The use of dry amniotic membrane in pterygium surgery

Abstract

Pterygium is a fibrovascular growth of the bulbar conjunctiva that crosses the limbus and extends over the peripheral cornea, in some cases resulting in significant visual morbidity. When treatment is indicated, surgery is necessary, and several management options exist. These include excision, conjunctival autografting, and the use of adjuvant therapies. This paper reviews the incidence and prevalence of pterygia and also describes the various techniques currently used to treat this condition. These management options are compared to the use of dry amniotic membrane grafting (AMG), specifically with regard to recurrence rates, time to recurrence, safety and tolerability, as well as patient factors including cosmesis and quality of life. AMG has been used in the treatment of ocular surface disease due to a variety of benefits, including its anti-inflammatory properties, as well as its ability to promote epithelial growth and suppress transforming growth factor-β signaling and fibroblast proliferation. However, rates of recurrence for AMG following pterygium excision still surpass other commonly used techniques, including conjunctival and limbal autografting. Nevertheless, there are circumstances in which AMG may be most beneficial to the patient, such as when preexisting conjunctival scarring is present, when the conjunctiva must be spared for future glaucoma filtering surgery, or in cases of large or double-headed pterygia. Therefore, surgeons should be prepared to offer this procedure as an option to their patients for the treatment of pterygia.

Sutureless Transplantation of Amniotic Membrane Using a Visible Light‐Curable Protein Bioadhesive for Ocular Surface Reconstruction

“…Compared with conjunctival autografting, AMT has the advantage that it does not leave a scar, as it does not require conjunctival removal at donor site. [ 15,16 ]…”

Human Amniotic Membrane Preparation, Preservation and Clinical Application Using Various Techniques for the Treatment of Ophthalmic Dysfunctions

“…A schematic diagram is given for showing the pterygium excision with AMT and conjunctival auto grafting ( Figure. 4) [67].…”

Scleral Necrosis Following Pterygium Excision: A Case Report

“…It is postulated to result from actinic damage to the limbal stem cells, hence, considered a focal limbal stem cell deficiency (Ronald, 2018). The most challenging aspect of pterygium excision is the high incidence of recurrence, as high as 88% with simple excision involving an uncovered bare sclera (Ronald, 2018;Noureddin G, &Yeung, S, 2016). The management options for prevention of pterygium recurrence are conjunctival autografting, amniotic membrane grafting and the use of adjuvant therapies including mitomycin C( MMC), 5-fluorouracil, anti-vascular endothelial growth factor (anti-VEGF) agents, and beta-irradiation (Noureddin G, &Yeung, S, 2016).…”