Current concepts and techniques in pterygium treatment

Ang, Leonard P. K.; Chua, Jocelyn; Tan, Donald

doi:10.1097/icu.0b013e3281a7ecbb

Cited by 193 publications

(171 citation statements)

References 55 publications

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“…However, this field is still evolving, although excision and adjunctive treatment with mitomycin C or conjunctival autograft is currently the most accepted and popular way of treating both primary and recurrent pterygium (23) . The surgeon's skill and experience may affect the recurrence rate, which can range from 2% to 39% in the case of a conjunctival autograft (24,25) . Nevertheless, even in the most experienced hands, graft suturing has the disadvantage of requiring longer surgical time than the bare sclera technique.…”

Section: Discussionmentioning

confidence: 99%

Pterygium surgery by means of conjunctival autograft: long term follow-up

Huerva¹,

March²,

Martínez-Alonso³

et al. 2012

Arq. Bras. Oftalmol.

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Purpose: To demonstrate the long term of follow-up of the recurrence rate after conjunctival autograft for pterygium surgery. Methods: A total of 112 patients operated for pterygium with conjunctival autografts and with more than one year follow-up were registered. Patients were called for voluntary examinations of their respective ocular surface statuses. Completing the study was only possible in 44 cases. Seven had bilateral pterygium. (N=51 operated pterygium). Results:The mean follow-up time was 49.06 months. In 29.45% of the cases, attachment was performed using non-absorbable sutures (nylon 10/0), while fibrin glue was used in 70.55% of the cases. Six cases of recurrence (11.76%) were found. The recurrence rate between primary and recurrent pterygium, and between sutures and fibrin glue proved to be not statistically significant; p>0.05. There were no significant differences between women and men with respect to recurrence. The median of age in the recurrence group was 40 years old, in contrast to 55 in the non-recurrence group; p=0.01517. All of these recurrences were associated with patients of Hispanic origins (from Latin America); p=0.001506. Conclusions: After a long follow-up period after autograft pterygium surgery, there were no statistically significant differences in recurrence rates for the application of sutures as opposed to fibrin glue; similarly, there were no statistically significant differences between the use of autograft in primary and recurrent pterygium. The greatest risk factors for recurrence were young age and Hispanic ethnicity.Keywords: Pterigium/surgery; Transplantation, autologous; Conjunctiva/transplantation, Sutures; Fibrin tissue adhesive RESUMO Objetivo: Demonstrar a taxa de recorrência em cirurgia do pterígio com transplante autólogo de conjuntiva após um acompanhamento a longo prazo. Métodos: Cento e doze pacientes operados de pterígio e transplante autólogo de conjuntiva, com mais de um ano de acompanhamento foram registrados. Os pacientes foram chamados para um exame voluntário de estado da superfície ocular. O estudo completo só foi possível em 44 pacientes. Sete deles tinha tido pterígio bilateral. (N=51). Resultados: A média de acompanhamento a partir do momento da cirurgia até o exame foi de 49,06 meses. A sutura não-absorvível (nylon 10/0) foi usada em 29,45% dos casos, enquanto que a cola biológica de fibrina foi usada em 70,55%. A recidiva do pterígio foi detectada apenas em 6 casos (11,76%). As recidivas entre pacientes operados de pterígio primário e recorrente, e entre o uso de suturas ou cola de fibrina não foram significativos (p>0,05). Também não houve diferença significativa na recorrência com relação ao sexo. A idade média no grupo de recidiva foi de 40 anos e no grupo sem recidiva de 55 anos (p=0,01517). Todas essas recorrências ocorreram em pacientes de origem hispânica (América latina) (p=0,001506). Conclusões: A longo prazo da remoção cirúrgica de pterígio utilizando um transplante autólogo de conjuntiva, não há diferença estatisticamente sig...

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Section: Discussionmentioning

confidence: 99%

Pterygium surgery by means of conjunctival autograft: long term follow-up

Huerva¹,

March²,

Martínez-Alonso³

et al. 2012

Arq. Bras. Oftalmol.

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“…12 All of these techniques involve the use of sutures or fibrin glue and are therefore vulnerable to associated complications.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 Although generally considered safe, fibrin glues are currently manufactured from human plasma and therefore carry the theoretical risk of transmissible disease. 12 Virus removal and inactivation procedures are included in the manufacturing process although may be of limited value against nonenveloped viruses such as hepatitis A virus and parvovirus B19. 15 New devices, such as the CryoSeal FS System, that generate fibrin sealant from autologous blood may eliminate the current risks associated with pooled plasma.…”

Section: Discussionmentioning

confidence: 99%

Sutureless and glue-free conjunctival autograft in pterygium surgery: a case series

Wit

Athanasiadis

Sharma

et al. 2010

Eye

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Aims Foreign materials used in ocular surface surgery may lead to local complications such as discomfort, scarring, or infection. Plasma-derived products such as fibrin glue may produce possible hypersensitivity reactions whereas the risk of viral transmission remains. We describe a simple method of achieving conjunctival autograft adherence during pterygium surgery avoiding potential complications associated with the use of fibrin glue or sutures. Methods After pterygium excision and fashioning of the autologous conjunctival graft, the recipient bed is encouraged to achieve natural haemostasis and relative dessication before graft placement. Excessive haemorrhage in the graft bed is tamponaded. Graft adherence and positioning is examined 20 min after surgery. Results A total of 15 eyes of 12 patients (mean (SD) age 73.7 (11.2) years), 8 females underwent SGF autologous conjunctival graft post-pterygium excision. Mean graft area was 24(1.5) mm 2 . Mean follow-up time was 9.2 (2.2) months. Cosmesis was excellent in all cases and visual acuity improved in one patient. There were no intra-or post-operative complications requiring further treatment. Conclusion This simple technique for pterygium surgery may prevent potential adverse reactions encountered with the use of foreign materials and in this small series provided safe and comparable results to current methods.

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“…Conjunctival autografting (CA) after pterygium excision is generally regarded as the procedure of choice because of its efficacy and long-term safety. 1 However, it is not possible to cover large defects created in surgery for double-headed or large recurrent pterygia. Also, the need to reserve the conjunctiva for future filtrating surgery in glaucoma patients is another limitation of this technique.…”

Section: Introductionmentioning

confidence: 99%

Amniotic membrane transplantation using fibrin glue in pterygium surgery: a comparative randomised clinical trial

Küçükerdönmez

Karalezlı

Akova

et al. 2009

Eye

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Purpose To compare the results of amniotic membrane transplantation (AMT) using fibrin glue vs vicryl sutures in pterygium surgery. Methods We carried out a prospective, randomised clinical study of 70 eyes (70 patients) with primary pterygium. After the removal of pterygium, patients were randomised to undergo AMT using fibrin glue (Tisseel, 32 eyes) or 8-0 vicryl sutures (38 eyes). Clinical examination and digital photographing were performed at each visit and the patients were followed up for at least 12 months. Post-operative symptoms in the first month were evaluated according to a fivepoint scale. Final appearances were graded from 1 to 4 in which grade 4 represented true (corneal) recurrence and grade 3 indicated conjunctival recurrence. Results The average operation time in the fibrin glue and suture groups were 11.2 ± 2.4 min (mean ± SD) and 18.7 ± 2.2 min, respectively (P ¼ 0.018). Significantly fewer post-operative symptoms were observed in the fibrin glue group at post-operative days 1, 7, and 14 (Po0.05 for all). At the end of the follow-up, true recurrence (grade 4) was developed in three eyes (9.4%) in the fibrin glue group, and in four eyes (10.5%) in the suture group (P ¼ 0.33). The rates of conjunctival recurrence (grade 3) were 21.9% (seven eyes) and 23.7% (nine eyes) in the fibrin glue and suture groups, respectively (P ¼ 0.38). Conclusions Amniotic membrane grafts can be successfully attached without any major complication in patients undergoing pterygium surgery. In addition, it is effective in shortening the duration of surgery and preventing post-operative discomfort. Although there seems to be no difference in the recurrence rates and cosmetic outcomes between both groups, neither technique represents best results.

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Current concepts and techniques in pterygium treatment

Cited by 193 publications

References 55 publications

Pterygium surgery by means of conjunctival autograft: long term follow-up

Pterygium surgery by means of conjunctival autograft: long term follow-up

Sutureless and glue-free conjunctival autograft in pterygium surgery: a case series

Amniotic membrane transplantation using fibrin glue in pterygium surgery: a comparative randomised clinical trial

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