Surgical Techniques and Adjuvants for the Management of Pterygium

Abstract

To provide an updated review of surgical techniques and adjuvants for the management of pterygium. Methods: A literature search was conducted in PubMed for studies published since January 2011. "Pterygium surgery" and the MeSH term "Pterygium/surgery" was used. The results were filtered for randomized controlled trials in English, yielding 60 citations. Results: One study compared topical anesthetic agents. One study compared methods of corneal polishing of the corneoscleral bed after pterygium excision. Numerous studies evaluated the use of conjunctival autograft versus amniotic membrane, superior versus inferior conjunctival autograft, and conjunctival versus limbal-conjunctival autograft. Many studies evaluated graft fixation methods. Several studies evaluated the adjuvant use of mitomycin C, 5-fluorouracil, and bevacizumab. A few studies evaluated the adjuvant use of steroids. Eleven studies evaluated various methods of postoperative management. Conclusions: Current evidence supports pterygium excision with conjunctival autograft fixation using fibrin glue, followed by patching until the first postoperative visit. Surgical adjuvants and postoperative use of artificial tears and topical cyclosporine 0.05% may further reduce recurrence. Postoperative use of topical steroids is highly variable because there is no consensus regarding the optimal dose, frequency, and duration of treatment.

Comparing Intracanalicular and Topical Steroid Use in Patients Undergoing Pterygium Surgery

“…1). Pain was analyzed by using the Kaplan-Meier estimator to estimate the median time to the first report of no pain (0) and the first report of mild pain (1). The median time for the case group to subside to 0 was 30 days, and the median time for the control group to subside to 0 was 35 days (Fig.…”

“…There were 174 observations: 87 for the case group and 87 for the control group. Hyperemia was analyzed by using the Kaplan-Meier estimator to estimate the median time to the first report of no hyperemia (0) and the first report of mild hyperemia (1). The median time to a hyperemia score of 0 was 61 days for the case group and 112 days for the control group (P¼0.334).…”

Preoperative Intralesional Bevacizumab Injection in Primary Pterygium in Tunisian Patients

“…Numerous surgical approaches have been attempted. 2 3 4 6 Currently, pterygium excision with conjunctival autograft represents the preferred surgical technique. 4 …”

“…Postoperative recurrence represents a major concern in pterygium management. 1 2 3 4 5 6 7 Thus, many authors recommend the use of adjunctive therapies including mitomycin C (MMC), 5-fluorouracil, topical cyclosporine, and beta irradiation to minimize the recurrence rate. 6 7…”

“…Increased levels of pro-angiogenic growth factors, especially the vascular endothelial growth factor (VEGF), had been identified in the pterygium tissue. 4 5 6 7 8 Thus, anti-VEGF injections have been used by several authors. 5 8 9 10 11 12 13 14 15 16 17 It is suggested that anti-VEGF decreases the vascularity of newly formed blood vessels in pterygia, hence reducing the recurrence rate.…”