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Schematic steps of the primary pterygium excision and repair with conjunctival flap technique. a-c, Pterygium excision. d and e, Transpositional flap preparation. f, Transpositional flap saturation to defect area.
Source publication
Purpose
To investigate and compare the efficacy of conjunctival autograft and conjunctival transpositional flap for the treatment of primary pterygium surgery.
Design
Retrospective, interventional case series analysis.
Materials and methods
Medical records of 48 patients who underwent pterygium surgery by conjunctival autograft or conjunctival tr...
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Aim: The aim of this study was to evaluate and compare keratometric changes after pterygium excision surgery. Settings and Design: The study was carried out at a tertiary eye care center in central Rajasthan, India. Materials and Methods: Total 50 patients of primary pterygium without any other corneal pathology were undergone to pterygium excision...
Citations
... Эффективность различных способов лечения птеригиума остается актуальным вопросом офтальмохирургии в связи с распространенностью в странах c повышенной инсоляцией, а также с нередким рецидивированием. Так, по данным литературы, частота рецидивов птеригиума может достигать 30-89 % в зависимости от способа хирургического лечения [1][2][3][4][5][6][7]. При этом более чем в 85 % случаев повторный рост наблюдается в первый год после оперативного лечения [8][9][10]. ...
We have proposed a method for fixing an autolimbal graft using a two-component autofibrin glue. The use of this adhesive composition is justified by the formation for strong adhesion and tissues fixation, as well as the relief of local inflammatory reaction due to the platelet-rich plasma (PRP) included in its composition. Objective . To compare the effectiveness of autolimbal transplantation using a two-component autofibrin glue and suture fixation in multiple recurring pterygium over a two-year follow-up period. Patients and methods . The study included 19 patients (20 eyes) with repeatedly recurring pterygium. The autolimbal graft was fixed using two-component autofibrin glue in the study group and using suture material (10/0 silk) in the control group. Using optical coherence tomography of the anterior segment, we assessed the adaptation of the graft in the bed and used a questionnaire to analyze the degree of discomfort in the postoperative period. A comparative analysis of the operation’s duration, epithelialization, and rehabilitation period was performed between the study groups, and cases of pterygium recurrence were recorded throughout the entire observation period (2 years). Results . A comparative analysis of the effectiveness of various methods of autolimbal graft fixation revealed a statistically significant reduction in the operation’s duration, the time to achieve complete epithelialization, and rehabilitation using two-component autofibrin glue. A lower level of discomfort in the postoperative period was noted in the study group. During two years of observation, 1 case of pterygium recurrence was recorded in each group. Conclusion . The advantages of using an adhesive composition for fixing an autolimbal transplant are the low level of surgical trauma and rapid rehabilitation of patients. Two-component autofibrin glue can act as a full-fledged replacement for the suture method of tissue fixation in the treatment of repeatedly recurring pterygium.
... P terygium is an excessive fibrovascular growth of tissue started from bulbar conjunctiva towards the cornea, usually looking like a wing, leading to astigmatism induction and vision loss if associated with pupil obstruction. 1 Pterygium is usually seen on the nasal aspect in the interpalpebral conjunctiva, which may lead to dryness of the eye, irritability, foreign body sensation, and limitation of eye movements. 2 Pterygium advancement pathogenesis seemed to be due to primary limbal barrier interruption because of liability to ultraviolet rays in this area associated with conjunctivalization which is a running action with consequent severe reproduction of conjunctival tissue, inflammatory cells, and blood vessels towards the cornea. ...
... 7 CLAu and conjunctival autograft (CAG) are considered the gold standard treatment with a recurrence rate between 3.5% and 21%. [8][9][10][11][12][13][14][15] However, it may be difficult or inadequate in cases with large excisions and in patients who may require glaucoma filtration surgery in the future. Mini-simple limbal epithelial transplantation (mini-SLET) requires less tissue than the conventional CLAu. ...
Purpose
The purpose of this double-masked, parallel randomised controlled trial was to compare the recurrence rate and other outcomes between conjunctival–limbal autograft (CLAu) and mini-simple limbal epithelial transplantation (mini-SLET) after excision of pterygium.
Methods
Eligibility criteria for participants was the presence of a primary nasal pterygium extending equally to or greater than two millimetres on the cornea on its horizontal axis from the nasal limbus. The participants were allocated into two groups (CLAu and mini-SLET) using simple randomisation with a table of random numbers. Participants and the outcome assessor were masked to the intervention. The study protocol is listed and available on https://clinicaltrials.gov (Identifier: NCT03363282 ).
Results
A total of 61 eyes were enrolled in the study, 33 underwent CLAu (group 1) and 28 mini-SLET (group 2), all eyes were analysed in each group. At 2, 3, 6 and 12 months the CLAu group exhibited a recurrence of 0%, 6.1%, 8.1% and 8.1%, while the mini-SLET exhibited a recurrence of 0%, 17.9%, 50% and 53.5% (p<0.05). There were no intraoperative or postoperative complications in either of the two groups.
Conclusion
The findings of this study suggest that mini-SLET has a higher recurrence rate and provides no advantage over CLAu in the treatment of primary pterygium.
... Definition of recurrence varied between publications, depending on whether it was exclusively conjunctival or extended onto the cornea. Only corneal recurrence rate was reported in this review, and this was defined as a new fibrovascular overgrowth reaching and exceeding the limbus in 26 subgroups [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]; a growth [ 1 mm or more anterior to the limbus in 7 subgroups [20,27,[36][37][38][39]; and a growth [ 1.5 mm or more anterior to the limbus in 1 subgroup [28]. ...
... Between 1993 and 2022, 16 publications about CAT met all the inclusion criteria and were included in the review [16][17][18][19][20][21][22][23][24][25][26][27][28][37][38][39]. None of the papers had adjuvant MMC used peroperatively. ...
Introduction:
The purpose of this study is to compare the "real-life" effectiveness of amniotic membrane graft (AMG) and conjunctival (CAT) or limbal conjunctival (LCA) autograft in the management of primary pterygium.
Methods:
Human-based studies on primary pterygium surgery that were published between 1993 and 2022 with at least 3 months of follow-up were identified, and only those that were retrospective were included. The global recurrence rate of pterygium was assessed for each surgical technique separately. Specific recurrence rates taking into consideration the fixation technique (glue versus sutures) were also measured.
Results:
35 real-life retrospective subgroups comprising a total of 3747 eyes were included in the final review. The mean global recurrence rates for CAT, LCA and AMG were 7.61%, 5.50% and 9.0%, respectively. Recurrences were less common for patients who received fibrin glue (5.92%, 2.56% and 3.60%) than for those who received sutures (8.99%, 6.03% and 23.0%) for the three groups, respectively. Surgical techniques combining CAT or LCA with AMG yielded an even lower global recurrence rate (1.83%).
Conclusion:
AMG seems like a reasonable option that could be considered in primary pterygium surgery, especially when glued to the underlying sclera. Combining AMG with other treatment modalities such as CAT or LCA seems to offer an interesting alternative in terms of recurrence.
... The reason for this is the difficulty of separating the fibrovascular tissue from a small graft, the smaller size of the graft in relation to the bare sclera, and the need for more sutures to hold the graft in the rotational method. 49 Although there is a consensus that flap is better than grafting for reconstructive surgery, 65 more clinical trials are needed to confirm the superiority of flap methods over conjunctival autograft treatment. 44 In a study conducted by Hassanen et al., the results showed that after a long period of follow-up for autograft and conjunctival flap surgery, there was no statistically significant difference in terms of the recurrence rate, but the flap technique was associated with less postoperative edema and was a faster and easier technique. ...
Pterygium is a bulbar conjunctival fibrovascular growth that crosses the limbus and extends onto the peripheral cornea, and in some cases leads to significant visual complications. The prevalence of this disease has been reported to be from 1.2% to about 40% in different parts of the world. Although there are various risk factors for pterygium, which include ultraviolet (UV) radiation, viral infection, hereditary factors, immune factors, aseptic inflammation, and environmental irritation, the pathogenesis of pterygium is mainly related to exposure to UV light. In addition to cosmetic problems, pterygium can lead to eye irritation, disrupt the transparency of cornea on the pupil area, and cause disorders such as corneal astigmatism and damage to the visual axis leading to vision impairment. In the last few years, the treatment of pterygium has been developed and various new solutions have been used. Surgery is the main treatment for pterygium. Various techniques such as Bare Sclera, Rotational Conjunctival Flap, Limbal Conjunctival Autograft, Amniotic Membrane Graft, and Free Conjunctival Autograft are used for the removal of pterygium. It also seems that the worrisome problem of recurrence has been significantly reduced with newer treatment methods. On the contrary, the use of auxiliary treatments such as mitomycin C, b-radiation, 5-fluorouracil, topical use of interferons, and Avastin are also effective in reducing the recurrence rate.
... Other flap techniques such as single/double sliding, transpositional, traditional and modified mini flap also show low recurrence rate (1.4% -10.3%). [18][19][20][21] Doublesliding conjunctival flaps surgery is useful to cover bare sclera when pterygium is larger or recurrent type. 19 Studies done in our population show recurrence rate following CAG, AMT and conjunctival flap varying from 3.3% to 25%, 7.84% to 10% and 6.6% to 9.76% respectively. ...
Purpose: To find out the effectiveness of rotational conjunctival flap in pterygium excision by analyzing intra/postoperative complications and recurrence rates. Study Design: Interventional case series Place and Duration of study: Al-Baseer Eye Hospital, Karachi from October 2019 to May 2022. Methods: All patients who had primary pterygium excision with rotational conjunctival flap in the hospital were included. Data collection was done using medical records regarding patient’s age, sex, laterality and location of pterygium, intra-operative and post-operative complications. Patients were examined for recurrence at or more than 3 months follow-up. For data analysis, IBM SPSS Statistics 23 was used. Results: A total of 36 patients underwent pterygium excision with rotational conjunctival flap under topical anesthesia by a single surgeon. Mean age at the time of surgery was 52.85±12.66 years. Male : female ratio was 5:4. Ninety four percent were nasally located. Major intraoperative complication (corneal perforation) occurred in one patient. Post-operative significant flap congestion was noted in 2 (5.5%), while partial flap retraction and sub-conjunctival hemorrhage was seen in 1 (2.7%) patient. Twenty six patients completed at least 3 months follow-up. Two (8%) patients had recurrence of mild-moderate degree within 6 months of surgery. Conclusion: Pterygium excision with conjunctival rotational flap is simple and effective method in selected patients. Harvesting, positioning and suturing of flap can be carried out single handedly. The method requires less surgical expertise, and has good post-operative results.
... The aim of surgery is to remove the lesion and avoid regrowth. Surgical techniques (see Figure 1) include the bare sclera technique, conjunctival autograft, amniotic membrane graft, and conjunctival-limbal graft [13][14][15][16][17][18][19]. Treatment also includes adjuvant therapy in the form of antimetabolites, antiangiogenic agents, and radiation [20]. ...
The search for the “gold standard” in the surgical treatment of pterygium has been ongoing for over two decades. Despite the development of various surgical techniques, recurrence rates range from 6.7% to 88% depending on the method used. This review discusses the latest and most commonly used methods for the surgical removal of pterygium, primarily focusing on efficacy and safety. Moreover, this review includes articles that either evaluated or compared surgical methods and clinical trials for primary and recurrent pterygium. Limited data are available on combined methods as well as on the efficacy of adjuvant treatment. The use of adjuvant intraoperative mitomycin C (MMC) and conjunctival autografting (CAU) are the two most highly recommended options, as they have the lowest rates of postoperative recurrence.
... It is important to note that there is no "perfect" surgical method that guarantees no pterygium recurrence after removal. e most commonly used surgical techniques include conjunctival autografting, transposition of a pedicled conjunctival flap, and amniotic membrane transplantations [12][13][14][15][16][17][18]. Adjuvant therapy in the form of antimetabolites, antiangiogenic agents, and radiation is used to reduce the risk of recurrence [19]. ...
The aim of the study was to compare the efficacy of the two most commonly used surgical methods for pterygium removal in the Polish population, conjunctival autograft versus amniotic membrane transplantation, and to evaluate the postoperative recurrence rate. A retrospective analysis of the medical records was conducted, including 65 patients who underwent surgery for primary or recurrent pterygium at an ophthalmology clinic in Bialystok, Poland, between 2016 and 2020. Surgical success (no regrowth) was achieved in almost half of the amniotic membrane patients (44%) and in most of the conjunctival autograft patients (79%), with statistical significance. The odds of successful surgery were 79% lower for subjects with amniotic membranes than for those with conjunctival autografts (OR with 95% CI = 0.21 (0.05; 0.94); p = 0.045 ). Our study confirms that the conjunctival autograft surgeries present more favorable success rates in Polish Caucasian population when compared to procedures involving amniotic membranes.
... Recurrence rates range from 3.3% to 13.5% (252)(253)(254)(255). Higher recurrence rates have been reported in cases of recurrent pterygium (31.3% to 33.3%) (253). ...
... Recurrence rates range from 3.3% to 13.5% (252)(253)(254)(255). Higher recurrence rates have been reported in cases of recurrent pterygium (31.3% to 33.3%) (253). It is considered to be one of the most effective method for management of pterygium (256). ...
... Rotational conjunctival flaps have been employed since the 40's to cover the pterygium excision site with different recurrence rates ranging from 3.2% as reported by McCoombes et al. (259) to 33.33% as reported by Alpay (227). Bilge compared this technique to conjunctival autografting and reported that both procedures had low recurrence rates without severe complications (253). This procedure is useful in patients with insufficient conjunctiva (260). ...
... 126 For primary pterygium, many studies have reported recurrence rates of lower than 15%, while for recurrent pterygia it lies within a range of 30-33%. [161][162][163][164][165] When combined with adjuvant options, recurrence of pterygium 3 months after conjunctival autografting ranges from 0% to 16.7%, while the recurrence at 6 months after the surgery ranges from 3.33% to 16.7%. 166 The recurrence rate after autografting technique can be lower when the surgery is combined with intraoperative or postoperative MMC therapy. ...
Pterygium is a relatively common ocular surface disease. The clinical aspects and the treatment options have been studied since many years ago, but many uncertainties still exist. The core pathologic pathway and the role of heredity in the development of pterygium are still attractive fields for the researchers. The role of pterygium in corneal irregularities, in addition to the refractive properties of pterygium removal, has been increasingly recognized through numerous studies. The association between pterygium and ocular surface neoplasia is challenging the traditional beliefs regarding the safe profile of the disease. The need for a comprehensive clinical classification system has encouraged homogenization of trials and prediction of the recurrence rate of the pterygium following surgical removal. Evolving surgical methods have been associated with some complications, whose diagnosis and management are necessary for ophthalmic surgeons. According to the review, the main risk factor of pterygium progression remains to be the ultraviolet exposure. A major part of the clinical evaluation should consist of differentiating between typical and atypical pterygia, where the latter may be associated with the risk of ocular surface neoplasia. The effect of pterygium on astigmatism and the aberrations of the cornea may evoke the need for an early removal with a purpose of reducing secondary refractive error. Among the surgical methods, conjunctival or conjunctival-limbal autografting seems to be the first choice for ophthalmic surgeons because the recurrence rate following the procedure has been reported to be lower, compared with other procedures. The use of adjuvant options is supported in the literature, where intraoperative and postoperative mitomycin C has been the adjuvant treatment of choice. The efficacy and safety of anti–vascular endothelial growth factor agents and cyclosporine have been postulated; however, their exact role in the treatment of the pterygium requires further studies.
