Evaluating the Efficacy and Safety of Different Pterygium Surgeries: A Review of the Literature

Abstract

The search for the “gold standard” in the surgical treatment of pterygium has been ongoing for over two decades. Despite the development of various surgical techniques, recurrence rates range from 6.7% to 88% depending on the method used. This review discusses the latest and most commonly used methods for the surgical removal of pterygium, primarily focusing on efficacy and safety. Moreover, this review includes articles that either evaluated or compared surgical methods and clinical trials for primary and recurrent pterygium. Limited data are available on combined methods as well as on the efficacy of adjuvant treatment. The use of adjuvant intraoperative mitomycin C (MMC) and conjunctival autografting (CAU) are the two most highly recommended options, as they have the lowest rates of postoperative recurrence.

Ocular-Surface Regeneration Therapies for Eye Disorders: The State of the Art

“…Management of pterygium is surgical, and a wide range of techniques have been described: bare sclera, conjunctival flap, conjunctival autograft, limbal conjunctival autograft, and amniotic membrane. Adjuvant therapies for pterygium management have also been used, such as mitomycin C, beta-radiation, 5-fluorouracil (5-FU), topical use of bevacizumab, and interferons [ 46 ]. The goal of surgery is to excise the pterygium, restore the cornea surface, and prevent the risk of pterygium recurrence.…”

“…The conjunctival autologous graft (CAG) consists in covering the bare sclera with a free graft of autologous conjunctiva after the pterygium removal, and it is nowadays the preferred approach given lower incidence of recurrence, usually between 3.3% and 16.7% in the case of primary pterygium [ 49 ], and around 33% in the case of treatment of pterygium recurrence [ 50 ]. The free autograft can be fixated with sutures (commonly Vicryl 8/0), fibrin glue, or the patient’s autologous blood [ 46 , 51 ]. No significant differences in pterygium recurrence among these three techniques are reported in the literature according to meta-analysis, however, the conjunctival autograft with fibrin glue presents a lower risk of graft displacement and conjunctival retraction, and also a shorter surgery time, compared to the other two techniques [ 52 , 53 ].…”

“…An alternative to conjunctival autograft is the use of an amniotic membrane (AM) graft, in which the bare sclera is covered by a patch of amniotic membrane graft, which, similar to CAG, can be sutured or glued. Compared to CAG, AM has a higher risk of pterygium recurrence (6.7–40.9%), but lower compared to bare sclera [ 46 , 49 , 54 ]. Several adjuvant treatments have been evaluated in the literature to reduce the risk of pterygium recurrence after surgical removal following all the aforementioned techniques.…”

Chinese Materia Medica preparation alleviates ocular surface inflammation after pterygium surgery

“…Currently, surgical resection is the only effective treatment for pterygium [2] , which mainly includes scleral exposure, conjunctiva-ap transposition, conjunctival autografting, and amniotic membrane transplantation [3][4] . Numerous clinical studies have shown that treatment by conjunctival autografting has the lowest recurrence rate among these surgical treatments, and thus conjunctival autografting has been recommended as the preferred treatment for primary pterygium [5][6] . However, the surgical injuries could lead to substantial ocular surface in ammation, causing evident ocular irritation in the patients post-surgery [7] .…”

Outcome of Pterygium surgery with conjunctival autologous graft using suture and tissue glue at the tertiary eye center, Thimphu, Bhutan

“…Fibrin glue is used due to its various advantages such as easy fixation of the graft, shorter operation time, reduction in complications and postoperative discomfort. However, high cost of the glue, risk of transmission of infections and severe allergic reactions are its main disadvantage 4 .…”