A New Technique for Pterygium Excision: Air-Assisted Dissection
Eye Clinic, Vakif Gureba Education Hospital, Istanbul, Turkey. Ophthalmologica
(Impact Factor: 1.68).
02/2006; 220(5):307-10. DOI: 10.1159/000094620
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: SUMMARY To evaluate and compare the effectiveness and safety of the human amniotic membrane graft with intraoperative application of Mitomycin C in primary pterygium surgery. In 60 consecutive patients, 60 eyes were included in the study. The patients were randomly divided into two groups, primary pterygium excision with intraoperative Mitomycin C (0.2 mg/ml) were applied to the 30 patients and amniotic membrane grafts were applied to the other 30 patients. Recurrence was detected in two patients (%6.66) who received amniotic membrane grafts, and in five patients (%16.66) who received primary pterygium excision with intraoperative Mitomycin C. No statistical difference was observed between groups according to the reccurence (p > 0.05). Suture lysis in early postoperative period was detected in one patient (%3.33) who received amniotic membrane grafts. Scleral melting was developed in one patient (%3.33) and punctate epitheliopathy was developed in one patient (%3.33) who received primary pterygium excision with intraoperative Mitomycin C. No statistical difference was observed between groups according to the complications (p > 0.05). Although no statistical difference was observed between two groups according to complication and reccurence, amniotic membrane graft method was safer than primary pterygium excision with intraoperative Mitomycin C.
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ABSTRACT: To study the microsurgical procedures for the treatment of large primary pterygium and their therapeutic effects. To observe the recurrence rate, the changes of visual acuity after microsurgery and the pathological relationships between pterygium and cornea/sclera under the surgical microscope.
Forty-six eyes of forty-one patients with pterygium which invading the cornea over the pupil border were included. Pterygium was dissected by various methods under surgical microscope. The pathological relationship between the pterygium and cornea/sclera was observed. The lengths of the pterygium head and its three parts were measured. Degenerative Tenon's capsule was removed totally and the wound was covered by rotated conjunctival flaps. These patients were followed-up for 12.0 - 50.2 months (median: 22.4 months). Changes in visual acuity and recurrence rate after operation were observed.
The average length of the total pterygium heads was (6.3 +/- 0.4) mm. The head was divided into three parts: the apical, loose and adhesive parts. The apical part was located at the top of the pterygium head with a length of (1.7 +/- 0.4) mm. The tissue of apical part was compact, hard, translucent and adhered to the cornea tissue. The adhesive part was a band in front of the anterior border of the limbus and paralleled to the limbus. The width of adhesive part was (0.9 +/- 0.1) mm and was tightly adhered to the cornea. The loose part lied between the apical and the adhesive part. The length of which was (3.6 +/- 0.4) mm and could be separated from the cornea easily. The neck and the body parts of pterygium could be separated easily from the limbus and sclera. Non-corrected visual acuity averaged 0.3 (ranged from finger count to 0.7) before the operation and averaged 0.7 (ranged from finger count to 1.5) 1 month postoperatively (Wilcoxon signed rank test u = 5.435, P < 0.01). Pterygium relapsed in 5 eyes with a recurrence rate of 11% (5/46).
There is a regular pathological relationship between the pterygium and the cornea/sclera under surgical microscope, which is fundamental for the microsurgery of the pterygium. Extensively degenerated Tenon's capsule should be removed totally and the defect should be covered by rotated conjunctival flaps. The recurrence rate is low and the visual acuity increases significantly after the operation.
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ABSTRACT: AIM: To investigate the method and observe effectiveness of autologous limbal stem cell transplantation combined with amniotic membrane transplantation in the treatment of recurrent pterygium. METHODS: Medical records of all patients with recurrent pterygium treated by autologous limbal stem cell transplantation combined with amniotic membrane transplantation from January 2010 through June 2011 were retrospectively analyzed, and the recurrent rate was observed. RESULTS: Totally 30 cases (32 eyes) were analyzed. The followed up time was 12 to 24 months, mean 16 months. In all eyes, 30 were transparent or only left a little corneal nebula, without new blood vessels, recurrence occurred in 2 eyes, and the recurrent rate was 6%. CONCLUSION: Autologous limbal stem cell transplantation combined with amniotic membrane transplantation is a safe and effective method for recurrent pterygium.
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