A new technique for pterygium excision: air-assisted dissection.
ABSTRACT To introduce a new technique which aids to remove the pterygium head and facilitates the establishment of a smooth and clear corneal surface without extra scraping or polishing.
We used 12 eyes of 12 patients undergoing pterygium excision. Air was injected into the side of the cap of the pterygium head with a 30-gauge needle, to create a dissection plane between the pterygium head and the cornea. After blunt dissection and excision of the pterygium, the conjunctival autograft technique was applied. Complications, postoperative smoothness and clarity of the cornea, and the recurrence rates were evaluated.
Dissection with air was successfully performed in 9 eyes (75%) in which blunt dissection was carried out easily. The corneas were clear and smooth postoperatively. In 3 eyes (25%) dissection with air was not completely successful, and scraping with a crescent blade had to be performed. One of the eyes with incomplete air dissection could not be clearly scraped. No major complications were observed. The recurrence rate was 8.3% (1 eye).
This new technique is a safe, easy and cheap method for removing the pterygium head from the corneal surface, which also facilitates the establishment of a clear and smooth corneal surface.
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ABSTRACT: In a retrospective survey of 117 operations for primary or recurrent pterygium, conjunctival autografting was compared with both excision without conjunctival closure ('bare sclera excision') and excision with complete conjunctival closure. The probability of corneal recurrence at 36 months after surgery was determined by survival curve analysis. In previously unoperated cases conjunctival autografting (n = 15) resulted in a 14% probability of recurrence, compared with 70% for bare sclera excision (n = 50) and 69% for excision with complete conjunctival closure (n = 20). In previously operated cases conjunctival autografting (n = 17) resulted in a 7% probability of recurrence, compared with 82% for bare sclera excision (n = 15). Hazard ratio analysis confirmed the statistical significance of these results at the 95% confidence level. Conjunctival autografting was more likely to produce an improvement in visual acuity than other forms of surgery.Eye 02/1993; 7 ( Pt 5):634-8. · 1.82 Impact Factor
Article: Surgical Management of Pterygium[show abstract] [hide abstract]
ABSTRACT: None of the current surgical procedures available for the treatment of pterygium is able to provide an outcome without complications and high recurrence rates. Adjunctive postop-erative therapies such as mitomycin-C and b-irradiation are sometimes added to reduce the re-currence rate. Such postoperative therapies sometimes can cause complications such as corneal edema, sclera necrosis, and secondary microbial infection. The use of a free conjunctival au-tograft to cover the bare sclera can prevent complications and reduce recurrence rates; however, use of this material requires skillful dissection and handling of the graft. (Comp Ophthalmol Update 4: xx-xx, 2003) Key words. amniotic membrane transplantation conjunctival autograft mitomycin-C ptery-gium COMPREHENSIVE OPHTHALMOLOGY UPDATE VOLUME 4, NUMBER 5 SEPTEMBER-OCTOBER 2003 Despite the fact that a variety of surgical procedures have been used to treat pterygium for many years, no single procedure has achieved com-plete success without complications. The literature clearly shows that bare sclera excision alone has unacceptably high recurrence rates of 3070%, supporting that it cannot be used to treat pterygium. 1 To reduce the re-currence rate to the level of 442.9%, it is necessary to add such adjunctive postoperative therapies as topical mitomycin-C or b-irradiation. 2-4 Un-fortunately, such adjunctive therapies when directed to the bare sclera can cause devastating complications, such as corneal edema, sclera necrosis, and secondary microbial infections. 5-8 To circumvent these undesirable compli-cations and to reduce recurrence rates, a free conjunctival autograft is used to cover the bare sclera. 9,10 Be-cause conjunctival autograft requires skillful dissection and optimal han-dling of the graft, its success depends on individual technique and surgical experience. 11 Conjunctival autograft may achieve a recurrence rate as low as 2%, but a wide range of higherComprehensive ophthalmology update 09/2003; 4(5):1.
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ABSTRACT: The optimum mode of treatment for symptomatic pterygia would combine efficacy (a low recurrence rate) with safety (freedom from sight threatening complications), and would not affect visual acuity adversely. The efficacy of pterygium excision with conjunctival autografting in a sun exposed population in which pterygia are prevalent has previously been questioned. A cross sectional review of 93 eyes of 85 patients was carried out by slit-lamp examination a minimum of 6 months (range 6-76 months) after pterygium excision and free conjunctival autografting. Case notes were reviewed to obtain details of complications and visual acuity changes related to surgery. Of six recurrences (6.5%) four of these were asymptomatic with minor recurrences. Two patterns of recurrence were identified: cross graft recurrence (three cases) and outflanking (three cases). Complications (wound dehiscence, three cases; Tenon's granuloma one case; conjunctival cyst, one case) were all corrected by minor surgical revision without sequelae. Unaided acuities were unchanged or improved 3 months after surgery in 86 cases, with a minor diminution (1 Snellen line) in seven cases. This study demonstrates a low recurrence rate for a safe technique in an area in which ongoing ultraviolet light exposure levels are high and pterygia are prevalent.British Journal of Ophthalmology 12/1993; 77(11):698-701. · 2.73 Impact Factor