Treatment Of Pterygium Research Articles

Comparison of three methods for pterygium treatment

Objective Compared the clinical effect of simple excision of pterygium, limbal epithelium and conjunctiva autografting combined excision and combined excision of pterygium with stem cell transplantation of comeal limbus.Methods Two hundreds and ten cases(230 eyes) were divided into three groups according to operative method, the first group(75 eyes) were treated with simple excision, the secondgroup(77 eyes) were treated with limbal epithelium and conjunctiva autografting combined excision, the third group(78 eyes) were treated with combined excision of pterygium with stem cell transplantation of corneal limbus.Comea healing, limbal neovascular and tissue like pterygium hyperplasia were observed.Resulst: Following up was 4-28 months(averaged 14.30 ± 7.42). Recurrence rate was 26.67% in group A, 10.39% in group Band 8.97%in group C.The recurrence of epithelium in the group A was higher than those of the other two groups, But there were no significant differences between group B and group C .The average repair time of epithelium in the group C and group B were 2.30 ± 0.31 days and 6.15 ± 0.40 days ,the differences were remarkable in two groups(P< 0.05).Conclusions Limbal epithelium and conjunctiva autografting combined excision and combined excision of pterygium with stem cell transplantation of corneal limbus can reduce the recurrence significantly, the latter can lower the repair time of epithelium remarkably. Key words: Pterygium ; Conjunctiva autografting ; Stem cell transplantation of corneal limbus; Curative effect

Operative Techniken bei chirurgischer Behandlung primärer und rezidivierender Pterygien

Surgical treatment of pterygia is indicated when there is a reduction of visual acuity secondary to the development of irregular astigmatism and an (impending) obscuration of the visual axis by the tumor. Poor cosmetic appearance and an insufficient corneal lubrication are more rare indications. The most popular surgical technique in this country appears to be a free conjunctival autograft which, depending on the priority of the surgeon, is combined with adjunctive antimetabolite therapy applied either in primary or recurrent cases. A simultaneous transplantation of conjunctival and limbal stem cell autografts is an excellent method to be considered particularly in cases of recurrent pterygia. In the case of non-existing healthy autologous tissue the resection bed can be covered by preserved amniotic membrane. A lamellar sectorial corneal graft might become necessary if there is a deep corneal defect. The well established technique of suturing the graft has been replaced by fibrin glue in some surgical centers.

Growth factor expression in ophthalmic pterygia and normal conjunctiva

The expression of growth factors in ophthalmic pterygium and phenotypically normal conjunctiva was examined and correlated with the clinical findings. Fifteen specimens of ophthalmic pterygia and 8 specimens of phenotypically normal conjunctiva were examined. Total RNA was extracted from all specimens and mRNA levels for transforming growth factor (TGFB1), vascular endothelial growth factor (VEGFA), basic fibroblast growth factor (FGF2), epidermal growth factor (EGF) and insulin-like growth factor (IGF1) were measured using real-time reverse-transcription PCR (qRT-PCR). Differences in the expression of these factors between pterygium and conjunctival specimens were examined, as well as correlations between RNA levels and clinical parameters. mRNA levels for VEGFA and FGF2 were significantly higher in pterygium, compared with conjunctival specimens, whereas the respective differences for other factors examined were statistically not significant. The mRNA levels for VEGFA and FGF2 were also significantly higher in recurrent compared with primary pterygium. Correlations between the mRNA levels and other clinical parameters were statistically not significant for the growth factors examined. The higher levels of FGF2 or VEGFA mRNA in pterygium imply that these factors may be involved in the pathogenesis or clinical behavior of the pterygium, including postoperative recurrence. VEGFA expression may have potential for use in the selective treatment of pterygium with anti-VEGFA agents.

Clinical Research on Surgical Treatment for Double-Head Pterygium

Purpose: To evaluate two surgical methods-amniotic membrane transplantation (AMT) and split-conjunctival grafts (SCG)-for double-head pterygium, with regard to the postoperative outcome and recurrence rate. Methods: In a total of 16 eyes (14 patients), 7 eyes (6 patients) receiving amniotic membrane transplantation and 9 eyes (8 patients) receiving split-conjunctival grafts were compared to evaluate recurrence and complications. Results: Within the amniotic membrane transplantation group, two eyes (29%) had corneal recurrence, and 3 eyes (43%) had conjunctival recurrence. The mean follow-up period was 21.93.5 months, and all recurrences were on the nasal side. The average period preceding the corneal recurrences was 7.21.8 months. Within the split-conjunctival grafts group, the mean follow-up was 13.62.1 months, and neither the corneal nor conjunctival recurrences were observed. In addition, the eyes of this group were more aesthetically stable, with only one eye exhibiting pseudo-pterygium at the donor site. Conclusions: In cases of double-head pterygium without contraindication of conjunctival autograft, the split-conjunctival grafts produced fewer recurrences and showed enhanced cosmetic results, as compared to the amniotic membrane transplantation, indicating that the split-conjunctival grafts is the superior choice over amniotic membrane transplantation.

Treatment of Primary Pterygium

To compare preserved human amniotic membrane transplantation and conjunctival autografts for treatment of primary pterygium. Thirty-seven eyes of 35 patients with primary pterygium underwent surgical excision. In group A, 25 eyes were treated with conjunctival autografts. In group B, 12 eyes were treated with preserved human amniotic membrane transplantation. These two groups were compared in terms of complications, recurrence, and final appearance, prospectively. We observed two cases of recurrence in group A and five cases of recurrence in group B. The onset of recurrence was about 5.5 months in both groups. We observed two eyes with Dellen ulcer and one case with a Tenon's cyst in the superior temporal quadrant in group A and one case of Dellen ulcer and granulation tissue of one eye in group B. We suggest that free conjunctival autografting is a more effective technique in primary pterygium in terms of lowering recurrences compared with the amniotic membrane transplantation technique.

Clinical analysis of three different methods for the treatment of pterygium surgery

Objective To investigate the value effect of the simple resection or combined with amniotic membrane grafting or autologous limbus of cornea stem cell grafting in three different ways to treatment for pterygium in order to reduce the postoperative recurrence rate.Methods In-patients with pterygium were ehosed from January 2006 to October 2008,there were 138 cases with 142 eyes were randomly divided into three groups,A group with simple pterygium excision had 46 cases with 46 eyes,B group with pterygium excision with amniotic membrane grafting had 46 cases with 48 eyes,C group with pterygium combined with Autologous limbus of cornea stem cell grafting in 48 eyes with 46 cases. Observed after the growth of the grafts,corneal wound healing,neovascularization and Mask pterygium recurrence rate.Results During 46 cases of A group there was 14 eyes for relapse,the relapse rate was 30.43%;B group with 48 eyes of two recurrences,recurrence rate was 4.17%,C group with 48 eyes,there were two recurrences,recurrence rate 4.17%.There were signifieant differences between A group and B group (X±4.59,P＜0.05);A group compared with C group,there was a significant difference (X2=9.98,P＜0.01);B group compared with C group,there was no significant difference (P＞ 0.05). Conclusions To be take the pterygium excision combined with amniotic membrane grafting or autologous limbus of cornea stem cell grafting can effectively reduce the rate of postoperative recurrence. Key words: Pterygium; Amniotie membrane grafting; Autologous limbus of cornea stem cell grafting

Treatment of Primary Pterygium: Role of Limbal Stem Cells and Conjunctival Autograft Transplantation

The limbus and its stem cells are important in the pathogenesis of pterygium. In this study, the usefulness of limbal stem cells and conjunctival autograft transplantation for the treatment of primary pterygium is assessed. In this prospective noncomparative cohort study, 42 eyes of 42 patients with grade I-III primary pterygium underwent pterygium excision followed by superotemporal limbal stem cells and conjunctival autograft transplantation. Pterygium recurrences and complications within a mean follow-up period of 18.26 months (range, 10-28 months) were assessed. There were no recurrences of pterygium growth except in 2 cases (4.75%). In addition, no significant complications were noted. No further surgical interventions were needed in any case except for reoperation in the 2 recurrent cases. Although limbal stem cells and conjunctival autograft transplantation is a time-consuming procedure, it is a safe and effective technique for the treatment of different grades of pterygium. It is useful in prevention of pterygium recurrence, which is a major problem in pterygium surgery.

Comparison of mitomycin C and limbal-conjunctival autograft in the prevention of pterygial recurrence in Turkish patients: A one-year, randomized, assessor-masked, controlled trial

Background: A pterygium is a fibrovascular overgrowth of degenerative bulbar conjunctival tissue that grows over the limbus onto the cornea. Although various approaches have been proposed for the treatment of pterygium, the common problem after these treatments is recurrence. Objectives: The goals of this study were to compare the efficacy of mitomycin C (MMC) and limbal-conjunctival autograft (LCAU) in preventing recurrence of primary pterygia and to monitor long-term adverse effects (AEs). Methods: Patients undergoing pterygium surgery between February 2006 and May 2007 were assessed prospectively and randomly divided into 2 groups using a random number table. The MMC group underwent pterygium excision and received 0.02% MMC intraoperatively for 2 minutes. The LCAU group underwent pterygium excision and LCAU. Recurrence and AE rates of the 2 treatments were compared during the 1-year follow-up period. Assessors for pterygial recurrence were masked to treatment group. Results: One hundred thirteen eyes (57 patients in the MMC group and 56 patients in the LCAU group) were included in the study. Thirteen of the patients (7 in the MMC group and 6 in the LCAU group) were withdrawn due to irregular attendance at follow-up visits or lack of sufficient dose and duration for postoperative topical antibiotic and steroid administration; their data were excluded from analysis. Fifty patients (MMC group: 26 men, 24 women; mean [SD] age, 48.0 [12.3] years; age range, 30–73 years; LCAU group: 27 men, 23 women; mean age, 49.0 [12.6] years; age range, 28–71 years) in each group completed the study. The mean (SD) length of the pterygium across the limbus was similar in the MMC group and the LCAU group (4.18 [1.27] vs 4.07 [1.24] mm). The mean follow-up period was also similar in the 2 groups (16.0 [1.9] vs 15.0 [1.7] months). The rate of recurrence was significantly greater in the MMC group than in the LCAU group (10 [20.0%] vs 2 [4.0%] patients; P=0.035). Seven patients (14.0%) in the MMC group experienced AEs: conjunctival cyst (3 patients), symblepharon (2), conjunctival granuloma (1), and dellen (1). In the LCAU group, 1 patient (2.0%; P=0.032 vs MMC group) experienced permanent graft edema. All patients in the LCAU group experienced transient graft edema, with recovery occurring in 3 to 4 weeks. There were no intraoperative complications and there was no graft rejection. Conclusions: Recurrence and postoperative AEs were less frequently observed in primary excision with LCAU than with MMC in these Turkish patients who completed the study. This study found that pterygium excision with LCAU was well tolerated and effective in these patients.

Clinical Research on Autografting of Limbus Stern Cells for Treatment of Recurrent Pterygium

Objective To evaluate the therapeutic effect of limbal corneal epithelial stem cells auto-grafting on patients with recurrent pterygium. Methods Eighty-eight cases (88 eyes) with recurrent pterygium were randomly divided into 2 groups, excision of ptergyium with limbal corneal epithelial stem cells autografting was as combine group A (44 cases,44 eyes), the other cases of primary pterygium (group B)were excised under microscope with routine microsurgical procedure. Patients were followed up for 4 to 28 months(averaged 14.30 ±7.42 months). Results There were 9 eyes(20.45%) and 3 eyes (6.82%) that recurred after the operation in two groups, the differences were significant between two groups(x2=1.137, P<0.05). Conclusion Limbal corneal epitheliat stem cells autografting was the most effective way on recurrent pterygium treatment. Key words: Pterygium; Stem cells; Transplantation; Recurrent

History of ophthalmology: a distinguished or extinguished field of scholarly activity?

Editor, I have read with the great interest Grzybowski’s (2007) letter in a recent issue of Acta. The author explores the history of ophthalmology and proposes more studies and focus on this subsection of ophthalmology. I would like to share with the readers a Turkish scientist who described medical and surgical management of some ophthalmic diseases. Şerefeddin Sabuncuoğlu (AD 1385–1468) lived in the city of Amasya in central Anatolia during the early period of the Ottoman Empire. This Turkish surgeon had worked for 14 years in Amasya hospital (Amasya Darüşşifası) as a chief surgeon, when only the masters would reach such a position. In 1465, at the age of 80, he wrote a book entitled Cerrahiyyetü’l-Haniyye (meaning Imperial Surgery). He cited the Greek, Arabic and Persian textbooks in this work. Cerrahiyyetü’l-Haniyye was rediscovered in the early 20th century. The book was in antique Turkish in Arabic letters. There are only three handwritten copies present in Paris and Istanbul and some parts of it are suspected to be missing. Professor Uzel (1992) examined these three copies and published them in 1992. Sabuncuoğlu had originally written two of these; his own coloured miniature drawings concerning the operative procedures, which were the oldest illustrations, involved in a Turkish-Islamic textbook and were also included. Interestingly, Sabuncuoğlu illustrated in coloured miniatures nearly all of the surgical procedures and instruments (Fig. 1) – even though the drawing of the human form is prohibited in the Islamic religion. His illustrations are not ornamentation, but are technical and descriptive. The book consists of three chapters with 193 known sections, dealing with all the fields of surgery including ophthalmology. Each section describes the diagnosis, classification and surgical technique in detail. The ophthalmic procedures described by Sabuncuoğlu are brief intraocular procedures including cataract surgery and treatment of corneal laceration with uveal tissue incarceration; eyelid disorders including eyelid warts, chalazion, metaplastic lashes, entropion, ectropion; pterygium surgery; and lacrimal system procedures reminiscent of the current dacryocystorhinostomy operation (Oguz et al. 2004). He also describes medical and surgical management of symblepharon, lymphangiectasia, pannus, proptosis and hypopyon (Oguz 2006). Sabuncuoğlu translated his knowledge into Turkish for his colleagues and students who did not know Arabic or Persian. Despite the passage of 600 years, a number of Sabuncuoğlu’s procedures regarding the eye are still compatible with modern ophthalmology. The description of the procedures in Uzel’s book gives us the impression that Sabuncuoğlu performed and experienced all these procedures himself, then wrote and illustrated his book. Although his miniatures do not have great artistic value, it is important to emphasize that they have been drawn in a modest but serious spirit according to Islamic rules. Sabuncuoğlu performed innovate procedures first on animals and then on himself and finally on his patients, as he had written in his other book Mucerrebname (The Book of Experiences) (Sabuncuoğlu 1465). The scalpel for the treatment of pterygium. This instrument is called a mibza by Sabuncuoğlu, and is used for the excision, peeling or shaving of pterygium tissue. In conclusion, I too think that there is ample room for research on the history of ophthalmology. We can increasingly unite the experience and become more familiar with our colleagues by understanding each others’ history, at both national and international levels.

Long-Term Results of Bare Sclera, Limbal-Conjunctival Autograft and Amniotic Membrane Graft Techniques in Primary Pterygium Excisions

Purpose: To compare the long-term follow-up results of the bare sclera technique (BST), limbal-conjunctival autograft technique (LCAT) and amniotic membrane graft technique (AMGT) in primary pterygium excisions. Materials and Methods: In this study, 48 eyes of 48 patients who underwent pterygium surgery using BST (group 1), 63 eyes of 63 patients who underwent pterygium surgery using LCAT (group 2) and 52 eyes of 52 patients who underwent pterygium surgery using AMGT (group 3) were compared with respect to corneal epithelialization, recurrence and complication of the procedures. The mean ages of the groups were 47.88 ± 14.21 years in group 1, 49.63 ± 14.42 years in group 2 and 47.92 ± 15.52 years in group 3. Patients were followed up to 72.39 ± 11.03 months in group 1, 69.91 ± 12.41 months in group 2 and 61.43 ± 9.83 months in group 3. Results: Postoperative corneal epithelialization was completed in 5.62 ± 1.74 days in group 1, 4.33 ± 0.91 days in group 2 and 4.79 ± 1.39 days in group 3. Corneal epithelialization time was earlier in group 2 than in groups 1 (p < 0.01) and 3 (p < 0.05). Recurrences were detected in 19 eyes (39.58%) in group 1, 11 eyes (14.29%) in group 2 and 12 eyes (23.08%) in group 3. The recurrence rate was significantly lower in group 2 than in groups 1 and 3 (p < 0.001). Postoperative complications were not seen in any of the groups. Graft retraction and necrosis were not detected in the LCAT and AMGT groups during the follow-up period. Conclusions: LCAT was found to be a more effective procedure than BST and AMGT, with decreased recurrence rates after pterygium excision. Limbal-conjunctival autograft seems to be a useful treatment in pterygium surgery due to higher success rates and lower recurrence rates. Amniotic membrane grafts may be an alternative surgical technique for pterygium treatment for patients with or without glaucoma who might need glaucoma surgery in the future.

Prospective Study on the Safety and Efficacy of Combined Conjunctival Rotational Autograft With Intraoperative 0.02% Mitomycin C in Primary Pterygium Excision

To describe the novel use of combined conjunctival rotational autograft (CRA) and intraoperative 0.02% mitomycin C (MMC) in the treatment of primary pterygium and to evaluate its safety and efficacy. Prospective interventional case series comparing with historical controls was conducted. Patients with primary pterygium underwent pterygium excision, MMC was applied to the scleral bed after the surface conjunctiva was harvested, and the CRA was sutured back with a 180-degree rotation. Patients were followed for a minimum of 1 year. Sixty-seven eyes from 67 patients participated in the study, of which 31 (46.3%) were men and 36 (53.7%) were women. The mean age was 58 +/- 10.6 years, (range 36-79 years). There were 2 recurrences (3%), one occurring at month 3 and the other at month 9. Compared with historical controls, CRA-MMC resulted in significantly fewer recurrences than MMC alone (P = 0.005) when adjusted for age and was equally effective when compared with limbal-conjunctival autografts. The main postoperative problem was graft injection, which was noted in 41 eyes (61%) at 1 year. To the best of our knowledge, this was the first study on the combined use of CRA and MMC in the treatment of primary pterygium. CRA with MMC was found to be effective in the prevention of recurrence. Although injection remained as a cosmetic concern, it was a safe alternative to limbal-conjunctival autograft in cases where mobilizing autologous conjunctival tissue would not be feasible.

Treatment of primary pterygium: Role of limbal stem cells and conjunctival autograft transplantation

Purpose:The limbus and its stem cells are very important in the pathogenesis of pterygium. In this study, the efficacy of limbal stem cells and conjunctival autograft transplantation for the treatment of primary pterygium will be assessed.Design:Prospective noncomparative cohort study.Materials and Methods:Forty-two eyes of 42 patients with grade I-III primary pterygium were included in the study. Pterygium excision was performed followed by superotemporal limbal stem cells and conjunctival autograft transplantation in all cases. Recurrence of pterygium and complications within a mean follow-up period of 18.26 months (10-28 months) was studied.Results:Recurrence of pterygium occurred in two eyes (2/42; 4.75%). No significant complications were noted. Apart from re-operation in the two recurrent cases, no further surgical interventions were needed in any case.Conclusions:Limbal stem cells and conjunctival autograft transplantation is a safe and effective technique for the treatment of different grades of pterygium. It is very useful in preventing pterygium recurrence, which is a major problem in pterygium surgery.

Pterygia: Pathogenesis and the Role of Subconjunctival Bevacizumab in Treatment

A pterygium is a very common conjunctival degenerative condition. It has been well established that there are different factors that are interrelated and involved in the growth of pterygia. Historically described more as a degenerative process, inflammation and fibrovascular proliferation have proven to be very important factors. Many studies have shown VEGF to be increased in the pathogenesis of pterygia. There are a variety of options for the management of pterygium. The over expression of VEGF in pterygium tissue led us to develop anti-angiogenic/anti-VEGF therapy which could induce regression of blood vessels and hence retard progression of pterygium. The role of angiogenesis and of VEGF in ocular pathology is established including in corneal neovascularization, specifically in pterygial tissue. Evidence suggests that local bevacizumab may be effective in treatment of ocular surface neovascularization. Currently, data in the use of subconjunctival bevacizumab in the treatment of pterygia are not conclusive. New anti-angiogenic therapies will hopefully focus more on facilitating delivery into tissue, increasing the duration of effect while continuing to minimize adverse side effects.

Efficacy of limbal-conjunctival autograft surgery with stem cells in pterygium treatment

PurposeTo determine the efficacy of limbal-conjunctival autograft surgery with stem cells in the management of primary and recurrent pterygium and determine the best corrected visual acuity after surgery.Materials and MethodsSurgical excision of pterygium and limbal-conjunctival transplantation with stem cells was of 40 eyes (of 31 patients) with pterygium. Thirty one cases were primary and nine cases were recurrent pterygia. Graft margins were secured to the recipient site while stem cells aspect was sutured to the limbus.ResultsAfter one year of follow-up, 37 of 40 (92.5%) eyes were free of recurrence. One of the three recurrent cases was aggressive (recurrence occurred two months after surgery) and the other two showed 2 mm corneal extension at 12 months follow-up. In 24 patients, out of 40 (60%), best corrected visual acuity improved more than two lines.ConclusionLimbal-conjunctival autograft surgery, including stem cells, appears to be an effective surgical technique in preventing pterygium recurrence and it can also help in improving the best corrected visual acuity.

Efficacité du traitement topique de ciclosporine A après excision du ptérygion primaire et autogreffe conjonctivo-limbique

To study the efficacy and safety of topical ciclosporin A (CsA) as an adjunctive therapy after surgical treatment of primary pterygium including excision and limbal conjunctival autograft (LCA) with respect to postoperative pain and complications. A prospective randomized clinical study was conducted in 60 consecutive patients with primary pterygium. Sixty eyes were operated on using the same surgical technique including excision and LCA. Thirty eyes were randomly treated with topical 0.05% CsA for 3 months after the surgery as a supplement to the standard topical therapy. All patients were followed for postoperative pain using the visual analog scale (VAS) for 1 week after surgery and for complications including recurrences for a period of 1 year. The average VAS was significantly lower in the CsA group (p=0.034). There was only one recurrence (3.4%) in the CsA group (n=28) and five recurrences (17.9%) in the control group (n=29). The other complications were substantial graft scarring (one in the CsA group, three in the control group), Tenon's granuloma (0/2), and fibrovascular proliferation (1/3). The ratio of the cases with no complications was statistically significantly higher in the CsA group (p=0.017). This study shows that topical CsA therapy after pterygium surgery may reduce postoperative pain and also decreases complications including recurrences.

The use of intralesional injection of 5 fluorouracil to induce regression of recurrent pterygium

Abstract Purpose To investigate the benefit of intralesional injections of 5FU for the treatment of recurrent pterygium Methods Retrospective case note review of patients following surgical excision for pterygium identified 6 patients with recurrence treated with 0.1‐0.2ml (2.5‐5mg) of intralesional 5 FU post operatively. The time to recurrence, post recurrence injections, grade of pterygium pre and post treatment and time to regression were identified. Results The study group consisted of 5 male and 1 female patients, affecting 6 right eyes. 3 patients developed primary recurrence. The other 3 patients had previous surgery with recurrence followed by further surgical excision and repeat recurrence. The average grade of recurrence was 3.5. All 6 patients showed regression of the fibrovascular tissue following intralesional 5FU injections with an average dose of 0.1‐0.2 ml (2.5‐5mg). 5 patients required 3 injections or less for regression, whilst one patient required 14 post recurrence 5FU injections. The average grade following regression was 1.7. This level of regression was maintained at an average of 9 months follow‐up. No complications of 5FU were reported. Conclusion The use of 5FU for the treatment of recurrent pterygium is safe and effective in limiting both progression and inducing regression of recurrent pterygium.

Comparing techniques for pterygium surgery

To compare various techniques of pterygium surgery including bare sclera, intraoperative mitomycin C application, conjunctival flap reconstruction, and conjunctival autografting technique. This study is designed to compare 4 currently used techniques in order to determine the complication and recurrence rates after pterygium exision. Included in the study were 77 eyes from 60 patients. Bare sclera technique was used to treat 21 primary pterygia;mitomycin C was used to treat 20 (16 primary, 4 recurrent) pterygia;18 (17 primary, 1 recurrent) pterygia were treated by conjuntival flap reconstruction;and 18 (9 primary, 9 recurrent) pterygia were treated by conjunctival autografting technique. All patients who underwent surgery were followed up for between 6 months and 2 years. Eight recurrences (38.09%) were observed in the bare sclera group whereas there were 5 (25%) recurrences in the mitomycin C group. In the conjunctival flap reconstruction group, 6 (33.33%) recurrences were detected. In the conjunctival autografting group, 3 recurrences were observed. There were no major complications threatening visual ability in the surgical patients. A comparison of the groups demonstrated that the recurrence rate was highest in the bare sclera group, and lowest in conjunctival autografting and mitomycin C treatment groups respectively. Although the conjunctival autografting technique is a more difficult and time consuming technique than the others, cosmetic and surgical results were found to be superior. We advise conjunctival autografting for the treatment of pterygium in view of the high recurrence rates of other techniques, and the possible complications of mitomycin C treatment for benign disease.

Corneal limbal autograft transplantation with conjunctival flap in the treatment of pterygium.

目的 观察采用巩膜隧道刀切取的自体带结膜瓣的角膜缘移植片治疗翼状胬肉的临床疗效.方法 对52例(60眼)采用翼状胬肉切除和自体带结膜瓣的角膜缘移植的翼状胬肉的资料进行回顾性研究.术后随访6～12月,观察术后角结膜植片生长情况,供区创面修复时间及翼状胬肉复发情况.结果 供区创面修复为7～10 d,角结膜植片生长良好.2眼复发,复发率3.33%.结论 采用巩膜隧道刀切取的自体带结膜瓣的角膜缘移植片能有效地降低翼状胬肉术后的复发率。

A Comparative Study of Tissue Glue and Vicryl Suture for Closing Limbal-Conjunctival Autografts and Histologic Evaluation After Pterygium Excision

To compare clinical and histopathologic outcomes of tissue glue and vicryl suture to attach limbal conjunctival autografts in pterygium surgery. Twenty-four eyes of 24 patients were included in this study. All eyes had primary pterygia and were treated with limbal conjunctival autograft transplantation after pterygium resection. Tissue glue (Tisseel) was used to attach the limbal conjunctival autograft in 12 eyes and vicryl sutures in 12 eyes. Patients were followed for 6 months. Histopathologic examination was performed in both groups on postoperative days 1, 15, and 45. Main outcome measures were patient comfort, graft success, complications, histopathologic evaluation, and recurrence of pterygium. Patient comfort was significantly higher in the tissue glue group than the vicryl suture group (P < 0.05). All grafts were intact in both groups during the follow-up period. No recurrence was observed during the 6-month follow-up in both groups. Foreign-body granulation tissue was not seen in any histopathologic studies in eyes with tissue glue, whereas it was observed in eyes with vicryl sutures from day 15 to day 45. The tissue glue was seen under the conjunctiva on the first postoperative day and was not seen on days 15 and 45. Our results showed that limbal conjunctival autografting is an effective surgical technique for the treatment of pterygium, and tissue glue was efficacious in securing the limbal conjunctival autograft in pterygium surgery. The use of tissue glue decreases patient symptoms during the postoperative period after pterygium surgery. Compared with sutures, tissue glue had no adverse effects on ocular tissue.