The efficiency of limbal conjunctival autografting in pterygium surgery

PURPOSE: To investigate the efficiency of limbal conjunctival autografting technique in pterygium surgery. METHODS: Eighty-four eyes of 68 patients with pterygium were treated by simple excision technique and 29 eyes of 24 patients with pterygium were treated by limbal conjunctival autografting technique. The definition of recurrence was fibrovascular tissue over the limbus onto the cornea in the area of previous pterygium excision. RESULTS: The ages of the patients were between 25 and 88. The follow-up periods ranged from 6 to 25 months. The patients treated by simple excision technique were followed up for 6 to 25 (average 15+/-6) months and the patients treated by limbal conjunctival auto-grafting technique were followed up for 7 to 24 (average 17+/-5) months. The recurrence rates were 27% (23 eyes) and 7% (2 eyes), respectively. There was a statistically significant difference in the recurrence rate between the patients who underwent simple excision and those who underwent limbal conjunctival autografting (p=0.016). CONCLUSIONS: Limbal conjunctival autografting is an effective surgical technique for the treatment of pterygium. It has a low recurrence rate when compared with the simple excision technique.     

自体角膜缘干细胞移植术治疗复发性翼状胬肉疗效观察

目的:观察自体角膜缘干细胞移植术治疗复发性翼状胬肉疗效。方法:把66例81眼复发性翼状胬肉患者随机分为两组,治疗组:34例44眼行翼状胬肉切除联合自体角膜缘干细胞移植术;对照组:32例37眼行翼状胬肉切除联合带蒂结膜瓣转移术。胬肉复发的定义:血管纤维组织重新侵入角膜。结果:术后随访12~24mo。治疗组治愈率98%,复发率2%;对照组治愈率84%,复发率16%。两组复发率有统计学意义(χ2=4.62,P<0.05),两组均无明显并发症。结论:自体角膜缘干细胞移植术治疗复发性翼状胬肉疗效高,复发率低于带蒂结膜瓣转移术。     

改良自体结膜瓣移植治疗翼状胬肉的临床初步报告

目的探讨一种治疗初发性翼状胬肉的新的手术方法,寻求防止初发性翼状胬肉术后复发的最佳手术方法。方法18例（18眼）初发性翼状胬肉,在手术显微镜下进行手术,彻底切除翼状胬肉组织,保留巩膜表面的眼球筋膜囊,同时从上方或下方取条状球结膜转位行改良的自体球结膜移植。术后随访12—20个月,平均（16．09±3．56）月。结果18例（18眼）均治愈,未见胬肉复发。术中术后未见并发症。结论手术显微镜下行保留眼球筋膜囊的翼状胬肉切除联合改良自体球结膜移植手术,术后复发率低,是治疗初发性翼状胬肉的一种新的安全有效的方法。     

Conjunctival autografting combined with low-dose mitomycin C for prevention of primary pterygium recurrence

PURPOSE: To compare the clinical outcome of pterygium surgery combining intraoperative mitomycin C (MMC) with a free conjunctival autograft, with three other methods of pterygium surgery, including intraoperative MMC alone, conjunctival autograft alone, and bare sclera without adjunctive treatment. DESIGN: Interventional, randomized and in part nonrandomized, prospective, comparative study. METHODS: setting: A university medical center department of ophthalmology. STUDY POPULATION: One hundred and twenty patients underwent pterygium excision surgery. These patients were divided into four treatment groups. INTERVENTION: In group 1 (30 patients), MMC, 0.2 mg/ml, was applied for three minutes. In group 2 (30 patients), conjunctival autografting was performed. Group 3 (30 patients) received sodium chloride 0.9% only, and group 4 (30 patients) underwent conjunctival autografting combined with one minute application of MMC, 0.2 mg/ml. MAIN OUTCOME MEASURE: Recurrence rates and complications. RESULTS: Pterygium recurred in two patients (6.6%) in group 1, in four patients (13.3%) in group 2, in 14 patients (46.6%) in group 3, and in none of the patients in group 4. chi(2) analysis revealed a significantly lower recurrence rate in group 4 compared with group 2 (P = .038) and with group 3 (P < .0001). Epithelialization of the wounds was complete within 14 days of surgery. No complications were demonstrated in any of the study groups except for one case of minor melting of the flap in group 4. CONCLUSIONS: This study indicates that pterygium excision with a free conjunctival autograft combined with intraoperative low-dose MMC is a safe and effective technique in pterygium surgery.     

Low-dose intraoperative mitomycin C as chemoadjuvant for pterygium surgery

PURPOSE: To evaluate the efficacy and safety of low-dose intraoperative mitomycin C (MMC) during bare sclera procedure and to compare the rates of pterygium recurrence between recurrent pterygium patients treated with adjuvant MMC and those reconstructed with a conjunctival autograft. METHODS: We studied the recurrence of pterygium, 12-month pterygium-free survival rates, final appearance, and postoperative complications in 96 eyes of 92 patients who received either intraoperative 0.02% MMC for 30 seconds or conjunctival autografting after pterygium excision. Patients were divided into three groups: group 1 included 38 eyes with primary pterygium undergone intraoperative MMC; group 2, 26 eyes with recurrent pterygium treated with intraoperative MMC; and group 3, 32 eyes with recurrent pterygium treated with pterygium excision and conjunctival autografting. RESULTS: Pterygium recurred in 3 (7.9%) of 38 eyes in group 1, 5 (19.2%) of 26 eyes in group 2, and 2 (6.3%) of 32 eyes in group 3. Despite the higher recurrence rate in group 2 compared with that of group 3, the difference between the two was not statistically significant (p = 0.22). The cumulative probabilities of success were 91.6+/-4.6%, 80.8+/-7.7%, and 92.3+/-5.4% at 12 months for groups 1, 2, and 3, respectively. Final appearance of the pterygium excision area was satisfactory in nearly two-thirds of the MMC-treated patients, 71.1% and 65.4% for groups I and 2, compared to 75.1% of patients who had undergone conjunctival autografting. No patients experienced severe complications during a mean postoperative follow-up of 27.3+/-4.1 months, 29.9+/-3.9 months, and 40.9+/-19.1 months for groups 1, 2, and 3, respectively. CONCLUSIONS: A single intraoperative application of 0.02% MMC for 30 seconds after pterygium excision is associated with minimal complication and effectively reduces the recurrence rates after excision of primary or recurrent pterygium. In comparison with conjunctival autografting, low-dose application of MMC after bare sclera procedure is less efficacious in preventing recurrence of pterygium, but simpler and produces a similar proportion of patients with satisfactory final appearance.     

Comparison of inferior conjunctival autografting and conjunctival tissue grafting from pterygium itself in the cases of filtering blebs and glaucoma suspects-A retrospective analysis

Purpose:This study aims at comparing the effectiveness of inferior conjunctival autografting (CAG) and conjunctival tissue grafting from pterygium itself (CTG) in the cases of filtering blebs/glaucoma suspects.Methods:One hundered and five eyes of 97 patients who underwent pterygium excision with conjunctival autografting (CAG) in the period from 2010 to 2016 were included. Fifty one eyes had filtering blebs and 54 were glaucoma suspects. Fifty two eyes of 49 patients (Group 1) had undergone pterygium excision with inferior conjunctival autograft (CAG) and 53 eyes of 48 patients (Group 2) had undergone pterygium excision with conjunctival tissue graft (CTG) from the pterygium itself. The minimum follow up period was 6 months.Results:Both groups had 2 eyes with recurrence, which was not statistically significant. Among other complications, graft retraction was seen with a higher incidence in Group 2, which was statistically significant.Conclusion:In situations where sparing of the superior conjunctiva is mandatory, both the techniques of inferior conjunctival autografting and conjunctival tissue graft from the pterygium itself are excellent alternate options with comparable outcomes and no additional risk of significant complications.     

Pterygium: surgical treatment

PURPOSE: The surgical management of pterygium is often complicated by recurrence of disease. The goal of this study was to compare three different surgical techniques used for the treatment of pterygium. METHOD: We propose a prospective and partly retrospective study on 167 cases of pterygium 151 were primary and 16 were recurrent, treated between 1 January, 1995 and 30 June, 1998. The surgical treatment used of 3 different techniques: pterygium excision for 111 eyes, pterygium excision with conjunctival autograft for 29 eyes, pterygium excision with application of mitomycin C for 27 eyes. RESULTS: Immediate results for the three kinds of treatment were good. No serious complications were noted. Long-term results show a recurrence rate of 10.3% for conjunctival autograft, 11.1% for mitomycin C application, while the pterygium excision alone had a recurrence rate of 55.9%. CONCLUSION: This study demonstrated that conjunctival autografting and the application of mitomycin C are safe surgical techniques that reduce the probability of recurrence after surgery for pterygium. They can be recommended for young people and patients exposed to sun. Mitomycin therapy is the most appropriate treatment for these cases, because of its simplicity, lower lost and the relative lack of complication.     

Conjunctival-limbal autografts for primary and recurrent pterygia: technique and results

Our technique of pterygium excision with conjunctival-limbal autografting is described and the safety and efficacy of the procedure in India is analysed. Case records of 51 consecutive patients (53 eyes) who underwent surgery at our institute between November 1992 and September 1994 were retrospectively analysed. Recurrence was defined as fibrovascular tissue crossing the corneoscleral limbus onto clear cornea in the area of previous pterygium excision. 2 (3.8%) of the 53 pterygia (primary 36; recurrent 17) recurred, after a mean follow up of 18.9 +/- 12.1 months (range: 1.5-43 months). Both recurrences occurred within a year of follow up, in patients who were < or = 40 years of age. No major operative or postoperative complications were encountered. The inclusion of limbal tissue in conjunctival autografts following pterygium excision appears to be essential to ensure low recurrence rates. The technique is safe, simple and inexpensive and is recommended for the management of both primary and recurrent pterygia in Indian eyes.     

自体角膜缘干细胞移植术治疗原发性翼状胬肉疗效观察

目的:观察自体角膜缘干细胞移植术治疗原发性翼状胬肉疗效。方法:把76例93眼原发性翼状胬肉患者随机分为两组:治疗组(41例51眼)行翼状胬肉切除联合自体角膜缘干细胞移植术;对照组(35例42眼)行翼状胬肉单纯切除术。胬肉复发的定义:血管纤维组织重新侵入角膜。结果:术后随访9～24mo。治疗组治愈率96%,复发率4%;对照组治愈率76%,复发率24%。两组复发率有统计学意义(χ2=8.09,P<0.01),两组均无明显并发症。结论:自体角膜缘干细胞移植术治疗原发性翼状胬肉疗效好,复发率低于单纯切除术。     

改良翼状胬肉结膜移植手术99例体会

目的探讨翼状胬肉手术中,采用改良方法,达到不用缝合线缝合移植片结膜的临床方法。方法对99例108眼翼状胬肉患者做翼状胬肉切除联合自体角膜缘结膜移植,采用烧灼粘合自体角膜缘结膜片,达到不用缝合线缝合移植片结膜的临床方法。结果术后随访108例102眼结膜移植片位置良好,6例6眼脱落或偏位,翼状胬肉复发率为5.56%。结论自体角膜缘结膜移植治疗翼状胬肉手术中,结膜烧灼粘合,节省缝线,患者异物感明显减轻,无须拆线,安全有效,简单易行,值得临床推广。     

翼状胬肉切除联合角膜缘干细胞移植术远期疗效分析

目的探讨翼状胬肉切除联合角膜缘干细胞移植及附加综合辅助治疗措施治疗翼状胬肉的临床远期疗效。方法回顾分析113例（117只眼）翼状胬肉切除联合角膜缘干细胞移植术病例,其中65只眼仅行常规手术,52只眼行常规手术联合综合辅助治疗。结果 65只眼仅行常规手术有4只眼复发,复发率为6.15%;52只眼行常规手术联合综合辅助治疗措施后2只眼复发,复发率为3.85%。经统计学分析,P〈0.05,差异有统计学意义。结论翼状胬肉切除联合角膜缘干细胞移植术治疗翼状胬肉安全、有效,尽量排除不利因素,采取综合辅助治疗措施可更有效地减少民办状胬肉术后复发率。     

Evaluation of the recurrence rate for pterygium treated with conjunctival autograft

Purpose

The aim of this study was to evaluate the recurrence rate for the conjunctival autografts in the treatment of primary pterygium.

Methods

Thirty-six eyes of 36 patients with the diagnosis of primary pterygium underwent surgical excision and were treated with conjunctival autografts. Complications, recurrence rate, and final appearance of the cases were evaluated prospectively.

Results

Complications were observed in five cases; three eyes with Dellen ulcer and two cases with a Tenon’s cyst in the superior temporal quadrant. Recurrence was detected in three cases in the study group. The onset of recurrence was 4.5 months. Higher complication rates were detected among the patient group below 54 years old than in the patient group aged 54 years or over, 22.2 % vs 5.6 % respectively (p?=?0.338). Complications were more frequent among male patients than among female patients, 22.2 % vs 5.6 % respectively (p?=?0.338). Recurrence was detected in four cases (8 %), with an average recurrence time of 4.5 months.

Conclusion

We suggest that conjunctival autografting is an effective technique in primary pterygium in terms of low recurrence rate. Increasing patient age is associated with significantly less risk of recurrence and complication.     

Pterygium excision with conjunctival autografting: an effective and safe technique.

The optimum mode of treatment for symptomatic pterygia would combine efficacy (a low recurrence rate) with safety (freedom from sight threatening complications), and would not affect visual acuity adversely. The efficacy of pterygium excision with conjunctival autografting in a sun exposed population in which pterygia are prevalent has previously been questioned. A cross sectional review of 93 eyes of 85 patients was carried out by slit-lamp examination a minimum of 6 months (range 6-76 months) after pterygium excision and free conjunctival autografting. Case notes were reviewed to obtain details of complications and visual acuity changes related to surgery. Of six recurrences (6.5%) four of these were asymptomatic with minor recurrences. Two patterns of recurrence were identified: cross graft recurrence (three cases) and outflanking (three cases). Complications (wound dehiscence, three cases; Tenon's granuloma one case; conjunctival cyst, one case) were all corrected by minor surgical revision without sequelae. Unaided acuities were unchanged or improved 3 months after surgery in 86 cases, with a minor diminution (1 Snellen line) in seven cases. This study demonstrates a low recurrence rate for a safe technique in an area in which ongoing ultraviolet light exposure levels are high and pterygia are prevalent.     

不同手术方式治疗翼状胬肉的临床疗效分析

目的：探讨不同手术方式治疗翼状胬肉的临床效果。

方法：对我院2006-01/2010-12行不同手术方式治疗的164例206眼翼状胬肉患者的临床资料进行回顾性分析。A组(36例50眼)采用单纯切除术; B组(41例47眼)采用单纯切除联合丝裂霉素术; C组(42例52眼)采用胬肉切除联合丝裂霉素和羊膜移植术; D组(45例57眼)采用胬肉切除联合自体角膜缘干细胞移植术。记录每例手术时间,术后1wk; 3,6,12,24mo进行随访观察,观察结膜愈合及胬肉复发情况等。

结果：A组复发率最高,B组复发率有所降低,C、D 组复发率较A组及B组明显降低,C、D 组复发率无明显差异。手术时间方面,单纯切除组的手术时间明显短于其他组,羊膜移植及自体角膜缘干细胞移植组的手术时间较长。复发主要发生在术后1a内。

结论：丝裂霉素可以降低单纯胬肉切除术的复发率,角膜缘干细胞移植及羊膜移植术可以更有效的降低胬肉的复发率。     

自体结膜角巩膜缘移植治疗原发性翼状胬肉(英文)

目的:评价自体结膜角巩膜缘移植术治疗原发性翼状胬肉的有效性。方法:原发性翼状胬肉患者15例(15眼),接受自体结膜角巩膜缘移植术。切除翼状胬肉后,植片的角膜缘部分与翼状胬肉切除处的角膜缘对位缝合,植片的上皮面向上。纤维血管组织在原翼状胬肉区遮盖角膜1mm以上定为复发。结果:随访平均8mo,所有的患者既无一例复发也无并发症发生。结论:单纯翼状胬肉切除联合自体结膜角巩膜缘移植是一种治疗原发性翼状胬肉安全有效的手术方法。     

不同术式治疗翼状胬肉的疗效分析

目的:比较巩膜暴露法、带球结膜瓣的角膜缘干细胞移植术、带球结膜瓣的角膜缘干细胞移植术联合术中封闭球结膜与Tenon囊之间间隙的手术方式治疗翼状胬肉的临床疗效。方法:翼状胬肉患者130例138眼,分为三组:A组(45例,48眼):采用巩膜暴露法行翼状胬肉切除术;B组(42例,45眼):带球结膜瓣的角膜缘干细胞移植术;C组(43例,45眼):翼状胬肉切除联合带球结膜瓣的角膜缘干细胞移植术及封闭球结膜与Tenon囊之间间隙。术后随访12mo。结果:三组复发率分别为27.1%,8.9%,4.4%。A组与其余两组比较存在显著差异(P<0.05),B组与C组存在差异,但无统计学意义。肉芽肿形成:A组3眼,B组2眼,C组未见。C组泪阜的形态及位置明显优于A组及B组。结论:带球结膜瓣的角膜缘干细胞移植术联合术中封闭球结膜与Tenon囊之间间隙能显著降低翼状胬肉术后复发率,减轻炎症反应,预防肉芽肿的形成,有助于恢复泪阜的正常形态及位置,是目前治疗翼状胬肉的较理想手术方式。     

Measures for preventing recurrence after pterygium surgery

PURPOSE: To introduce an improved technique of pterygium surgery and to compare postoperative results between this technique and previous techniques. METHODS: In a retrospective survey, the records of 216 consecutive eyes with primary pterygium that underwent surgery by three different techniques were reviewed. The new technique (mini-flap technique) involves making a small excision of the pterygium body, removing the pterygium head by scraping with forceps, applying mitomycin C (MMC), and performing a small conjunctival transposition flap. The previous technique (large-flap technique II) involved making a large excision in the pterygium body, removing the pterygium head with a knife, applying MMC, and performing a large transposition flap. Large-flap technique I is the same as large-flap technique II except for the use of intraoperative MMC. The recurrence rate of each technique was estimated by the Kaplan-Meier life table analysis. RESULTS: The recurrence rates estimated at 1 year after surgery were 15.5% in large-flap technique I, 4.2% in large-flap technique II, and 0% in the mini-flap technique. Large-flap technique II or the mini-flap technique had significantly lower recurrence rates compared with large-flap technique I ( p = 0.02 and p < 0.01, respectively). The mini-flap technique had a significantly lower incidence of conjunctival scarring or granuloma compared with large-flap technique I and large-flap technique II ( p = 0.05 and p = 0.03, respectively.) CONCLUSIONS: The mini-flap technique was useful for preventing recurrence and was technically easier and induced fewer postoperative complications than large-flap techniques I and II.     

A Comparative Study of the Effect of Fibrin Glue versus Sutures on Clinical Outcome in Patients Undergoing Pterygium Excision and Conjunctival Autografts

Purpose

To compare the effect of using fibrin glue or 10-0 nylon sutures on the clinical outcome of patients undergoing pterygium excision and conjunctival autografting.

Methods

We retrospectively reviewed the medical records of 52 eyes from 46 patients who underwent pterygium excision and conjunctival autografting and were followed up for more than 3 months. The operation duration, postoperative inflammation, complications, and recurrence rates were compared between groups of 20 patients (22 eyes) for whom fibrin glue was used (fibrin glue group) and 26 patients (30 eyes) for whom suturing was performed with 10-0 nylon (suture group) in pterygium excision and conjunctival autografting.

Results

The operation duration was 27.71 (5.22) minutes in the fibrin glue group and 43.30 (8.18) minutes in the suture group (p = 0.000). Seven days after the operation, the fibrin glue group showed milder conjunctival inflammation than the suture group (p = 0.000). Postoperative complications and corneal recurrence rates were not statistically different between the two groups.

Conclusions

The use of fibrin glue in pterygium excision with conjunctival autografting is likely to be a more effective, safer procedure than suturing.     

Analysis of variation in success rates in conjunctival autografting for primary and recurrent pterygium

AIMS: To evaluate the success rates of conjunctival autografting for primary and recurrent pterygium performed in a tertiary ophthalmic centre. METHODS: The outcome of 139 cases with primary pterygia and 64 cases with recurrent pterygia who underwent excision with conjunctival autografting was retrospectively reviewed. Outcome was evaluated in terms of recurrence of pterygia onto the cornea. The recurrence rates were determined using Weibull survival functions, in a mixture model that included a component allowing for cure. The suitability of this model was verified using Turnbull's non-parametric method for interval censored data (1974). Estimated recurrence free probabilities were based on the fitted Weibull survival curves. RESULTS: Mean follow up was 8.4 months in the primary group, and 9.5 months for the recurrent group. 29 out of 139 cases of primary pterygia recurred (20.8%) while 20 out of 64 cases in the recurrent group (31.2%) recurred. Recurrence rates varied widely among surgeons, ranging from 5% to 82%. Recurrence rates were inversely related to previous experience in performing conjunctival grafting. The recurrence free probability was 84% at 3 months, 73% at 1 year for primary pterygia, and 80% at 3 months, 67% at 1 year for recurrent pterygia. There was no statistical difference in recurrence rates between primary and recurrent groups (p= 0.80). CONCLUSION: The success of conjunctival autografting for pterygium in this series varies widely, and may be related to a significant learning curve or differing surgical techniques for this procedure. This may account for the wide variation in reported success of this procedure in the ophthalmic literature.     

Inferior conjunctival autograft for primary pterygia

OBJECTIVE: Superior conjunctival graft is commonly used in pterygium surgery, which may adversely affect the outcome of future filtration surgery. We retrospectively studied the success rate of inferior conjunctival autografting for primary pterygia in our unit. DESIGN: A noncomparative, retrospective, interventional case series. PARTICIPANTS: Thirty eyes of 27 patients treated between August 1996 and February 2001 with primary pterygia. INTERVENTION: Excision of pterygium followed by conjunctival autograft harvested from the inferior bulbar conjunctiva. Surgeries were performed by an experienced surgeon (CL) in 23 patients and by trainees in the remaining four cases. MAIN OUTCOME MEASURES: Recurrence of the pterygium and complications. RESULTS: Mean follow-up was 27 months (range, 8-53). Recurrence occurred in one eye (3.3%). This was a white female in her early fifties, with recurrence detected 3 months after the surgery. Conjunctival scarring at the donor site was observed in 11 eyes (36.66%). There was no symblepharon formation. There was no restriction of up gaze. Hemorrhage under the conjunctival graft developed in three eyes, corneal dellen near the limbus developed in four eyes, and epithelial inclusion cysts at the recipient site developed in two eyes. CONCLUSIONS: Inferior conjunctival autografting is an effective technique with a low recurrence rate. This is a useful technique in cases in which it is not possible or desirable to use the superior conjunctiva as a donor source.