Treatment Of Recurrent Pterygium Research Articles

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.

Результаты периферической послойной кератопластики при лечении рецидивирующего птеригиума

Результаты периферической послойной кератопластики при лечении рецидивирующего птеригиума

Хирургическое лечение рецидивирующего птеригиума методом транспозиции аутоконъюнктивального трансплантата

Хирургическое лечение рецидивирующего птеригиума методом транспозиции аутоконъюнктивального трансплантата

К вопросу о возможностях хирургического лечения рецидивирующего птеригиума

К вопросу о возможностях хирургического лечения рецидивирующего птеригиума

Outcome of intraoperative use of mitomycin C combined with conjunctival auto graft in recurrent pterygium

Background and objectives: Recurrent pterygium is an important ocular problem in our country. There are different modalities of treatment for recurrent pterygium. The present study was undertaken to determine the effect of intraoperative mitomycin C along with conjunctival auto graft to prevent recurrence of pterygium.Methods: Patients with recurrent pterygium attending a tertiary care hospital in Dhaka from January 2013 to June 2015 were included in the study. Cases were randomized into two groups. Group 1 had pterygium surgery with conjunctival auto graft and Group 2 had auto graft and intraoperative mitomycin C (0.02%). All cases were followed up for one year to assess recurrence of pterygium.Results: A total of 54 recurrent pterygia cases were included in the study. The age of study population was 25 to 65 years. The recurrence rate of pterygium after 12 months was 77.7% in group 1 and none in group 2. No major postoperative complication was observed.Conclusion: The study demonstrated that the use of intraoperative mitomycin C along with conjunctival auto graft had significant effect in preventing the recurrence of pterygium.IMC J Med Sci 2016; 10(2): 49-52

Amniotic membrane transplantation combined with mitomycin C application for recurrent pterygium

Objective To evaluate the clinical effect of amniotic membrane transplantation combined with mitomycin C application for recurrent pterygium.Methods A retrospective randomized study was performed on 100 cases of recurrent pterygium treated by amniotic membrane transplantation combined with mitomycin C application in our hospital form June 2010 to June 2013.They were randomly divided into group A and group B.Group A underwent amniotic membrane transplantation combined with mitomycin C application for 5 minutes.Group B only accepted amniotic membrane transplantation.The recurrence rate and surgical complications were compared between the two groups.Results The recurrence rate and incidence of surgical complications in group A were lower than that in group B (P ＜ 0.05).Conclusion Compared with amniotic membrane transplantation alone,amniotic membrane transplantation combined with mitomycin C application is safer and more effective in the treatment of recurrent pterygium. Key words: Transplantation, membrane, amniotic ; Mitomycin C ; Pterygium, recurrent

Comparison of Two Techniques for the Treatment of Recurrent Pterygium: Amniotic Membrane vs Conjunctival Autograft Combined with Mitomycin C

Purpose: To compare the results of amniotic membrane transplantation (AMT) combined with mitomycin C (MMC) to the results of free conjunctival autograft (CA) combined with MMC for the treatment of patients with recurrent pterygium. Methods: In this prospective study, 60 eyes of 55 patients with recurrent pterygium were included and randomly assigned into group I (n = 30) who underwent AMT combined with MMC (AMT-MMC) and group II (n = 30) who underwent CA combined with MMC (CA-MMC). During a mean follow-up of 27.2 ± 20.8 months, recurrence of pterygium, change in uncorrected visual acuity and complications (including pain, corneal, conjunctival or scleral changes) were analyzed and were compared between groups. Results: Five eyes of 5 patients were lost to follow-up and were removed from analysis. The mean age (p = 0.274), the mean follow-up (p = 0.063), the number of prior pterygium excision surgeries (p = 0.641) and the mean preoperative visual acuity (p = 0.959) were similar in both groups. Recurrence was seen in 2 eyes (8%) in AMT-MMC group and 4 patients (13.3%) in CA-MMC group (p = 0.531). Postoperative visual acuity (p = 0.237), change in visual acuity (p = 0.525), severe pain (p = 0.531) and epithelial defect lasting more than 5 days (p = 0.510) were similar in both groups. Conclusions: Amniotic membrane combined with MMC has similar recurrence rate to CA combined with MMC, in patients with recurrent pterygium. Similar outcomes and complication rates make AMT-MMC a promising method for the treatment of recurrent pterygium cases.

Phototherapeutic keratectomy for treatment of recurrent pterygium

Objective To evaluate the treatment outcomes of excimer laser phototherapeutic keratectomy (PTK) for recurrent pterygium.Methods 106 eyes of 106 patients diagnosed with recurrent pterygium that underwent PTK or autologous limbal stem cell transplantation were retrospectively evaluated.PTK treatment group (53 eyes):Pterygia were treated by separating and excising conjunctiva and pathological tissues.The residual pathological tissues underwent PTK with the Technolas 217z excimer laser.Control group (53 eyes):autologous limbal stem cell transplantation was performed.Data were analyzed for preoperative and postoperative reepitheliation,recurrence rate,and corneal astigmatism.Results The mean reepitheliation time of PTK group was (3.96 ± 0.78) days,and it was significantly shorter than that of control group (4.67 ± 1.01) days (t =-4.071,P ＜ 0.01).The mean postoperative corneal astigmatism in PTK group declined about (0.72 ± 0.80) D comparing to the preoperative one,and the improvement was signifi-cantly more than that of the control group (0.42 ± 0.43 D) (t =-1.342,P =0.02).The mean follow-up time was (18.05 ± 5.32) months.3 cases recurred in PTK group,the recurrence rate was 5.66％ ; 4 cases recurred in control group,the recurrence rate was 7.55％.There was no significant difference in recurrent rate between the two groups (x2 =0.368,P =0.70).Conclusion PTK can be a safe and effective therapeutic alternative for recurrent pterygium.It can avoid excessive operative trauma,hasten reepitheliation,and reduce corneal astigmastism.It can effectively decrease the recurrence rate of pterygium as autologous limbal stem cell transplantation. Key words: Keratectomy, phototherapeutic ; Pterygium; Stem cell, limbal

Subconjunctival Bevacizumab Injection in Treatment of Recurrent Pterygium

Objective: To determine the clinical effect of subconjunctival injection of bevacizumab in regression or halting growth in patients with recurrent pterygium.Method and materials: The study was an off-label; 2-dosing, interventional case series involving 20 patients with recurrent pterygium. They received subconjunctival bevacizumab (0.2 ml/2.5 mg). Vascularity and thickness of Pterygium was graded. Size of the pterygium (measured by surface area in cm2) was recorded from baseline to 6 months, after injection. Treatment-related complications and adverse events were reported. The main outcome of measurements was the change in grading, size, vascularity, thickness and color intensity.Results: 9 males (45%) , 11 females (55%) of 20 patients were conducted in study with a mean age of 50.46 years ± 18.30 (rang 38-70). There was a significant reduction in grading with significant difference in the mean surface area of pterygium at different intervals (P<0.05) and the size of pterygium was reduced. The reduction of color intensity was significant (P=0.031). No significant topical or systemic adverse reactions were recorded.Conclusions: Subconjunctival bevacizumab injection is useful in management of patients with recurrent pterygium without significant local or systemic adverse effects.

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

Treatment of recurrent pterygium treated by microsurgical management

目的 用显微外科技术治疗复发性翼状胬肉,同时比较角膜缘干细胞移植联合丝裂霉素C(mitomycin C,MMC)治疗复发性翼状胬肉的临床疗效.方法 将62例(67眼)患者随机分为2组,治疗组采用角膜缘干细胞移植联合应用丝裂霉素C,共34例(38眼);对照组单纯采用角膜缘干细胞移植技术,共28例(29眼),术后随访6～30 个月.结果 治疗组1眼复发,复发率2.63%,对照组3眼复发,复发率10.34%,两组比较差异有统计学意义(P＜0.05),角膜创面上皮平均愈合时间治疗组为(6.61±1.79)d,对照组为(5.83±1.91)d,两组比较差异无统计学意义(P＞0.05).结论 角膜缘干细胞移植术联合应用丝裂霉素C治疗复发性翼状胬肉再复发率低,未发生不良并发症,为治疗复发性翼状胬状安全和有效的手术方法。

Mitomycin C and conjunctival autograft for recurrent pterygium

To observe the efficiency of intraoperative low-dose Mitomycin-C combined with conjunctival autograft in the treatment of recurrent pterygium. Fifteen eyes with recurrent pterygium were included in this study. The mean age of the patients was 51.6 +/- 11.4 (9 men, 6 women). All patients underwent excision of the pterygium tissue and subconjunctival fibrous tissue with a no cautery approach. 0.2 mg/ml Mitomycin-C (0.02%) was applied for 3 min. Conjunctival autograft was obtained from the superotemporal bulbar conjunctiva of the same eye. Eyes were followed for a mean period of 21.0 +/- 9.1 months. Recurrence was seen in two eyes (13.3%) during the follow-up period. The only complication seen was graft edema (two eyes; 13.3%) which healed after pressure patching. Graft necrosis, scleral melting or failure of revascularization was not noted. Intraoperative application of 0.2 mg/ml Mitomycin-C combined with conjunctival autograft reduces recurrence in recurrent pterygium cases, with minimal complications.

Comparison of Three Methods for the Treatment of Pterygium: Amniotic Membrane Graft, Conjunctival Autograft and Conjunctival Autograft plus Mitomycin C.

Objective: To compare three techniques combined with excision in the treatment of primary and recurrent pterygium: amniotic membrane transplantation, conjunctival autograft, and conjunctival autograft plus mitomycin C. Materials and Methods: Forty-nine eyes of 49 subjects (30 primary, 19 recurrent pterygium) were included in this study. Combined with excision, 25 eyes (18 primary, 7 recurrent pterygium) were treated with conjunctival autografts (Group 1), and 16 eyes (12 primary, 4 recurrent pterygium) were treated with amniotic membrane transplantation for the closure of the defect (Group 2). In 8 eyes (all recurrent pterygium) low-dose mitomycin C (0.02%) was applied topically to the defect area and a conjunctival autograft was applied thereafter (Group 3). The three groups were compared with regard to the recurrence of pterygium and the defect area requiring treatment. Results: The number and percentages of recurrence seen in groups 1, 2 and 3 were as follows: 4 (16%), 4 (25%), and 0(−), respectively. For the treatment of primary pterygium cases, amniotic membrane closure and conjunctival autograft closure were comparable in effectiveness (p > 0.05). In the treatment of recurrent pterygium, there was no significant difference between the three techniques (p > 0.05). Amniotic membrane closure and conjunctival autografts were equally effective for the treatment of both primary and recurrent pterygium (p > 0.05). The graft size was significantly larger in the cases with recurrent pterygium (p = 0.016). Conclusions: Amniotic membrane closure and conjunctival autografts seem to be equally effective in the prevention of recurrence of primary pterygium. Conjunctival autografts combined with mitomycin C are as effective as the above two techniques to prevent recurrence in the treatment of recurrent pterygium. Due to the larger area of subconjunctival fibrosis, a larger defect area is created after the excision of pterygium tissue and a larger graft is needed to close this defect in recurrent pterygium. This factor can guide the surgeon during the planning of the surgery to choose the most appropriate technique for closure of the defect.

Fresh lamellar keratoplasty associated with amniotic membrane transplantation for treatment of recurrent pterygium

目的 探讨新鲜板层角膜联合羊膜移植治疗复发性翼状胬肉的临床效果.方法复发性翼状胬肉16例(22眼),采用新鲜板层角膜联合羊膜移植进行治疗,并随访观察6月～2年.结果全部患者上皮愈合良好稳定,表面完整光滑,角膜基本透明,视力保持不变,无排斥反应,无复发.结论新鲜板层角膜含健康的角膜缘干细胞和角膜上皮细胞,可迅速修复损伤的角膜表面.羊膜有抗炎、抑制血管新生及纤维化,阻止变性结膜组织生长的作用,用新鲜板层角膜联合羊膜移植治疗复发性翼状胬肉效果显著。

Clinical observation of corneal limbal autograft for treating recurrent pterygium

目的 观察自体角膜缘干细胞移植术治疗复发性翼状胬肉的临床效果.方法对复发性翼状胬肉27例(30眼)在手术显微镜下行胬肉切除加自体角膜缘干细胞移植术,术后随访6月以上,观察其效果.结果30眼中治愈29眼,治愈率为96.67%;1眼胬肉复发,复发率3.33%.结论角膜缘干细胞移植术能明显减少胬肉手术的复发率。

Long-term follow-up results of lamellar keratoplasty as a treatment for recurrent pterygium and for scleral necrosis induced by beta-irradiation.

To evaluate the efficacy and safety of lamellar keratoplasty (LK) in the treatment of recurrent pterygium and of scleral necrosis induced by beta-irradiation. A retrospective review of patients who, between 1988 and 2001, underwent LK for the above indications. Recurrence rates, tectonic outcomes, pre- and postoperative visual acuities, and complications were analyzed. In the recurrent pterygium group, LK was performed on 68 eyes. The mean age (mean +/- SD) at presentation was 45.1 +/- 13.7 years (range 17 to 77). The recurrence rate following LK was 5.9%, with a mean time to recurrence of 6.2 +/- 2.9 months (range 3 to 10). In all cases, the recurrence occurred above or below the lamellar grafts, and a second LK prevented any further recurrence. The mean length of follow-up was 27.1 +/- 26.6 months (range 3 to 132). The best-corrected visual acuity (BCVA) improved or remained unchanged in 65 of the 68 eyes (95.6%) but was reduced in the remaining three eyes (4.4%). In the scleral radionecrosis group, LK was performed on 30 eyes. The mean age at presentation was 67.7 +/- 10.3 years (range 37 to 85). Tectonic restoration was achieved in all patients. The mean length of follow-up was 49.0 +/- 45.1 months (range 8 to 120). The BCVA improved or remained unchanged in all patients. No significant complications were identified. Lamellar keratoplasty is a safe and effective treatment option for both recurrent pterygium and beta-irradiation-induced scleral necrosis. In our opinion, LK is the treatment of choice for multiple or aggressive recurrences of pterygium and a successful management option for scleral radionecrosis.

Evaluation of Limbal Conjunctival Autograft and Low-Dose Mitomycin C in the Treatment of Recurrent Pterygium

To assess the effectiveness of limbal conjunctival autograft and low-dose mitomycin C in the treatment of recurrent pterygium. Thirty-four eyes with recurrent pterygium underwent surgical excision followed by the intraoperative application of low-dose (0.05%) mitomycin C and the use of limbal conjunctival autograft. All patients were observed for at least 18 months for any complications, including recurrences. Neither recurrences nor serious complications were recorded. Visual acuity improved significantly (P < .05) in eyes with pterygium extending 3 mm or more beyond the limbus. Simple excision and low-dose mitomycin C followed by limbal conjunctival autograft is a safe and effective way of treating recurrent pterygium.

Tratamento do pterígio recidivado por transplante autólogo de conjuntiva

Objetivo: Avaliar a resposta ao tratamento do pterígio recidivado, usando a técnica do transplante autólogo de conjuntiva. Métodos: Foi realizado estudo retrospectivo de 36 pacientes (36 olhos), portadores de pterígio recidivado, submetidos a transplante autólogo de conjuntiva. O tempo de seguimento mínimo foi de seis meses. Resultados: Observou-se recidiva em 41,6% dos pacientes, perda do enxerto em 5,5% e deiscência de sutura em 2,7%. Conclusões: O transplante de conjuntiva é procedimento com baixo índice de complicações. Porém, quando usado no tratamento do pterígio recidivado, a taxa de recorrência permanece alta.

Pterigium Excision With Application of Mitomycin-C In Enugu, Nigeria

Aim: To evaluate the usefulness of mitomycin-C as it relates to modern techniques in the prevention and treatment of recurrent pterygium. Patients and method: Patients with pterygium and recurrent pterygium were enrolled. Patients’ personal data including age, sex and surgical history were noted. The exclusion criteria applied were failure to comply with at least 6 months of follow-up, and patients whose primary surgeries were performed in centers not included in the study . Included also was a retrospective study of patients who had pterygium excisions with the same surgical technique but without application of any adjuvant. Results: A total of 28 patients satisfied the inclusion criteria. Eighteen of them had surgery for the first time, 15 had re-surgery after initial excision with 5-fluorouracil. A total of 33 eyes were operated on as 5 of the patients had surgery in both eyes . The recurrence rate was 12.0%. For comparative analysis, 32 patients were studied retrospectively with recurrence noted in 20 (62.5%) of them. Conclusion: The rate of recurrence in this study was found to be low with application of low dose mitomycin-C during bare sclera pterygium excision. Without any applications , recurrence rate was found to be as high as 62.5%. This procedure has been found to be simple, affordable and effective. Key words: Recurrent pterygium, prevention, treatment, mitomycin-C. [Jnl College Medicine Vol.7(1): 2002: 24-26]

Limbal-conjunctival autograft transplantation for recurrent pterygium.

To assess the usefulness of limbal-conjunctival autograft transplantation (LCAT) for the treatment of recurrent pterygium. Seventeen eyes with advanced recurrent pterygium underwent LCAT All had already been treated at least twice either by simple excision (n=15) or by conjunctival rotation autograft (n=2). Three eyes (17.65%) had symblepharon at the time of surgery, so LCAT was combined with amniotic membrane transplantation. The autograft was taken from the supero-lateral part of the same eye and transferred to the area where the pterygium had been excised. During 6-18 months of follow-up no postoperative complications occurred. In 15 eyes (88.24%) no pterygium recurrence was recorded; recurrence occurred in two eyes (11.76%) after 8 and 5 months. In three eyes with a combined symblepharon formation, remission of both pterygium and symblepharon growth was obtained. LCAT seems to be a promising and safe procedure for recurrent pterygium.