Intraoperative daunorubicin versus conjunctival autograft in primary pterygium surgery

PURPOSE: To evaluate the safety and efficacy of intraoperative daunorubicin during a bare sclera procedure in primary pterygium surgery and to compare with conjunctival autograft. METHODS: The data for 84 patients who underwent pterygium surgery at Safdarjung Hospital and Guru Nanak Eye Center were analyzed retrospectively. The patients were divided into two groups: group A, those who underwent bare sclera excision along with conjunctival autograft, and group B, those who underwent bare sclera excision with intraoperative daunorubicin (0.02%) for 3 minutes. We evaluated pterygium recurrence and postoperative complications for both groups. Recurrence of pterygium was defined as growth of 2 mm of fibrovascular tissue over the corneoscleral limbus into the clear cornea in the area of previous pterygium excision. RESULTS: Follow-up ranged from 18 to 37 months (mean, 27). Recurrence rates of 8.33% (three of 36) and 7.14% (three of 42) were found in groups A and B, respectively. When compared statistically, the difference was not significant. All the recurrences occurred in patients younger than 30 years of age. Pyogenic granuloma, graft edema, loose graft, and dellen formation were seen, respectively, in 5.5% (two of 36), 2.77% (one of 36), 2.77% (one of 36), and 2.77% (one of 36) patients in group A. Nine of 42 (21.42%) patients in group B had chemosis of the conjunctiva and two of 42 (4.76%) had delayed epithelization. CONCLUSION: We conclude that intraoperative daunorubicin (0.02%) and conjunctival autograft are both equally effective adjuncts to pterygium surgery.     

Pterygium surgery: conjunctival rotation autograft versus conjunctival autograft

BACKGROUND AND OBJECTIVES: To compare the safety and efficacy of conjunctival rotation autograft to conjunctival autograft in primary pterygium surgery. PATIENTS AND METHODS: A prospective randomized study was performed of 39 eyes in 31 patients who had undergone pterygium surgery. Nineteen eyes were treated by conjunctival rotation autograft (Group A). Twenty eyes were treated by conjunctival autograft (Group B). Follow up ranged from 8 to 12 months (mean 11 months). Recurrence was defined as postoperative regrowth of 2 mm fibrovascular tissue onto clear cornea in the area of previous pterygium excision. Four eyes were excluded from the study. Delayed wound healing occurred in 11.76% of eyes, and 5.88% of eyes had persistent congestion in Group A. A loose graft was present in 5.55% of eyes, and 5.55% of eyes had dellen formation in Group B. CONCLUSION: We conclude that conjunctival rotation autograft and conjunctival autograft are both equally effective methods to reduce the recurrence rate after pterygium surgery. Conjunctival rotation autograft can be tried as an alternative attractive procedure for pterygium surgery to reduce the chances of recurrence. However, a larger, randomized, prospective double masked study with more patients and a longer follow up will eventually demonstrate the superiority of one procedure over the other.     

Comparison of conjunctival autograft and conjunctival transposition flap techniques in primary pterygium surgery

Purpose

To investigate and compare the efficacy of conjunctival autograft and conjunctival transpositional flap for the treatment of primary pterygium surgery.

Comparison between sutureless and glue free versus sutured limbal conjunctival autograft in primary pterygium surgery

Purpose

To compare and evaluate the safety and efficacy of two surgical techniques for the management of primary pterygium.

Design

Prospective randomized clinical trial using the CONSORT 2010 Statement (Consolidated Standards of Reporting Trials) for parallel group randomized trials.

Setting

Department of Ophthalmology, Al-Minya University, Faculty of Medicine, Egypt.

Methods

The study included 150 eyes of 150 patients with primary pterygium. The mean age was 49 ± 12 years (range 24–74 years). Simple excision under local anesthesia was performed followed by closure of the bare sclera by suture less and glue free conjunctival autograft in 50 eyes of 50 patients (group 1), versus the conventional method of a sutured conjunctival autograft in 100 eyes of 100 patients (group 2).

Results

The pterygium recurrence rate was 6% for group 1, 8% for group 2.Graft dehiscence occurred in 4 eyes out of 50 (8%) in group 1. Graft retraction occurred in 6 (12%) out of 50 eyes for group 1 versus 6 eyes (6%) in group 2. Pyogenic granuloma occurred in 3 (3%) eyes out of 100 in group 2. No other serious complications were noted. At the 3 week visit the overall patient satisfaction score was statistically significantly higher for group 1 (P < 0.002) compared to group 2. At 3 months postoperatively, the gain in uncorrected visual acuity (UCVA) ranged from 0.2 to 0.5 Log MAR in 10 eyes.

Conclusion

Sutureless and glue free conjunctival autograft technique is easy, safe, effective, prevents potential adverse reactions encountered with the use of foreign materials. This technique has an acceptable pterygium recurrence rate that is comparable to conventional sutured conjunctival autograft for primary pterygium.     

Preventing conjunctival autograft inversion in pterygium surgery

BACKGROUND: Surgeon-dependent variables influencing pterygium surgical outcome using the conjunctival autograft technique include conjunctival retraction as a consequence of subepithelial contracting fibrous tissue, and autograft inversion causing necrosis and sloughing of the graft. METHOD: A simple and useful technique of pterygium excision is described, which helps to ensure the correct surface and linear orientations of the conjunctival autograft, and also defines the end point of adequate excision of the subepithelial connective tissue. CONCLUSION: This simple technique of defining the anterior surface and the centrifugal orientation with the letter "G" marked on the graft prevents reverse orientation of the graft.     

Comparison of limbal-conjunctival autograft and intraoperative 0.02% mitomycin-C for treatment of primary pterygium

Purpose To compare the outcomes of use of intraoperative 0.02% mitomycin-C (MMC) and limbal-conjunctival autograft (LCAG) for treatment of primary pterygia. Material and method One hundred and twelve eyes of eighty patients with primary pterygia were randomly treated either by intraoperative 0.02% MMC for 5 min or LCAG. Recurrence (defined as fibrovascular tissue invading the cornea >1.5 mm) and complications were evaluated. Results Fifty-two eyes were included in the MMC group and sixty in the LCAG group. Recurrence occurred in three eyes (5.76%) in the MMC group and in two eyes (3.33%) in the LCAG group. This difference between recurrence in the two groups was not statistically significant (P > 0.05). Incidence of complications such as conjunctival cysts, symblephara, conjunctival hyperemia, and subconjunctival hemorrhage was similar in both groups (P > 0.05) whereas corneal epithelial defects (CED), irritation, lacrimation, and photophobia were more common in the MMC group (P < 0.05). Conclusion Simple excision then intraoperative use of 0.02% (MMC) for 5 min or LCAG are similarly successful in the treatment of primary pterygia. Some complications, for example irritation, lacrimation, photophobia, and CED are more common when simple excision is followed by MMC.     

Effectiveness of conjunctival autograft transplantation in pterygium surgery

INTRODUCTION: Pterygium is a fibrovascular overgrowth of bulbar cunjonctiva over the cornea and may produce visual impairment. Many surgical techniques and adjunctive therapies have been proposed but recurrence remains frequent. MATERIALS AND METHODS: We report a prospective study of 52 eyes treated by limbal conjunctival autograft for primary and recurrent pterygium. We compare our results with the technique of simple excision performed in 111 cases of pterygium (3 being a recurrent pterygium). RESULTS: The mean age of the patients was 45 years. 30 cases of pterygium were primary (57.7%) and 22 were recurrent (42.3%). After an average follow-up of 14 months, the incidence of recurrence was 10%. Only 2 of these recurrent cases of pterygium were primary. DISCUSSION: Conjunctival autograft is a simple, safe, and highly effective procedure for the treatment of pterygium. It reduces the rate of recurrence more than simple excision (55.9% after a follow-up of 1 year). CONCLUSION: The introduction of limbal conjunctival autograft for the treatment of pterygium meets three main goals: safety, good optical outcome and a lower rate of recurrence. This procedure could be accepted as a successful technique for cases with recurrent pterygium specially in younger patients and when the environment al factors lower the development of recurrent pterygium.     

Femtosecond laser-assisted conjunctival autograft preparation for pterygium surgery

Purpose

Pterygium is a common ocular surface disorder. Conjunctival autografting (CAG) following pterygium resection is the gold standard treatment. CAGs without Tenon's tissue provide better results but are more technically difficult to achieve. In this study, we evaluated the feasibility and reproducibility of femtosecond laser (FSL)-assisted CAG preparation.

A comparative study of recurrent pterygium surgery: limbal conjunctival autograft transplantation versus mitomycin C with conjunctival flap

OBJECTIVE: To compare the recurrence rate following treatment of recurrent pterygia using one of two techniques-limbal conjunctival autograft transplantation versus low-dose intraoperative mitomycin C (0.2 mg/ml) combined with conjunctival flap closure. DESIGN: Randomized clinical trial. PARTICIPANTS: Eighty-one patients with recurrent pterygia treated by limbal conjunctival autograft transplantation (n= 41) or mitomycin C combined with conjunctival flap (n= 40) participated. INTERVENTION: Limbal conjunctival autograft transplantation or low-dose intraoperative mitomycin C application with conjunctival flap technique was performed on recurrent pterygium cases. MAIN OUTCOME MEASURES: Recurrence of pterygium and postoperative complications. RESULTS: During mean follow-up periods of 16+/-1.9 and 15.5+/-1.5 months, six recurrences (14.6%) in the limbal conjunctival autograft transplantation group and five recurrences (12.5%) in the mitomycin C group were observed (P=0.77). The difference between the mean ages of recurrent (26.4+/-8.0 years) and nonrecurrent (35.8+/-11.9 years) cases for all patients was statistically significant (P=0.014). Technically, limbal conjunctival autograft transplantation seemed to be more difficult. The most frequent complication in limbal conjunctival autograft transplantation was graft edema, whereas that in the mitomycin C group was superficial keratitis. CONCLUSION: Both techniques showed similar recurrence rates in the treatment of recurrent pterygia. Although technically easier to perform, further follow-up is necessary to determine the long-term safety of low-dose intraoperative mitomycin C with conjunctival flap closure. The surgeon's familiarity with either procedure should determine the method of choice.     

角膜缘干细胞移植术中结膜瓣的宽与窄对原发性翼状胬肉的疗效比较

目的:对比下方角膜缘干细胞窄结膜瓣与宽结膜瓣移植联合丝裂霉素C治疗原发性翼状胬肉的长期效果与复发率.方法:采用回顾性研究,共纳入146例(193眼)原发性翼状胬肉患者.其中91例采用下方角膜缘干细胞窄结膜瓣移植联合丝裂霉素C治疗(NI-LCAT组),102例采用下方角膜缘干细胞宽结膜瓣移植联合丝裂霉素C治疗(WI-LCAT组).随访对比两组复发率、供体区、植片植床情况与相应并发症.结果:NI-LCAT组与WI-LCAT组复发率分别为3.3％与4.9％,两者差异无统计学意义.两组植片植床情况未见明显差别.两组供体区最常见并发症均为轻中度结膜瘢痕(NI-LCAT组18.6％,WI-LCAT组13.2％).其他并发症包括结膜下上皮囊肿与受体区肉芽肿发生率在两组间差异无统计学意义.Kaplan-Meier生存分析显示两组间累积手术成功率差异无统计学意义.结论:下方角膜缘干细胞窄结膜瓣与宽结膜瓣移植联合丝裂霉素C治疗原发性翼状胬肉复发率相似.相比宽结膜瓣组,窄结膜瓣组对结膜供体区创伤较小,对保留上下方结膜更为有效.     

两种方法治疗原发性翼状胬肉的疗效观察

目的：比较自体结膜瓣移植术( conjunctival autograft transplant, CAT )和角膜缘干细胞移植术( limbal conjunctival autograft transplant, LCAT)治疗原发性翼状胬肉的临床效果。
　　方法：前瞻性、随机、对照病例研究。收集2014-01/2015-01在解放军第四七四医院诊断为原发性翼状胬肉患者共120例120眼,依次纳入本研究,奇数者行 CAT,偶数者行LCAT。
　　结果：术后随访1a,完成随访107例107眼,CAT 组患者54例54眼,术后复发4眼,复发率7.4%;LCAT 组患者53例53眼,术后复发2眼,复发率3.8%。两组间复发率无统计学意义(P=0.678)。
　　结论：CAT 组和 LCAT 组均能有效治疗原发性翼状胬肉,降低术后翼状胬肉复发率,但 LCAT 是治疗原发性翼状胬肉的最优术式。     

自体结膜瓣移植术和角膜缘干细胞移植术对原发性翼状胬肉术后泪膜的影响

目的：比较自体结膜瓣移植术(CAT)和角膜缘干细胞移植术(LCAT)对原发性翼状胬肉患者术后泪膜的影响。

方法：前瞻性研究。收集2018-09/2019-05在新疆军区总医院北京路医疗区眼科诊断为原发性翼状胬肉患者共150例150眼,依次纳入本研究,奇数者行CAT,偶数者行LCAT,术前,术后1、3、6mo,1a完成泪膜破裂时间(TBUT)、SchirmerⅠ试验(SⅠt)和眼表疾病指数(OSDI),结果进行统计学分析。

结果：患者129例129眼完成术后1a随访,CAT组64例64眼,复发4眼(6.2%); LCAT组65例65眼,复发3眼(4.6%),两组复发率无差异(P=0.718)。CAT组和LCAT组TBUT、SⅠt和OSDI评分术前和术后1、3、6mo,1a均有差异(P<0.05),术后1mo和术后3、6mo,1a均有差异(P<0.05),术后3、6mo和术后1a均无差异(P>0.05)。CAT组和LCAT组不同时间点TBUT、SⅠt和OSDI评分均无差异(P>0.05)。

结论：CAT和LCAT均能有效治疗原发性翼状胬肉,术后复发率低且相近,两种手术方式改善原发性翼状胬肉术后泪膜功能的程度相近。     

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).