Visual and refractive Outcome After Pterygium Excision by Different Techniques

Abstract

Purpose: To compare outcome after primary pterygium excision using conjunctival transpositional flap, conjunctival autografting and bare sclera followed by minimal dose Beta irradiation as regard intra-operative and post-operative complications, refractive and cosmetic outcome. Methods:The study was conducted on 45 eyes of 45 patients with primary pterygium that were prepared to surgical excision at Mansoura ophthalmic center in the period from February 2019 till March 2020. The eyes were divided into three groups; each group had 15 eyes. Group (I) subjected to pterygium excision using conjunctival transpositional flap, group (II) subjected to pterygium excision using conjunctival autografting and group (III) subjected to pterygium excision using bare sclera followed by minimal dose Beta irradiation. Snellen chart visual acuity measurement then converted to logMAR, Manifest refractions using the auto-refractometer, slit-lamp examination, grading of pterygium, and anterior segment photography were performed preoperatively. The patients were followed up on the first day and the first week after surgery and then at months 1, 3 and 6. Results:The preoperative mean refractive astigmatism (3.33 ± 1.01 D) was significantly reduced to 1.33 ± 0.53 D postoperatively (p< 0.001). Preoperative mean visual acuity (BCVA) was 0.495 ± 0.117 improved to 0.120 ± 0.092 postoperatively. which was statistically significant (p<0.001). Minor complications like congestion, chemosis, subconjunctival haemorrhage and wound dehiscence were seen. However, major complications as recurrence were detected in two eyes of bare sclera technique.Conclusıons: free conjunctival autografting and conjunctival transpositional flap are safe and effective methods of pterygium excision in lowering recurrence rate in addition to better cosmotic and surgical results rather than bare sclera method. Further researches are recommended with longer follow up duration on large number of cases