Photodynamic therapy of corneal neovascularization with verteporfin

PURPOSE: To describe the effect of photodynamic therapy (PDT) using verteporfin (Visudyne) on corneal neovascularization (CNV) in two patients. METHODS: Two patients with corneal neovascularization were treated with a nonthermal laser light at 689 nm delivered 15 min after an intravenous infusion of verteporfin. Postoperative outcome of neovascularization was followed clinically (inflammation, intraocular pressure, and visual acuity) and photographically [color photographs and corneal fluorescein and indocyanine green (ICG) angiography] for a minimum of 6 months. RESULTS: Successful photothrombosis of corneal neovascularization was obtained immediately after treatment in the two patients, and regression was verified by corneal fluorescein and ICG angiography. In one case, partial vessel recanalization was observed after 1 month, and treatment was repeated, with complete regression of new vessels. No relevant side effects were observed in our cases. CONCLUSIONS: PDT with verteporfin is an effective and safe procedure indicated for patients with corneal neovascularization; however, multiple sessions may be required.     

术中应用丝裂霉素治疗不同类型原发性翼状胬肉的疗效观察

目的:探讨丝裂霉素在不同类型原发性翼状胬肉术中局部应用的疗效。方法:选择翼状胬肉组织侵入角膜内>2mm的原发性翼状胬肉患者259例279眼,在显微镜下,按常规方法切除翼状胬肉的头颈体部,用0.2mg/mL的丝裂霉素溶液在巩膜上作用3min,生理盐水充分冲洗,缝合结膜,术后滴复方妥布霉素眼液,4次/d,涂复方妥布霉素眼膏,1次/晚,第7d拆线。随访12～18mo。结果:术后,271眼达到治愈标准,治愈率97.1%;8眼复发,复发率为2.9%。单眼单侧、双眼单侧、单眼双侧的复发率分别为1.8%,2.5%,14.3%。结论:术中局部应用丝裂霉素治疗原发性单眼单侧翼状胬肉效果良好,复发率明显降低,且未见明显副作用;而单眼双侧的翼状胬肉患者治疗后复发率仍较高。     

Photodynamic therapy of circumscribed choroidal hemangioma

PURPOSE: To evaluate efficacy of photodynamic therapy (PDT) with verteporfin in treatment of posterior pole symptomatic circumscribed choroidal hemangiomas. MATERIAL AND METHODS: Four patients (3 men and 1 woman), 15-55 years old (mean age: 29 years) with circumscribed choroidal hemangiomas of the posterior pole, were examined. The hemangiomas localization were subfoveal in one patient, extrafoveal in 2 cases, and juxtapapillar in one case. The diagnosis of choroidal hemangioma was established on the base of clinical examination, A and B--scan ultrasound imaging, Doppler ultrasonography, fluorescein and indocyanine angiography results. Tumour thickness before treatment ranged from 2.3-3.6 mm (mean thickness: 2.8 mm). One course of PDT with verteporfin was performed in 3 cases, while in one patient PDT was performed four times. RESULTS: In a follow-up period which range from 3 to 14 months (mean 5.7 months) all cases demonstrated clinical features of lesion regression with a reduction of thickness on ultrasonography and choroidal vasculature on angiograms. Visual acuity was improved in 3 patients (from 1 to 4 lines on Snellen charts), or remained stable in 1 case. CONCLUSIONS: Our preliminary results indicate that PDT with verteporfin is a safe and effective method of treatment for circumscribed choroidal hemangiomas, especially in patients with posterior pole location of the tumour.     

Intravenous diclofenac as prophylactic treatment for verteporfin-associated low back pain

PURPOSE: The authors report on the therapeutic effect of intravenous diclofenac on verteporfin associated low back pain (LBP), which is the most frequent adverse effect of photodynamic therapy (PDT) for macular degeneration. METHODS: The authors studied 818 patients who received PDT with verteporfin for choroidal neovascularization. Systemic blood pressures were recorded in all study participants half an hour before PDT treatment. All patients who experienced LBP during verteporfin infusion were asked to grade their pain as mild (1), moderate (2), severe (3), or unbearable (4). RESULTS: Thirty-three patients had LBP during their first verteporfin infusion. Of these, 11 subjects (1.34% of all) reported increased pain scores (level 2 to 4) and received intravenous diclofenac ahead of their next PDT. Patients with LBP during verteporfin infusion had significantly higher systolic blood pressures than uncomplicated cases (180 mmHg vs 155 mmHg, p=0.01). Treatment with intravenous diclofenac short before PDT significantly reduced the patients' mean pain score by 1.8 levels (p=0.0001). CONCLUSIONS: In this study, intravenous application of diclofenac short before verteporfin infusion effectively prevented verteporfin associated LBP in patients with systemic hypertension.     

Photodynamic therapy using verteporfin in circumscribed choroidal haemangioma

AIM: To investigate the safety and efficacy of photodynamic therapy with verteporfin in patients with choroidal haemangioma. METHODS: A non-randomised, prospective clinical investigation of 19 patients with symptomatic circumscribed choroidal haemangioma was performed. Unsuccessful pretreatment (external beam irradiation, laser photocoagulation) was performed in four patients. Patients were included when (1) subretinal exudation involving the fovea, (2) a decrease in visual function, and (3) additional symptoms (for example, metamorphopsia) were present. Photodynamic therapy (PDT) was performed with verteporfin at a concentration of 6 mg/m(2) body surface area and a light dose of 100 J/cm(2) at 692 nm. RESULTS: The mean follow up time was 10.6 months (2-24 months). The mean number of treatment sessions was 2.15 (range 1-5). Visual acuity improved by at least one line in 73.3%, by at least two lines in 42.1%, was stable in 21.1%, and decreased by one line in 5.2% of the patients. Exudation was completely resolved in 94.8% of the cases. Regression of tumour height was documented in all 19 tumours. Patients receiving any pretreatment before PDT, a visual acuity of 0.1 and less, a history of more than 30 months, and no significant response after the first PDT session, did not show any significant improvement. Cox regression analysis revealed that the number of PDT treatment sessions was inversely associated with the improvement in visual acuity of at least two lines. No recurrences and no local or systemic side effects were observed during the follow up time. CONCLUSION: PDT using verteporfin is a safe and effective therapy for the treatment of symptomatic choroidal haemangioma even in tumours located beneath the fovea.     

Limbal versus conjunctival autograft transplantation for advanced and recurrent pterygium

PURPOSE: To compare the safety and efficacy of limbal versus conjunctival autograft transplantation for treating advanced and recurrent pterygia. DESIGN: Randomized, prospective clinical trial. PARTICIPANTS: Seventy-nine patients with advanced primary or recurrent pterygia treated by conjunctival (n = 36) or limbal-conjunctival (n = 43) autograft transplantation. INTERVENTION: Twenty four eyes with primary and 12 eyes with recurrent pterygia underwent free conjunctival autograft transplantation (group A), and 28 eyes with primary and 15 eyes with recurrent pterygia underwent limbal-conjunctival autograft transplantation (group B). MAIN OUTCOME MEASURES: Recurrence of pterygium and complications. RESULTS: With a 3-year minimum of follow-up, 2 cases of primary (8.3%) and 4 cases of recurrent (33.3%) pterygia in group A showed recurrence. No patients in group B developed recurrence. CONCLUSIONS: In this study both techniques were effective in cases of advanced primary pterygia with no statistically significant difference. Limbal transplantation appeared more effective than free conjunctival transplantation for treatment of recurrent pterygia (P < 0.05).     

Photodynamische Therapie mit Verteporfin beim Aderhautmelanom

BACKGROUND: The aim of this study was to evaluate whether photodynamic therapy (PDT) with verteporfin is able to induce tumor cell necrosis in human uveal melanomas. METHODS: On four eyes with an uveal melanoma, PDT with verteporfin was performed on the tumor 2-3 days before planned enucleation. The eyes were evaluated histologically.RESULTS: In two melanomas with only mild pigmentation some effects after PDT were detected on tumor tissue in a depth up to 2.5 mm at light doses > or =100 J/cm(2). Histologically, vascular occlusion and thrombosis in tumor vessels were observed. In the heavily pigmented melanoma no tumor necrosis was induced with the above-mentioned parameters. CONCLUSION: Depending on treatment parameters and tumor pigmentation, PDT with verteporfin is able to induce tumor necrosis in human uveal melanomas. Based on these results it is possible that PDT can become an adjuvant treatment method for uveal melanoma.     

应用1/3剂量光动力学疗法治疗急性CSC

观察1/3剂量光动力学疗法（photodynamic therapy, PDT）治疗急性中心性浆液性脉络膜视网膜病变（central serous chorioretinopathy, CSC）的短期疗效。 方法：选取急性CSC患者26例26眼,行单次1/3量维替泊芬（2mg/m2）进行PDT治疗,术前和术后1,4,12wk进行最佳矫正视力和OCT的检测,且于术前、术后4wk和12wk进行眼底荧光素血管造影（FFA）,吲哚青绿血管造影（ICG）检查,观察治疗的有效性和安全性。 结果：术后1wk,26眼中有20眼（77%）视网膜下积液吸收,其余6眼（23%）视网膜下液部分吸收;术后4wk,26眼视网膜下积液全部吸收,22眼荧光渗漏完全消失,脉络膜血管高渗透性消失;术后12wk,26眼均病情平稳,无复发。治疗后1wk,最佳矫正视力从术前平均0.41升高至0.80。随访期间26眼均未见任何不良反应。 结论：1/3剂量PDT治疗急性 CSC短期内安全有效     

Differential expression of matrix metalloproteinases and their tissue inhibitors at the advancing pterygium head

PURPOSE: Pterygia are a proliferative and inflammatory growth of limbal epithelial stem cell origin, characterized by corneal tissue invasion and extensive matrix remodeling including the destruction of Bowman's layer (BL). The purpose of this study was to determine the expression of matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs (TIMPs) at the advancing pterygium edge. METHODS: Formalin-fixed, paraffin-embedded whole eyes (n = 11) with pterygia attached, were serially sectioned and analyzed immunohistochemically to determine the spatial distribution of four MMPs and three TIMPs. Tear samples were collected from other patients with pterygia (n = 11) and displayed by gelatin zymography. RESULTS: Collagenase-1 was expressed by pterygium epithelial cells, corneal stromal fibroblasts and pterygium fibroblasts that had migrated between the epithelium and BL at the advancing pterygium edge. Collagenase-3 and gelatinases A and B were detected in all pterygia, intensely staining columnar epithelial cells directly adjacent to the denatured BL. In addition, gelatinase A immunoreactivity was observed on BL. Immunoreactivity for TIMP-1 and -3 paralleled that of the gelatinases, with more intense staining in epithelial cells and fibroblasts where BL was absent. TIMP-2 was faintly detected in pterygium epithelial cells but intensely stained pterygium fibroblasts. Gelatinase B was the most abundant gelatinolytic enzyme present in tears, elevated approximately twofold in eyes with pterygia versus the contralateral control eyes. CONCLUSIONS: This investigation is the first to identify the expression pattern of MMPs and TIMPs at the advancing pterygium edge in specimens of human eyes and in tears derived from patients with pterygia. These enzymes may be responsible for the destruction of BL, and their pattern of differential expression suggests that each may play a selective role in the pathogenesis of pterygia.     

中国维替泊芬光动力疗法治疗年龄相关性黄斑变性中心凹下脉络膜新生血管的多中心临床研究

目的探讨以维替泊芬为光敏剂的光动力疗法（PDT）治疗年龄相关性黄斑变性（AMD）合并黄斑中心凹下典型脉络膜新生血管（CNV）的疗效和安全性。方法采用多中心、开放、非对照Ⅲ期临床试验。受试对象为黄斑中心凹下以典型CNV为主的AMD患者。观察期限为24周。于第1次治疗后12和24周末进行复查。在首次治疗后12周,如发现CNV复发,则重复进行光动力治疗。比较治疗前后眼底病灶及视力的改变。记录治疗及随诊中所有的不良反应。结果共有32例患者入选,符合选择标准的患者为31例（31只眼）。在24周的观察中,38．7％的治疗眼视力增加5个字母以上,视力提高或减少小于15个字母者占83．9％。首次治疗后12周,CNV完全无渗漏的为12．9％;有渗漏,但局限于原病灶区的为61．3％;渗漏有进展者为25．8％。首次治疗后24周,病灶和病灶周围萎缩区大小、整个病变区域的最大直线距离均比治疗前稍有扩大,但差异均无统计学意义（P=0．65,0．31,0．12）。由此表明,在治疗的24周中,患眼的病灶基本稳定,未见明显扩大。PDT治疗后未发现病灶瘢痕明显扩大。整个临床试验中,11例（34．4％）发生了不良事件,其中7例（21．9％）为轻度不良事件,3例（9．4％）为中度不良事件,1例（3．1％）为重度不良事件。PDT治疗后24周,血尿常规和心电图检查均未见明显异常。结论用维替泊芬为光敏剂的PDT治疗AMD患者黄斑中心凹下CNV有较好的疗效,可以减轻CNV的渗漏,延缓视力下降,而且与药物相关的不良事件发生率低。因此,以维替泊芬为光敏剂的PDT治疗AMD继发的典型CNV其疗效肯定且安全。     

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.     

Safety enhanced photodynamic therapy with half dose verteporfin for chronic central serous chorioretinopathy: a short term pilot study

AIM: To evaluate short term safety of an enhanced photodynamic therapy (PDT) protocol with half dose verteporfin for treating chronic central serous chorioretinopathy (CSC). METHODS: 20 eyes of 18 patients with symptomatic chronic CSC underwent PDT using 3 mg/m2 verteporfin. Verteporfin was infused over 8 minutes followed by indocyanine green angiography guided laser application 2 minutes later. Serial optical coherence tomography (OCT) and multifocal electroretinography (mfERG) recordings were performed before PDT, at 4 days, 2 weeks, and 1 month after PDT. The best corrected visual acuity (BCVA), OCT central retinal thickness, and mean mfERG response amplitudes and peak latencies were compared longitudinally. Subgroup analysis was further performed for eyes with or without pigment epithelial detachment (PED). RESULTS: At 1 month after PDT, the median BCVA improved from 20/40 to 20/30 (p = 0.001). The mean central retinal thickness also reduced from 276 microm to 158 microm (p < 0.001) and 17 (85%) eyes had complete resolution of serous retinal detachment and/or PED. MfERG showed no significant changes in the mean N1 and P1 response amplitude and latency for all eyes. Subgroup analysis demonstrated that eyes without PED had a significant increase in the mean central mfERG P1 response amplitude with reduction in P1 peak latency at 1 month post-PDT. For eyes with PED, transient reduction in the mean central P1 response amplitude was observed at 4 days post-PDT. CONCLUSIONS: The modified safety enhanced PDT protocol with half dose verteporfin appeared to be a beneficial treatment option for patients with chronic CSC, especially in eyes without serous PED. Further controlled study is warranted to demonstrate the long term safety and efficacy of this treatment option.     

Photodynamic therapy and vitelliform lesions

PURPOSE: To investigate the effect of photodynamic therapy (PDT) with verteporfin on patients with vitelliform lesions caused by cuticular drusen or adult-onset foveomacular vitelliform dystrophy (AOFVD). DESIGN: Observational case series. PATIENTS AND METHODS: Eight eyes of seven patients from two centers were examined prospectively. Each patient received PDT with verteporfin applied to the vitelliform lesions. RESULTS: Photodynamic therapy did not significantly affect the median visual acuity outcome (20/50 before PDT and 20/66 after PDT) in all seven treated patients. Of note, however, were four eyes of four patients who experienced a severe decrease in visual acuity after PDT with verteporfin. The temporary relationship of the vision loss to the treatment suggests that this may represent an adverse effect from therapy. The fluorescein angiographic appearance was virtually unchanged in all treated patients, whereas indocyanine green angiography showed typical PDT-associated reduction of choroidal perfusion in the treatment area. CONCLUSION: Photodynamic therapy does not have a positive influence on the visual outcome in patients with vitelliform lesions and may have a negative impact on vision in some treated patients. It is important for physicians using PDT to exercise caution in distinguishing between choroidal neovascular membranes and vitelliform lesions because the outcome in this latter group may be worse with application of PDT than with the natural course.     

Verteporfin photodynamic therapy of six eyes with retinal capillary haemangioma

Acta Ophthalmol. 2010: 88: e334–e340

Abstract.

Purpose: Single‐centre consecutive interventional case series by retrospective chart review to evaluate the efficacy of verteporfin (Visudyne?) photodynamic therapy (PDT) of retinal capillary haemangioma (RCH). Methods: Following an initial period of observation, six eyes of five patients with RCH (juxtapapillary 3 and extrapapillary (EP) 3) received 1–3 sessions of standard verteporfin PDT upon the development of progressive vision‐threatening complications. Four of the five patients had von Hippel‐Lindau (VHL) disease. Follow‐up included documentation of best‐corrected Snellen visual acuity (BCVA), tumour regression, and presence or absence of subretinal fluid (SRF) and/or lipid exudation as assessed by dilated fundus examination (DFE), fundus photos, and optical coherence tomography (OCT). These parameters were documented at 1 week, 1 month, and 3 months following each PDT session and up to 32 months following the first PDT. Results: All eyes showed favourable response to PDT as defined by tumour regression or stabilization as well as improvement of SRF and lipid exudation. BCVA improved or stabilized in three eyes. Three eyes required PDT retreatment for recurrent SRF. Epiretinal membrane (ERM) worsened in three eyes, requiring vitreoretinal surgery at a median of 6 months following PDT. Conclusions: PDT is a moderately effective treatment for juxtapapillary and EP RCH. In this series, PDT resulted in tumour regression or stabilization as well as in the improvement of SRF and lipid exudation in all cases. However, stabilization or improvement of visual acuity was observed in only 50 per cent of the cases. The treatment benefits may be limited by pre‐existing macular changes and worsening of ERM. A larger prospective study is necessary to validate these findings.     

Role of Photodynamic Therapy in Polypoidal Choroidal Vasculopathy

Purpose To determine the efficacy of photodynamic therapy (PDT) with verteporfin for polypoidal choroidal vasculopathy (PCV). Methods PDT was performed in 35 patients (35 eyes) with PCV. We evaluated the number of treatments and compared visual acuity (VA), ophthalmological findings, and changes in polypoidal lesions and branching vascular networks by measuring lesion diameters using Heidelberg retina angiography before PDT, and then every 3 months for 1 year after PDT. Results The mean annual number of treatment sessions was 2.2. VA was improved or maintained in 80% of the patients. Retinal pigment epithelium detachment, retinal detachment, hemorrhage, and/or exudates disappeared in 69%, and leakage resolved in 74% of the patients. Polypoidal lesions disappeared completely on indocyanine green angiography in 83% of the patients. All branching vascular networks persisted. Polypoidal lesions had recurred at the termini of the remaining branching vascular networks at 9 months after the first PDT in two eyes and at 12 months in one eye. Conclusions PDT with verteporfin for PCV appears to improve or maintain VA for the first posttreatment year. Approximately 70% of PCV cases showed improved ophthalmoscopic findings. However, as polypoidal lesions recur after PDT in some cases, further study is needed to confirm the long-term efficacy of PDT for PCV. Jpn J Ophthalmol 2007;51:270–277 @ Japanese Ophthalmological Society 2007     

Long-term follow-up study of mitomycin eye drops as adjunctive treatment of pterygia and its comparison with conjunctival autograft transplantation

We observed 48 patients for 7-21 months (mean, 18 months) after pterygium excision and 2 weeks of placebo or mitomycin topical therapy to evaluate whether or not the short-term efficacy of mitomycin in preventing pterygium recurrence would be reflected in long-lasting efficacy as well. Placebo-treated pterygia showed a 73% recurrence rate. One of 58 (1.7%) mitomycin-treated pterygia recurred (p less than 0.05). We also performed a pilot study comparing pterygia treated with excision followed by 0.4 mg/ml of mitomycin to pterygia treated with excision coupled with conjunctival autograft transplantation to estimate the number of patients required for a randomized clinical trial comparing these two treatment modalities and thereby to decide whether or not such a study would be justified. Thirteen primary and two recurrent pterygia were treated with mitomycin, while 14 primary and one recurrent pterygia were treated with conjunctival autograft transplantation. With mean follow-up times of 4 and 6 months, respectively, no recurrences were noted in the mitomycin-treated group, while the conjunctival autograft transplantation group had one recurrence (6.6%). We estimate that 400 patients would be required for a properly designed clinical trial comparing these two effective therapies for prevention of recurrent pterygia. We conclude that such a study is unjustified, and further conclude that the vastly less expensive, simple therapy of mitomycin eye drops is the more appropriate treatment.     

Randomised controlled study of conjunctival autograft versus amniotic membrane graft in pterygium excision

AIM: To determine whether amniotic membrane can be used as an alternative to conjunctival autograft after pterygium excision. METHODS: 287 eyes with either primary or recurrent pterygium were included in this study. All eyes were randomised to undergo conjunctival autograft or amniotic membrane transplantation after pterygium excision by a single surgeon. 106 eyes in primary pterygium and 14 eyes in the recurrent group were treated with conjunctival autograft, and 148 eyes in primary pterygium and 19 eyes in the recurrent group were treated with amniotic membrane transplantation. Patients were followed up at 6 weeks and 6 months after operation. The main outcome measurement was recurrence rate after surgery. RESULTS: In the conjunctival group, the recurrence rate was 12.3%, 21.4% and 13.1% for primary, recurrent and all pterygia, respectively. In the amniotic membrane group, the recurrence rate was 25.0%, 52.6% and 28.1% for primary, recurrent and all pterygia, respectively. The recurrence rate for all pterygia in the amniotic membrane group was significantly higher than that in the conjunctival group (p = 0.003). CONCLUSIONS: Amniotic membrane graft had a higher recurrence rate than conjunctival autograft. However, it is an alternative choice, especially for advanced cases with bilateral heads or patients who might need glaucoma surgery later.     

1/3量维替泊芬光动力学疗法治疗急性中心性浆液性脉络膜视网膜病变

目的: 观察1/3量维替泊芬光动力学疗法(photodynam ic therapy,PDT)治疗中心凹下急性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的疗效。方法: 我院眼科门诊2010-05/2011-05确诊为急性CSC患者22例22眼,行单次1/3量维替泊芬光动力学治疗,术前和术后1,2,4wk及3mo进行光学相干断层扫描(optical coherence tomography,OCT)的检测,且于术前、术后4wk进行视网膜荧光造影(fundus fluorescein angiography,FFA)、脉络膜血管造影(indocyanine green angiography,ICGA)检查,观察治疗的有效性和安全性。结果: 术前22眼OCT均显示视网膜浆液性神经上皮脱离,造影中均存在明显荧光渗漏及脉络膜血管扭曲扩张弥漫荧光渗漏;术后1wk,OCT显示7眼视网膜下积液部分吸收;术后2wk时11眼视网膜下渗液完全吸收,术后4wk时22眼视网膜下渗液完全吸收,22眼FFA显示荧光渗漏消失,15眼ICG显示扭曲扩张的脉络膜血管管径形态有所改变,7眼脉络膜血管形态改变不明显。视力从术前平均0.5升高至0.9,视物变形情况22眼均明显改善。随访期间22眼均未见任何不良反应。结论: 1/3量维替泊芬PDT治疗急性CSC短期内安全有效。     

Profile of complications in pterygium surgery - A retrospective analysis

Purpose:Analysis of complication profile after pterygium excision, in primary and recurrent pterygia.Methods:Retrospective analysis of all the patients who had undergone pterygium excision in a tertiary center in South India from 2010 to 2018 was analyzed. A total of 2356 eyes in 2028 patients were included in the study. Patients who had undergone conjunctival autografting for primary pterygium, conjunctival limbal autografting for recurrent pterygium, vertical split conjunctival autografting for double head pterygium were included in the study. In all the surgical procedures fibrin glue was used for fixation of the autograft. The follow-up period ranged from 6 months to 75 months, with an average of 17 months. Patients with less than 6 months of follow-up were excluded from the study.Results:The following postoperative complications were noted, Sub-conjunctival hemorrhage in 912 eyes (38.7%), edema of the graft in 522 cases (22.15%), graft loss in 22 cases (0.93%), graft retraction in 692 cases (29.37%) and sliding of the graft was seen in 9 cases (0.38%). Granuloma was seen in 4 cases (0.16%) at the host site and 5 cases (0.21%) at the donor site. Recurrence was seen in 34 patients (1.44%). Other severe complications like corneal melt were seen in only 1 case (0.04%) who was operated on for recurrent pterygium. In comparison between primary and recurrent pterygia; subconjunctival hemorrhage, edema of the graft, graft loss, and recurrence was significantly (P < 0.05%) higher in recurrent pterygia.Conclusion:Various complications can occur post pterygium surgery as listed above. Selecting a proper procedure for a particular type of pterygium with a proper graft fixation technique will improve the outcome with minimal complications.     

Photodynamic therapy for wound-healing modulation in pterygium surgery. A clinical pilot study

Background This study was performed to evaluate the safety and efficacy of photodynamic therapy with the carboxyfluorescein ester BCECF-AM as an adjunctive treatment procedure for pterygium surgery to reduce the rate of recurrence.Methods In this nonrandomized prospective clinical trial, 19 eyes with nasally located primary pterygium were examined. All eyes were treated with the bare sclera surgical technique. Seven eyes received in addition treatment with BCECF-AM solution and blue light. All patients were evaluated at least after 1 day, 1 week, 1 month, 3 months, and 1 year. Postoperative fibrovascular growth from the limbus of at least 1 mm was defined as recurrence.Results The intraoperative application of BCECF-AM solution did not cause anterior chamber flare or any other significant side effects. The bare sclera surgery rate of recurrence was 0% (zero of 12) after 3 months and 91% (11 of 12) after 1 year. The additional photodynamic therapy treatment had a rate of recurrence of 14.2% (one of seven) after 3 months and 71.4% (five of seven) after 1 year.Conclusions The applied PDT technique seems to be a safe procedure but is associated with a high rate of recurrence. In conclusion, the evaluated PDT treatment procedure, at this point, should not be considered. As we found a high rate of recurrence also in the control group, the bare sclera technique is not effective, even in primary pterygia.