Recurrence and Complications after 1000 Surgeries Using Pterygium Extended Removal Followed by Extended Conjunctival Transplant

doi:10.1016/j.ophtha.2012.06.021

Ophthalmology

Volume 119, Issue 11, November 2012, Pages 2205-2210

Presented in part at: the World Cornea Congress, April 2010.

https://doi.org/10.1016/j.ophtha.2012.06.021 Get rights and content

Objective

To document the recurrence rate and complication rate of pterygium extended removal followed by extended conjunctival transplant.

Design

An open, prospective study of consecutive pterygium patients undergoing pterygium extended removal followed by extended conjunctival transplant.

Participants and Controls

The study included 1000 consecutive patients undergoing pterygium surgery between August 2001 and September 2009.

Interventions

All patients underwent pterygium extended removal followed by extended conjunctival transplant by the author with attempted follow-up for 1 year.

Main Outcome Measures

Recurrence and complication rates.

Results

Follow-up of >1 year was obtained in 99% of patients. There was 1 recurrence in the 1000 surgeries (0.1%) with 95% confidence intervals of 0.003%–0.56% (Fischer exact test). Seven patients required further surgery: 3 had graft replacements, and 1 each for recurrence, strabismus, inclusion cyst, and granuloma. One patient lost 4 lines of vision from a corneal ulcer.

Conclusions

Pterygium extended removal followed by extended conjunctival transplant results in one of the lowest recurrence rates reported in the world's literature and an acceptable complication rate.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Patients

This research was conducted under Human Research Ethics Committee approval and conformed to the tenets of the Declaration of Helsinki. All patients in whom either a primary or recurrent pterygium was to be removed by the author between August 2001 and September 2009 were entered into a prospective trial of surgery using pterygium extended removal followed by extended conjunctival transplant examining specifically the endpoints of recurrence rates and complication rates.

All patients were

Results

A thousand consecutive pterygium surgeries were included into this study, and where more than 1 pterygium was removed from a patient, these were considered as separate entries. These include the previously reported 250 primary pterygium removals²³ and the 111 recurrent pterygium removals.²⁴ There were a total of 806 primary pterygium removals and 194 recurrent pterygium removals. The biographical details of the population are listed in Table 1.

Nine hundred ninety-two of the pterygium surgeries

Discussion

Pterygium removal has always been associated with a variable recurrence rate with most scientific reports describing existing or new techniques that purport to reduce the rate at which the pterygium returns.2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 There seems to be a consensus that simply excising the pterygium and leaving bare sclera or simply closing the resultant conjunctival defect results in a recurrence rate of up to 82%.2, 3 If these findings are replicated

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Citation Excerpt :
Limitations of this study include its retrospective nature and small sample size. However, this may be related to the low incidence of strabismus after pterygium excision,30 which makes it difficult to generate a large sample and limits the ability to conduct a well-powered prospective study. In addition, while this group of patients underwent the same general approach to treatment, a strict standardized protocol was not used, allowing flexibility for the treating physician to exercise his or her clinical judgment.
To report the characteristics of patients with restrictive diplopia following pterygium excision and a successful treatment approach for the strabismus.
Retrospective interventional case series.
This study was set in a single academic institution and included 15 patients with restrictive diplopia after pterygium excision. Patients with any other reason for strabismus were excluded. Patients were evaluated for deficits with special attention to diplopic measures. The intervention was a combined procedure by a strabismologist and oculoplastic surgeon to correct the diplopia. The primary outcome measurements were subjective and objective improvement of diplopia.
Fifteen patients (mean age = 49 years) who developed diplopia after pterygium excision were included. Mean time to diplopia was 6 months. All patients had limited abduction in the previously operated eye causing esotropia in the abductive field (mean deviation = 18 prism diopters). After intervention, all patients were no longer diplopic in primary gaze. In the abductive field, 11 (73%) patients had residual small angle esotropia (mean = 7 prism diopters) in ipsilateral extreme end-gaze only. Only 2 patients required additional surgical intervention for scar tissue removal. No patients underwent medial rectus recession.
Restrictive diplopia is a potential complication after pterygium excision, particularly for patients with a history of recurrent pterygia requiring multiple excisions and previous amniotic membrane graft placement with fibrin glue. However, diplopia after pterygium excision in primary position is surgically correctable with scar tissue removal and ocular surface reconstruction, without needing medial rectus recession. Given the high volume of pterygium excision, awareness of postoperative restrictive strabismus and the potential for correction is critical.
Conjunctival Autograft Versus Amniotic Membrane Transplantation for Treatment of Pterygium: Findings From a Cochrane Systematic Review
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To summarize key findings from a systematic review of the effectiveness and risks of conjunctival autograft (CAG) compared with amniotic membrane transplant (AMT) for pterygium.
Cochrane systematic review.
We included only randomized controlled trials (RCTs) in which CAG and AMT had been compared for primary or recurrent pterygia. The primary outcome was recurrence of pterygium ≥1 mm onto the cornea by 3 and 6 months post surgery. We adhered to Cochrane methods for trial selection, data extraction, risk of bias evaluation, and data synthesis.
Twenty RCTs with 1866 participants (1947 eyes) were included. Pterygium recurrence 6 months after surgery ranged from 3.3% to 16.7% in the CAG group and 6.4% to 42.3% in the AMT group based on data from 1021 eyes in 10 RCTs. Estimated risk ratios from meta-analysis indicated that CAG-treated eyes had a 47% lower risk of recurrence 6 months after surgery compared with the AMT group (RR, 0.53, 95% confidence interval [CI], 0.33–0.85). For 96 eyes with recurrent pterygium, the risk of recurrence 6 months after CAG was reduced by 55% compared with AMT (risk ratio [RR], 0.45, 95% CI, 0.21–0.99). Three-month recurrence rates were similar for CAG and AMT based on data from 538 eyes (6 RCTs).
CAG was more effective than AMT to prevent pterygium recurrence by 6 months post surgery, especially in recurrent pterygia. CAG-treated eyes had half the recurrence rates of AMT-treated eyes. Future RCTs should assess changes in patient-reported outcomes (symptoms, cosmesis) and visual acuity, and evaluate effects of surgical variations.
Deprivation and follow-up issues following “perfect” pterygium surgery in the NHS
2024, Eye (Basingstoke)
Modified Limbal-Conjunctival Autograft Surgical Technique: Long-Term Results of Recurrence and Complications
2023, Cornea
Effectiveness of conjunctival-limbal autograft with marginal Tenon’s layer excision in pterygium treatment: non-randomized comparative study
2023, Research Square

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: Manuscript no. 2012-301.

: Supported in part by the Prevent Blindness Foundation, Brisbane, Australia, which had no role in the design or conduct of the research.

: Financial Disclosure(s): The author has made the following disclosures: Lawrence Hirst owns the trademark P.E.R.F.E.C.T. for PTERYGIUM.

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Original articleRecurrence and Complications after 1000 Surgeries Using Pterygium Extended Removal Followed by Extended Conjunctival Transplant

Objective

Design

Participants and Controls

Interventions

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Patients

Results

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Surv Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

The History of Ophthalmologyvol. 1. Antiquity

Effect of pterygium morphology on pterygium recurrence in a controlled trial comparing conjunctival autografting with bare sclera excision

Arch Ophthalmol

Meta-analysis on the recurrence rates after bare sclera resection with and without mitomycin C use and conjunctival autograft placement in surgery for primary pterygium

Br J Ophthalmol

Recurrence rate and complications after beta irradiation for pterygia

Ophthalmology

Favorable long-term results of primary pterygium removal by bare sclera extirpation followed by a single 90Strontium application

Eur J Ophthalmol

Intraoperative mitomycin C in the treatment of pterygium

Cornea

Original article
Recurrence and Complications after 1000 Surgeries Using Pterygium Extended Removal Followed by Extended Conjunctival Transplant