Pterygium surgery in Victoria: A survey of ophthalmologists

Aim: To determine the surgical approaches and adjunctive therapies currently used by Victorian ophthalmologists for the treatment of primary and recurrent pterygia. Method: Ophthalmologists practising in Victoria were asked to complete a written survey relating to their experience with pterygium surgery. Results: Responses were received from 142 of 165 ophthalmologists surveyed (86%). Of these, 107 (75%) had performed at least one pterygium operation during the preceding 2 years. Excision followed by beta irradiation was the most commonly performed procedure for both primary (57%) and recurrent (35%) pterygia. The next most commonly performed procedure for primary pterygia was excision leaving bare sclera (15%) and, for recurrent pterygia, excision with autologous conjunctival transplantation (26%). Considerable variation was observed in surgical technique, choice of adjunctive therapy, postoperative care and in the surgeons' estimates of the frequency of major complications. Conclusion: Although there is little consensus regarding the surgical management of pterygium, beta irradiation remains the most commonly used adjunctive therapy in Victoria.     

Outcomes of autoconjunctival grafting for primary pterygia when performed by consultant compared with trainee ophthalmologists

PURPOSE: To define rates of recurrence and surgical complications of primary pterygia excision with autoconjunctival grafting when the surgery is performed by consultant ophthalmologists compared with trainee ophthalmologists. METHODS: A total of 174 patients with primary pterygia treated by excision and autoconjunctival grafting were included for analysis. Patients were divided into two groups according to whether their surgery was performed by a consultant ophthalmologist (group A) or a trainee ophthalmologist (group B). Data were collected with respect to demographics, surgical complications and recurrence. Recurrence rates were analysed utilizing Fisher's exact test. Additionally, Kaplan-Meier survival curves for interval censored data were constructed. Surgical complications were analysed utilizing Fisher's exact test. RESULTS: The recurrence rate in group A was 6.8% and in group B was 19.4%. This difference was statistically significant (P = 0.05). The rate of surgical complication occurring in group A was 6.6% and in group B was 23.3% and this was also statistically significant (P = 0.005). No relationship was found between either patient age or the size of pterygium and recurrence or complications in either group A or group B. CONCLUSION: Autoconjunctival grafting is regarded as the gold standard for preventing pterygium recurrence following excision. This study suggests that the experience of the surgeon can influence success rates and complications. There is a significant learning curve indicating the need to supervise trainee surgeons.     

复发性与原发性翼状胬肉广泛切除联合羊膜移植治疗观察

目的:评估广泛性翼状胬肉切除联合羊膜移植术治疗复发性与原发性翼状胬肉的疗效。方法:回顾性分析作者手术治疗的复发性翼状胬肉患者38例40眼(A组)及原发性翼状胬肉195例231眼(分为B组156例185眼和C组39例46眼),追踪观察1～6a。结果:行广泛性翼状胬肉切除联合羊膜移植术后A组复发6眼,复发率为15%,B组复发11眼,复发率为6%。C组行单纯广泛性翼状胬肉切除术后复发10眼,复发率22%。A组与B组(P<0.05),B组与C组(P<0.01)间复发率的差异具有统计学意义。结论:广泛性翼状胬肉切除联合羊膜移植术治疗复发性与原发性胬肉安全有效,能降低术后复发率,但对原发性胬肉的效果更好。     

Comparison of conjunctival graft thickness after primary and recurrent pterygium surgery: Anterior segment optical coherence tomography study

Objective:

The objective of the following study is to compare the conjunctival graft thickness measured with anterior segment optical coherence tomography (OCT) after primary and recurrent pterygium excision.

Design:

Prospective, interventional and comparative study.

Participants:

A total of 20 eyes of 20 patients with primary pterygium (primary group) and 20 eyes of 20 patients with recurrent pterygium (recurrent group) were enrolled.

Materials and Methods:

All patients underwent pterygium excision with conjunctival autograft transplantation. Conjunctival graft thickness was measured at 1 week, 1 month and 3 months after surgery using the Visante-OCT (Carl-Zeiss Meditec, Dublin, CA, USA). Main outcome measure was the mean conjunctival thickness determined as the mean of three measurements at 1, 2 and 3 mm posterior to the scleral spur.

Results:

There were no statistically significant differences in age, sex, or laterality between the groups. Mean thickness of the graft in primary and recurrent groups, respectively, was 430 ± 127 μm and 461 ± 178 μm at 1 week after surgery (P = 0.587), 114 ± 19 μm and 162 ± 48 μm at 1 month after surgery (P = 0.001) and 109 ± 15 μm and 107 ± 18 μm at 3 months after surgery (P = 0.726).

Conclusion:

The findings revealed that conjunctival thickness after primary or recurrent pterygium excision was greatest at 1 week after surgery and continued to decrease for up to 3 months. Mean graft thickness differed significantly between the two groups only at 1 month after surgery.     

Split thickness buccal mucous membrane grafts and β irradiation in the treatment of recurrent pterygium

BACKGROUND—Pterygium is a common problem and after surgical removal may recur in up to 80% of cases, depending on the technique of primary excision. Recurrent pterygia can be aggressive and repeated excision may result in severe conjunctival scarring and shortening, resulting in insufficient conjunctiva to perform further grafting and lid surgery. When there is insufficient autologous conjunctiva, mucous membrane must be obtained from other sites. Full thickness buccal mucous membrane grafts have been described, but they may result in a beefy red appearance, with graft contraction and a poor tear film.
METHOD—The use of split thickness buccal mucous membrane grafts is described in three patients with recurrent pterygium, two in combination with lamellar keratoplasty. β Irradiation was used as adjuvant therapy in all cases.
RESULTS—In all three cases an acceptable cosmetic appearance was achieved, with no recurrence of the pterygium, and a good range of eye movements.
CONCLUSIONS—It is recommended that split thickness buccal mucosal grafts, combined with β irradiation, should be considered in complex cases of pterygium recurrence when there is insufficient autologous conjunctiva and conjunctival shortening with restricted eye movements.

Keywords: pterygium; split thickness buccal mucous membrane graft; β irradiation     

Scedosporium prolificans sclerokeratitis 10 years after pterygium excision with adjunctive mitomycin C

Scedosporium prolificans is an unusual infection, especially following pterygium surgery. A 63-year-old man who developed an uncomfortable, red right eye 10 years after pterygium surgery with adjunctive mitomycin C is described. To the best of the authors' knowledge, this is the first reported case of S. prolificans sclerokeratitis following pterygium surgery with adjunctive mitomycin C.     

自体结膜角巩膜缘移植治疗原发性翼状胬肉

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。     

Treatment of pterygia in Queensland

All practising ophthalmologists in Queensland completed a written survey on their current methods of treatment of pterygia. The indications for surgical removal, in decreasing order of importance, were mainly size, symptomatic complaints, cosmetic appearance and activity. Most surgeons graded pterygia into a variety of classifications. The most common form of treatment for primary pterygia was simple excision plus mobilisation of conjunctiva and suturing conjunctival free edges together followed by bare sclera technique, and simple excision plus thiotepa drops. For recurrent pterygia simple excision plus beta-irradiation was the most common form of treatment, followed by simple excision plus thiotepa drops and simple excision plus mobilisation of conjunctiva and suturing conjunctival free edges together. A third of the ophthalmologists electively avoid cautery use during pterygium surgery, while almost a quarter of the ophthalmologists attempt to polish the corneal and limbal region. When beta-radiation or Thiotepa is used there is a general consensus on the dosage for each of these. Seventeen per cent of ophthalmologists said they had not encountered any complications after pterygium surgery with the remainder quoting corneoscleral necrosis from beta-radiation and Tenon's granuloma as the most common complications. It would appear that there is no consensus on the best way to treat pterygia in Queensland, which probably reflects the lack of scientific proof for one method being superior to another.     

两种术式治疗原发性翼状胬肉的疗效比较

目的:比较显微镜下胬肉转位术与单纯胬肉切除联合自体角膜缘干细胞移植术治疗原发性翼状胬肉的临床疗效。方法:将51例61眼患者随机分为两组,转位术组和角膜缘干细胞移植术组,术后随访1～2a。结果:转位组1眼复发,复发率为3%,角膜缘干细胞组1眼复发,复发率为3%,两组差异无统计学意义。结论:胬肉转移术治疗原发性翼状胬肉角膜创面修复快,复发率低,是一种值得重新评价的手术方法,值得推广应用。     

Comparative evaluation of lymphatic vessels in primary versus recurrent pterygium

Purpose

To compare lymphangiogenesis in primary versus recurrent pterygium.

Methods

Tissues from 88 excised primary and 34 recurrent pterygia were evaluated, and tissues from 7 nasal epibulbar conjunctivae segments were used as controls. The lymph-vascular area (LVA), lymph-microvascular density (LMD), and lymph-vascular luminal diameter (LVL) were examined and compared between the primary and recurrent pterygia. In addition, the expression of VEGF-A and VEGF-C in the primary and recurrent pterygia were determined by ELISA and real-time PCR. The relationships between the mRNA level and LVA, LMD, and LVL were clarified.

Results

Although there was no significant difference in quantification of LVL between primary and recurrent pterygia, the quantification of LVA and LMD in recurrent pterygia dramatically increased in comparison with primary pterygia (both P-values <0.01). Compared with primary pterygia, the VEGF-A and VEGF-C mRNA levels were up-regulated significantly in recurrent pterygia (both P-values <0.05). There was a significant relationship between VEGF-C mRNA and LVA, LMD, and LVL, while VEGF-A mRNA was only closely correlated with LMD in recurrent pterygia.

Conclusions

Lymphangiogenesis develops in recurrent pterygium, for which transient up-regulation of VEGF-C might be responsible.     

自体角膜缘移植治疗翼状胬肉60例疗效观察

目的 探讨胬肉切除联合自体角膜缘移植治疗翼状胬肉的手术效果。方法 切除胬肉后用自体角膜缘移植的方式治疗翼状胬肉60例（68眼），术后随访3月～1年。结果 随访期内有3眼复发（4．41％），未发现睑球粘连者。结论 翼状胬肉切除联合自体角膜缘移植有利于重建角膜缘功能，是一种治疗翼状胬肉有效的手术方法。     

三种术式治疗翼状胬肉的疗效分析

目的:分析三种手术方式治疗翼状胬肉的效果,探寻减少复发的最佳术式。方法:第一组48例51眼单纯翼状胬肉切除术,第二组46例47眼行带蒂结膜瓣移植联合丝裂霉素C术,第三组43例45眼行角膜缘干细胞移植术。结果:患者术后随访观察6mo～2a,其中第一组有13眼复发,复发率为25%。第二组有3眼复发,复发率为6%。第三组有1眼复发,复发率为2%。结论:自体角膜缘干细胞移植可有效降低翼状胬肉术后的复发率,是目前较理想的手术方法。     

两种不同翼状胬肉手术方式对角膜屈光的影响

目的：探讨两种不同手术方式治疗原发性翼状胬肉前后视力及眼屈光度的情况。

方法：将翼状胬肉患者120例120眼随机分为A和B组,每组各60眼。A组采用翼状胬肉切除加自体角膜缘干细胞移植术; B组采用翼状胬肉切除加羊膜移植术。术后1wk内每天在裂隙灯显微镜下观察结膜和角膜创缘的愈合情况、移植片的生长情况、有无感染、角膜上皮修复情况及角膜新生血管生长情况等。术前2wk及术后3wk均进行裸眼视力、角膜曲率、角膜散光的检测。

结果：两组术后3wk的裸眼视力、角膜曲率和角膜散光与术前2wk比较,差异具有统计学意义(P<0.05); 而两组之间比较,术后3wk的差异无统计学意义(P>0.05)。

结论：两种翼状胬肉手术方式均可使角膜屈光改变,提高术眼视力,降低散光。应根据患者自身情况决定手术方式。     

改良式翼状胬肉切除联合自体角膜缘干细胞移植术治疗翼状胬肉

目的:分析改良式翼状胬肉切除联合自体角膜缘干细胞移植(CAT)术治疗翼状胬肉的疗效。方法:选取2018-01/2021-01在本院眼科就诊的翼状胬肉患者140例154眼,按随机数字表法进行分组,观察组70例76眼采用改良式翼状胬肉切除联合CAT术治疗,术中使用改良虹膜恢复器;对照组70例78眼采用常规翼状胬肉切除联合CAT术治疗,术中使用传统虹膜恢复器。术后随访1a,比较两组患者的视力、主观症状和结膜体征(结膜充血、结膜水肿)评分、角膜上皮愈合情况及术后并发症和复发情况。结果:与术前比较,两组患者术后1、3、5d时视力均显著下降(P<0.05),但组间均无差异(P>0.05);与术后1d比较,两组患者术后3、5、14d时主观症状评分、结膜充血程度和结膜水肿程度评分均显著下降(P<0.05),且观察组术后3、5、14d时主观症状评分、结膜充血程度和结膜水肿程度评分均显著低于对照组(P<0.05);观察组术后3、5、14d时角膜荧光素染色(FL)评分均显著低于对照组,角膜上皮缺损修复时间≤5d的患者比例显著高于对照组(P<0.05)。观察组结膜肉芽肿、睑球黏连...     

云南省怒江州贡山县翼状胬肉的流行病学调查

目的:调查云南省贡山县人群翼状胬肉患病率,通过问卷调查,获取相关信息,了解当地翼状胬肉的人群分布特点及可能相关危险因素。方法:采用整群抽样方法在云南省贡山县抽取26个调查点共3070例调查对象,对其翼状胬肉患病情况进行分析。结果:该地区人群中发现翼状胬肉患者108例,患病率为4.4%;男女间患病无统计学差异,分别为1.6%和2.8%;随年龄增长患病率逐渐增加。结论:翼状胬肉是云南贡山地区常见的眼表疾病,年龄、职业、紫外线暴露情况是该地区翼状胬肉发生的主要危险因素。     

Combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C in the treatment of primary pterygium

PURPOSE: To introduce a new technique of conjunctival reconstruction after primary pterygium excision, and to evaluate the efficacy of combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C application in preventing recurrence of primary pterygium. METHODS: In a prospective, non-comparative case series, 43 eyes of 41 consecutive patients with primary pterygium were studied. In all patient eyes, after excision of pterygia, 0.02% mitomycin C was applied topically for 2 min over the exposed scleral surface and "symmetrical conjunctival flap transposition" was performed to reconstruct the conjunctival defect. The main outcome measures were pterygium recurrence or any complications related with surgery or mitomycin C. RESULTS: The mean age of the patients was 47.5 +/- 12.4 years (range 30-70 years). Among the 38 patients who were not lost to follow up, three patient eyes (7.5%) had grade 1, 24 eyes (60.0%) had grade 2 and 13 eyes (32.5%) had grade 3 pterygium. The mean follow up was 12.2 +/- 5.7 months (range 7-28 months). No recurrence or sight-threatening complications were encountered in any patient eye throughout the follow-up period. CONCLUSION: Combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C application may be an effective surgical alternative in preventing recurrence of primary pterygium. Although the procedure seems to be free from severe complications, surgeons and patients should be well aware of the risk of late radiomimetic complications of mitomycin C. Comparative, randomized trials with more number of patients and longer follow up are required to further establish the safety and efficacy of this treatment strategy.     

Clinical analysis of risk factors contributing to recurrence of pterygium after excision and graft surgery

AIM:To find the risk factors related to the reproliferation of the pterygial tissue after excision and graft surgery.METHODS:Charts of 130 eyes of 130 patients who had pterygial excision from March 2006 to April 2011 were reviewed. Preoperative pterygium morphology, surgical methods, and adjunctive treatments were statistically analyzed for their relationship with recurrence.RESULTS: During the follow-up period, recurrence was observed in 20 eyes (15.4%). None of the preoperative morphologic features were affected the rate of the recurrence. However, an age < 40y [P =0.085, odds ratio (OR) 3.609, 95% confidence interval (CI) 0.838-15.540] and amniotic membrane graft instead of conjunctival autograft (P =0.002, OR 9.093, 95% CI 2.316-35.698) were statistically significant risk factors for recurrence. Multivariate analysis revealed that intraoperative mitomycin C (MMC) (P=0.072, OR 0.298, 95% CI 0.080-1.115) decreased the rate of recurrence.CONCLUSION:Younger age is a risk factor for reproliferation of pterygial tissue after excision and amniotic membrane transplantation (AMT) are less effective in preventing recurrence of pterygium after excision based on the comparison between conjunctival autograft and AMT. Intraoperative MMC application and conjunctival autograft reduce recurrence.     

不同术式治疗原发性翼状胬肉的临床效果分析

目的:比较分析羊膜移植术、自体角膜缘干细胞移植术及术中应用0.2g/L丝裂霉素C治疗原发性翼状胬肉的临床效果。方法:回顾性分析我院232例曾行原发性翼状胬肉手术的患者,其中82例行羊膜移植术治疗,90例行自体角膜缘干细胞移植术治疗,60例在术中应用0.2g/L丝裂霉素C治疗,比较三种术式术后复发率及并发症。结果:自体角膜缘干细胞移植术和术中应用0.2g/L丝裂霉素C治疗原发性翼状胬肉的复发率低于羊膜移植术(P<0.05);而自体角膜缘干细胞移植术和术中应用0.2g/L丝裂霉素C之间复发率无差异(P>0.05)。角膜上皮缺损,流泪和畏光在0.2g/L丝裂霉素组发生比例较其他两组高(P<0.05),在自体角膜缘干细胞移植组和羊膜移植组两组间差异无统计学意义(P>0.05)。结膜充血及结膜下出血在三组间无统计学差异(P>0.05)。结论:与其他两种术式相比,自体角膜缘干细胞移植术治疗原发性翼状胬肉,有着复发率低、并发症少的优点。     

原发性与复发性翼状胬肉的临床指标及实验室指标差异

翼状胬肉是一种临床常见的人眼表结膜疾病,目前主要归因于慢性紫外线暴露。以往研究主要集中于翼状胬肉的临床特点、外科治疗和发病机制,而对原发性翼状胬肉和复发性翼状胬肉的区别归纳较少。本文总结了关于原发性和复发性胬肉的差异性研究的最新发现,对原发性和复发性翼状胬肉的临床表现、组织病理学、实验室研究差异进行一综述。     

武汉城区及周边农村翼状胬肉患病率的流行病学调查

目的:了解翼状胬肉在武汉城区及周边农村地区的分布特点。方法:在武汉城区及周边农村地区随机整群抽取16818例作为调查对象,统计翼状胬肉患病率。结果:武汉城区及周边农村地区翼状胬肉总患病率为3.853%,其中男性患病率2.965%,女性患病率4.555%;武汉城区翼状胬肉总患病率为2.951%,其中男性患病率2.212%,女性患病率3.532%;周边农村地区翼状胬肉总患病率为5.534%,其中男性患病率3.792%,女性患病率6.931%。以上女性患病率均高于男性,有统计学意义(P<0.05)。结论:武汉城区及周边农村地区翼状胬肉总患病率及各自患病率分别为3.853%,2.951%,5.534%,女性发病率均高于男性。