 ± 2 min) compared to conjunctival autograft group (35.0 ± 5 min) (p = 0.001). Mean BCVA improved to 0.8 in both groups. The recurrence was observed in 2 eyes of conjunctival autograft group, while none of the eyes showed recurrence in PRGF group. Graft loss was observed in 2 cases in PRGF group and in 1 eye in conjunctival autograft group. None of the patients reported general or local side effects of the treatment.Conclusions: PRGF is a simple, fast, reliable and effective therapeutic tool to promote wound healing and prevent recurrence after advance pterygium excision.

Comparison between Sutureless and Sutured Conjunctival Autograft for Surgical Treatment of Pterygium

Comparison between Sutureless and Sutured Conjunctival Autograft for Surgical Treatment of Pterygium

Risk Factors for Recurrence in the Treatment of Recurrent Pterygium.

The aim of this study was to identify the postoperative recurrence rate of recurrent pterygium and to evaluate risk factors for the recurrence. This study was a retrospective interventional nonrandomized consecutive case series. In this single-center study, 119 eyes of patients with recurrent pterygium who underwent surgery with a follow-up period of >12 months after the surgery were analyzed. The clinical characteristics of pterygium were classified according to the length of corneal involvement and Tan grade. The main outcome was the recurrence rate. The secondary outcome was the risk factors for recurrence. The mean follow-up period was 42 ± 28.6 months. Recurrence was observed in 15 patients (12.6%). The average postoperative recurrence period was 7.7 ± 6.7 months. Twelve patients experienced a recurrence within 12 months. Eyes with recurrence had a significantly greater length of corneal involvement (2.47 ± 0.72 mm) and number of previous surgery (1.9 ± 1.3) than those without (1.97 ± 0.74 mm, and 1.3 ± 0.7, both P = 0.04). Multivariate analysis showed that recurrence was significantly associated with the length of corneal involvement (odds ratio [OR] 2.38, 95% confidence interval [CI], 1.02-5.57, P = 0.05) and the number of previous surgeries (OR: 1.91, 95% CI, 1.03-3.58, P = 0.04) but not with sex (OR: 3.71, 95% CI, 0.90-15.2, P = 0.07), age (OR: 0.99, 95% CI, 0.94-1.04, P = 0.59), and use of mitomycin C (OR: 0.31, 95% CI, 0.07-1.21, P = 0.09). The postoperative recurrence rate of recurrent pterygium was 12.6%. The preoperative length of corneal involvement and number of previous pterygium surgeries were significantly correlated with recurrence. Male sex and nonuse of mitomycin C tended to correlate with recurrence.

Sub-conjunctival injection of 5 Fluorouracilversus Bevacizumab in Treatment of Primary Pterygium

Purpose: To compare effectiveness and safety of 5 Fluorouracil versus Bevacizumab as sole therapy in the treatment of primary pterygium. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital Lahore, from January 2022 to January 2023. Methods: A total of 64 patients were included and divided into 2 groups of 32 patients each. Group A patients received monthlyinjection of 0.1ml, Fluorouracil(5FU) for 3 months while 3 injections of 0.1ml Bevacizumab were administered in group B. Primary outcome measure was effectiveness (defined as improvement in Pterygiumgrade), at 4 weeks following the administration of last injection. Patients were examined for pterygium grading as well as any side effects of injections on each follow up visit. Data analysis was done bySPSS, Version 23.0. Results: Mean age of patients in group A was of 33.53±11.3 yearsversus 30.97±12.6 years in group B with a range of 15–55 years. There were 45 (70.3%) males and 19 (29.7%) females. Improvement was seen in 21 patients (65.6%) in group A, as compared to only 2 (6.3%) in group B. There was a significant difference in pterygium improvement between the two groups (p&lt;0.001). Conclusion: 5 Fluorouracil is more effective than Bevacizumab as sole therapy in treatment of primary pterygium but equally safe in terms of side effects.

Pilot Study of Seamless Diplen Membrane for Pterygium Excision

We report a technique of fixation of rotational flap of the conjunctiva in primary surgical treatment of pterygium using a biodegradable adhesive Diplen membrane. A 78 years old patient was referred to ophthalmology department of «……………..» in September 2022 for treatment of pterygium of right eye. Primary pterygium surgery was performed using fixed rotational flap of the conjunctiva. In this method, the conjunctival flap is rotated to close the open sclera and fixed with a biodegradable adhesive Diplen membrane.The flap did not undergo ischemic changes, retained its original position and fully took root. Inflammatory and allergic reactions to the components of the membrane were not observed. Seamless fixation of conjunctival flap using an adhesive Diplen membrane is a safe, cost-effective and reliable method of treating pterygium.

Chirurgie du ptérygion par greffe conjonctivale sans suture ni colle biologique : étude préliminaire au centre hospitalier universitaire de Cocody à Abidjan

PurposeTo optimize the pterygium management by delineating the role of sutureless, glueless conjunctival graft. Materials and methodsThis was a prospective cohort study carried out at the Centre hospitalier universitaire de Cocody between October 1st, 2021 and March 31st, 2022. It analyzed a series of 36 cases of stage I, II and III pterygium by Cornand's classification, who underwent surgery by a sutureless conjunctival graft technique without biological glue. ResultsDemographically, 33.3% of our study population were between 30 and 40 years of age, with a mean of 47.86 years. The patients showed a female preponderance, 53%, with a male:female ratio of 0.89. At the clinical level, 75% of our population presented for ocular redness, 84% had a nasal pterygium, and 75% were stage 2. In terms of postoperative course and appearance, we observed 80.55% graft stability, 5.56% graft retraction, 2.78% graft displacement, and 11.11% graft loss. At the conclusion of follow-up, we noted an 8.33% recurrence rate. DiscussionThe use of intraoperative blood ensures patient safety and postoperative comfort. This technique demonstrates satisfactory results with primary, nasal pterygia. ConclusionConjunctival autograft without sutures or biological glue might be a very promising surgical alternative in the surgical treatment of pterygium.

Comparison of mini-simple limbal epithelial transplantation and conjunctival–limbal autograft for the treatment of primary pterygium: a randomised controlled trial

PurposeThe purpose of this double-masked, parallel randomised controlled trial was to compare the recurrence rate and other outcomes between conjunctival–limbal autograft (CLAu) and mini-simple limbal epithelial transplantation (mini-SLET) after excision...

Retracted: Efficacy and Safety of Amniotic Membrane Transplantation Combined with Closure of Tenon Capsule and Bulbar Conjunctival Space in the Treatment of Primary Pterygium.

[This retracts the article DOI: 10.1155/2022/5844973.].

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

Intralesional Injections of 5-Fluorouracil: innovative and effective treatment of Primary Pterygium

To determine the effectiveness of intralesional 5-Fluorouracil (5-FU) in symptomatic relief, astigmatism, and desire for surgery in patients with primary pterygium. The experimental study was carried out between January and March 2020 in the Ophthalmology Unit of the Hospital del Salvador, Chile. Fourteen eyes (14 patients) were selected on the surgical waiting list and exposed to fortnightly intralesional injections of 10 mg of 5-FU. An initial evaluation was performed with OSDI for symptomatic measurement, a photographic camera and slit lamp for clinical appearance, and an auto-refractometer for astigmatism, being re-evaluated 60 days later, adding the question of whether they maintained the desire to undergo surgery. The sample was divided into groups A and B depending on whether they received two or one dose of 5-FU, respectively. The average age of the participants was 56.8 ± 11.1 years. Group A presented an initial OSDI of 50 ± 23.8, which, after the intervention, decreased to 21 ± 13.5 (p < 0.001). Group B had an initial OSDI of 47 ± 17.3, decreasing to 22 ± 16.2 (p < 0.005)-statistically significant changes. The degree of astigmatism had no changes. Regarding the physical aspect, there was a reduction in the size of the lesion in 2 of the 14 patients, both in group A. Two patients decided not to undergo surgery after the intervention. The intralesional injection of 5-FU showed a significant improvement in symptomatic relief without associated complications, generating a therapeutic alternative in patients with primary pterygium without surgical indication.

Effectiveness of bare sclera technique versus conjunctival autograft transplantation for pterygium treatment

Effectiveness of bare sclera technique versus conjunctival autograft transplantation for pterygium treatment

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.

Management of Primary Pterygium with Intralesional Bevacizumab (AVASTIN) Injection

Objective: To determine the management of primary Pterygium with intralesional Bevacizumab (AVASTIN) Injection.&#x0D; Study Design: Quasi-Experimental Study&#x0D; Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Oct 2019 to Mar 2020.&#x0D; Methodology: Sixty patients of Primary Pterygium with Grades 1, 2, and 3 were included. Pre-Intralesional injection evaluation includes the Ocular surface disease Index (OSDI), grading of Pterygium and ophthalmic examination, refraction,slit lamp bimicroscopy, fundoscopy, tonometry, and corneal topography. After four weeks of intralesional injection,reassessment was done. &#x0D; Results: A total of 60 participants with the mean age of the participants was 44.06±14.83 years were included in the study. In 26(43.3%) patients, grittiness, epiphora, redness, and photophobia were reported, and 16(26.6%) patients reported blurring of vision that improved in 100% of patients after intralesional injections. There was statistical significance (p-value ≤0.05) in means of K1, Sim K astigmatism, Surface asymmetry index, Surface Regularity Index, Grade of Pterygium, and Ocular surface disease index before and after the intralesional injection of Bevacizumab. However, no significant difference was recorded in Uncorrected Visual Acuity, Best Corrected Visual Acuity, and K2 parameters in pre and post-injection states (p-value ≥0.05).Only 7(11.6%) patients reported subconjunctival haemorrhage after the procedure.&#x0D; Conclusions: Treatment of Primary Pterygium with intralesional Bevacizumab injection successfully improves symptoms,Ocular Surface Disease Index, and reduces corneal astigmatism with minimum complications.

Primary Pterygium Excision with Amniotic Membrane Grafting among Rural Eye Patients in Bangladesh

Objective: Since treatment of pterygium by topical and systemic medications is not effective, surgical treatment remains the only way to resolve the problem. This study was therefore aimed to evaluate the outcome of primary pterygium excision with amniotic membrane graft among patient with eye diseases in rural Bangladesh. Methodology: This study was conducted at the Pangsha Eye Hospital of District Rajbari among a total 280 pre-selected eye patients having primary pterygium over the period of 7 years (January 2012-June 2019). Surgical excision was performed with transplantation of preserved amniotic membrane on to the bare sclera. Every patient was followed up for at least next 6 months. Results: The results were evaluated in terms of recurrent pterygium growth and related complications. Of total 280 patients, pterygium was excision both of 138 (49.29%) being male and 142(50.71%) being female with mean ages of 43.36±10.88. The pterygium extended on to the corneas for 4.76±1.4 mm (range 3 to 8) mm. Only 11(4%) eyes demonstrated recurrent pterygium. Seven of them were male and 4 were female which was managed by second grafting leading to complete resolution. Of various complications, mild hematoma was observed in 3 cases, and, in 2 cases were had mild sclera dryness in bare scleral area after pterygium excision which were managed by topical steroid and artificial tear. Conclusion: Findings of this study yielded that primary pterygium excision with amniotic membrane transplantation is remains a safe and effective surgical technique with minimum recurrence rate. The Journal of Ad-din Women's Medical College; Vol. 11 (1), Jan 2023; p 4-13

Correction of refractive disorders after surgical treatment of recurrent pterygium (case study)

Lamellar keratoplasty is the most effective and safe method of surgical treatment of recurrent pterygium, providing restoration of the corneal frame and optical properties and a high anti-relapse effect due to the barrier properties of the lamellar graft. However, potential postoperative changes in the regularity of the anterior and posterior surfaces of the cornea (especially in case of advanced stage of fibrovascular tissue growth) do not always allow achieving high functional results of treatment. The article presents a clinical case that demonstrates the effectiveness and safety of excimer laser correction of refractive disorders after surgical treatment of pterygium.