Management of complicated multirecurrent pterygia using multimicroporous expanded polytetrafluoroethylene

Abstract

AimsTo evaluate the efficiency of multimicroporous expanded polytetrafluoroethylene (e-PTFE) insertion in complicated multirecurrent pterygia.MethodsA total of 62 eyes from 62 patients with a multirecurrent pterygium associated with symblepharon or motility restriction-related binocular diplopia were recruited. All eyes underwent pterygia excision followed by application of 0.033% mitomycin C, amniotic membrane transplantation and conjunctival limbal autograft. Multimicroporous e-PTFE was then inserted intraoperatively in 30 eyes between the transplanted amniotic membrane and the conjunctiva (group A), but not inserted in the other 32 eyes (group B). The main outcome measures were symblepharon formation, motility restriction, binocular diplopia, subjective score of conjunctival hyperaemia and postoperative pterygium recurrence.ResultsIn the mean follow-up period of 17.2±2.3 months, symblepharon formation, motility restriction, diplopia and conjunctival hyperaemia were significantly improved after surgery in group A patients (p=0.000, 0.000, 0.008 and 0.000, respectively). Postoperative symblepharon formation, motility restriction and conjunctival hyperaemia were significantly less in group A compared to group B (p=0.024, 0.027 and 0.000, respectively). After surgery, corneal recurrence developed in one eye (3.3%) from group A, which was significantly lower than the eight eyes (25%) from group B (p=0.027).ConclusionsMultimicroporous e-PTFE insertion may provide a novel approach for treating intractable complicated multirecurrent pterygia.

Molecular Basis of Pterygium Development

“…Recently, the intraoperative insertion of expanded polytetrafluoroethylene (e-PTFE), a biocompatible fluoropolymer used for soft tissue reconstruction, has been shown to significantly reduce pterygium recurrence when transplanted between the amniotic membrane and conjunctiva in multirecurrent pterygium. 169 Once surgical excision has been performed, adjunctive therapy is used to prevent pterygium recurrence. The most common therapies are Mitomycin C (MMC), b-radiation, and 5-fluoruroacil .…”

PRECLUDE® Pericardial Membrane for the management of perforated corneal ulcer in patients with systemic autoimmune inflammation

“…Multimikroporöses Einbringen der e-PTFE-Membran könnte Ansatzpunkte zu neuen Therapien zur Behandlung vom komplizierten, mehrfach rezidivierenden Pterygia liefern [5,15].…”

New treatment options for pterygium

“…A recent study for patients with multi-recurrent pterygia found that the implantation of multi-microporous expanded polytetrafluoroethylene between AM and conjunctiva in conjunction with mitomycin C and a conjunctival limbal autograft led to significantly lower recurrence rates from 25% to 3.3% (p = 0.027) and also reduced symblepharon (p = 0.024), motility restriction (p = 0.027), and hyperemia (p < 0.001) [16].…”

“…This led to a significant reduction in recurrence rates [2,6]. A recent Cochrane meta-analysis of 1947 eyes of 1866 patients revealed superiority of CAG over AM with a risk ratio (RR) for recurrence of pterygium (primary and recurrent) of 0.53 (95% confidence interval [CI]: 0.33-0.85; p = 0.009) at 6-month follow-up and recurrence rates from 3.33% to 16.7% in the CAG and 2.6% to 42.3% in the AM group [6]. Therefore, thorough pterygium and Tenon's tissue removal combined with a CAG transplantation is currently considered the gold standard surgical procedure.…”