The study of etiological and demographic characteristics of pterygium recurrence: a consecutive case series study from Pakistan

Abstract

To determine the agents of recurrence, the demographic features, and the management and outcomes of pterygium cases treated at Aga Khan University Hospital (AKUH), Karachi. This hospital-based descriptive study included 147 patients with pterygium (147 eyes) from both sexes, who presented at the Ophthalmology Department at AKUH between January 1, 2002 and December 31, 2010. Data regarding their demographic profile and other factors were collected in a well-structured proforma. Data were analyzed using frequencies, proportions, group means, standard deviations, and Pearson's chi squared test. The male to female ratio in our study was 2:1, with factors such as younger age (<50 years) at presentation (P = 0.04, Pearson's chi squared test) and the presence of secondary pterygium (P = 0.050) correlated significantly with the recurrence of pterygium. There was a definite trend of decreased recurrence seen with lower grade of pterygium (P = 0.06). The recurrence rate in our study was 8.8 %. These results suggest that a younger age coupled with a higher grade of pterygium as well as a history of multiple recurrences leads to increased susceptibility of recurrence after surgical excision. Early diagnosis and appropriate management will lead to a better prognosis.

Clinical results for combination of fibrin glue and nasal margin suture fixation for attaching conjunctival autografts after pterygium excision in Chinese pterygium patients

“…These results are in accordance with studies showing that the grade and morphology of pterygium influences recurrence rates when autografting with fibrin glue, in addition, studies showed that there appeared to be significantly more recurrences in the high grade group than the low grade group. [ 11 , 12 ] Our postoperative complication and recurrence results after pterygium surgery compared favourably with the other published studies.…”

“…It is a challenge to treat Chinese pterygium patients using only glue to fix a CAG because of the high grade and large size of pterygiums in the patients being treated, which may meet severe postoperative inflammation and unstable CAG. Mahar and Manzar [ 11 ] and Sandra et al [ 12 ] reported that there was a definite trend of increased postoperative complication such as recurrence with higher grade of pterygium when autografting with fibrin glue. [ 11 , 12 ] In our Institution, we began using fibrin glue in CAGs in 2014 and have found several complications, such as graft loss/displacement, dehiscence, proliferative granuloma, and pterygium recurrence, which may be due to the abovementioned reason.…”

“…Mahar and Manzar [ 11 ] and Sandra et al [ 12 ] reported that there was a definite trend of increased postoperative complication such as recurrence with higher grade of pterygium when autografting with fibrin glue. [ 11 , 12 ] In our Institution, we began using fibrin glue in CAGs in 2014 and have found several complications, such as graft loss/displacement, dehiscence, proliferative granuloma, and pterygium recurrence, which may be due to the abovementioned reason. Therefore, we tried to improve the graft stability and reduce graft related complication by combining fibrin glue and sutures in the nasal margin to fix the conjunctiva graft.…”

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“…From previous literature, it is understood that pterygium size and grade increases the risk of recurrence [25][26][27]. In our cases, it cannot be determined if attendings selected the more complex and higher grade cases.…”

The Variation in Surgical Technique and Role of Physician Experience in Pterygium Surgical Outcomes

“…If this holds true, the attendings' recurrence rates may trend higher due to more difficult procedures and higher risk of recurrence. Younger age also increases the risk for recurrence, but age was not significantly different between the experience groups [25,[28][29][30].…”