Graft retraction was seen in 620 cases (29.45%) and 72 cases (28.6%) in primary and recurrent pterygium respectively, with no significant P value (P = 0.857). Would you like email updates of new search results? Histologically, pterygia are an accumulation of degenerated subepithelial tissue which is basophilic with a characteristic slate gray appearance on H&E staining. Marticorena J, Rodrguez-Ares MT, Tourio R, Mera P, Valladares MJ, Martinez-de-la-Casa JM, et al. Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of OphthalmologyDisclosure: Nothing to disclose. 13:22. Conjunctival recurrence of pterygium was seen in 2 (8.7%) of the steroid group and in 1 (4.0%) of the control group (P=0.47). Dellen was seen in 16 cases (0.76%) of primary pterygium and 5 cases (1.99%) of recurrent pterygium, without a significant P value (P = 0.1079). Elliot R. The aetiology of pterygium. The nasal half was released from its base and placed over the nasal bare sclera without changing the orientation. Hemostasis was allowed to occur spontaneously without the use of cautery as little oozing is useful as it helps in adherence of graft to the bed. Results: The site is secure. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTE5MjUyNy1jbGluaWNhbA==, Distortion and/or reduction of central vision, Chronic scarring of the conjunctiva and the cornea, Perforation of the globe, vitreous hemorrhage, or retinal detachment (all rare). Sebban A, Hirst LW. Positive, significant, and moderate correlations were found between the pterygium size and the change in IOL power. The transplants healed with excellent cosmetic result. Demographic data, number, types of pterygia included in the study, and the follow-up period is shown in Table 1. 2003 Apr;110(4):806-10. doi: 10.1016/S0161-6420(02)01970-X. 1993 Sep. 111(9):1167-8. The stabilization of the graft was tested with a Weck-cel spear centrally and on each free edge to ensure firm adherence to the sclera. In 1985, Kenyon et al. Despite resolution of inflammation and granuloma with triamcinolone injection, a conjunctival recurrence was noted at 6 months after surgery (i). FOIA Would you like email updates of new search results? A higher index of suspicion for concurrent malignancy is required for patients living in areas with higher UV index. The graft was quickly flipped over to the sclera. D'Ombrain A. WebTo demonstrate the long-term outcome of pterygium surgery with adjunctive amniotic membrane transplantation (AMT) and intraoperative mitomycin C (MMC) in a large case series. Nassar MK, El-Sebaey AR, Abdel-Rahman MH, El-Ghonemy K, Shebl AM. Kenyon KR, Wagoner MD, Hettinger ME. 1990 Oct. 9(4):331-4. Inflamed pterygia may cause irritation, foreign body sensation, and tearing which, in many cases, can be alleviated with over the counter vasoconstrictor drops, lubricating drops and ointments. Federal government websites often end in .gov or .mil. Design: Various aetiologies have been attributed to its cause, but mainly the ultra-violet rays are the common and important cause for the occurrence of pterygium. Evaluation of the effectiveness of intraoperative mitomycin C in pterygium surgery for African eyes. In one of the cases of graft loss, the patient did have recurrence and underwent resurgery elsewhere. To avoid the pterygium growing back, you should take the prescribed steroid drops and avoid sun exposure to the eye. Surgical removal is the treatment of choice. official website and that any information you provide is encrypted Epub 2014 Jan 31. 38:1. Bookshelf Complications in eyes with intraoperative MMC followed by LCAG or AMG transplantation. Objective: Venkateswaran N, Galor A, Wang J, Karp CL. Pterygium and ultraviolet radiation:A positive correlation. The cost of surgery is another very important factor to be considered. It is a study conducted on patients presenting with Primary Pterygium to outpatient department of Ophthalmology at, Yin M, Li H, Zhang Y, Dai H, Luo F, Pan Z. Interferon Alpha-2b Eye Drops Prevent Recurrence of Pterygium After the Bare Sclera Technique: A Single-Center, Sequential, and Controlled Study. [QxMD MEDLINE Link]. There were no intraoperative complications seen. Nine-year incidence and risk factors for pterygium in the Barbados Eye Studies. Thus, the material cost of the no glue and no suture method became significantly lower than that of the sutures or using fibrin glue. Out of 2028 patients, 914 patients were male and 1114 patients were female. Kodavoor SK, Tiwari NN, Ramamurthy D. Long-term analysis of an unconventional way of doing double-head pterygium excision. Conclusions: Grade 3 outcome after pterygium surgery with a bare-sclera technique and intraoperative MMC application. Kodavoor SK, Soundarya B, Dandapani R. Visual and refractive outcomes following simultaneous phacoemulsification and pterygium excision with conjunctival autograft. 2022 Sep 9;19(18):11357. doi: 10.3390/ijerph191811357. Am J Ophthalmol. Saw SM, Tan D. Pterygium: prevalence, demography and risk factors. For eyes with moderate or severe postoperative inflammation, subconjunctival triamcinolone was injected; these included 6 (26.1%) and 9 (36%) in the steroid and control groups, respectively (P=0.54). Postoperative pain on day 1 after surgery was consistently rated as 3 out of 10 on a visual analog score. (b) Graft edema. Recurrence rate can be as low as 1 in 1000 depending on surgical approach. Suture-related complications include infection, granuloma formation, and chronic inflammation, whereas plasma-derived fibrin glue has the potential risk of prion disease transmission and anaphylaxis in susceptible individuals. A total of 205 cases of pterygium underwent excision with conjunctival autograft without using sutures or glue. WebThe mean age was 63.8 years. HHS Vulnerability Disclosure, Help As the lesion progresses, vision may be affected by induction of astigmatism or obscuration of the visual axis. A yellowish transplant serous edema was sometimes observed and was slightly more common in the mitomycin used group. 2017 May;42(5):696-700. doi: 10.1080/02713683.2016.1236965. Epub 2006 Nov 30. 1961. UV radiation, proximity to the equator, dry climates, outdoor lifestyle[1]. The effect of mitomycin C on corneal endothelium in pterygium surgery. A number of potential therapeutic options exist for the management of pterygia ranging from conservative management with lubrication to surgical excision with conjunctival autografts. Ophthalmology. Cornea. Patients with pterygia present with various complaints, ranging from no symptoms to significant redness, swelling, itching, irritation, and blurring of vision associated with elevated lesions of the conjunctiva and contiguous cornea in one or both eyes. Please enter a valid username and password and try again. Safety and efficacy of pterygium extended removal followed by extended conjunctival transplant for recurrent pterygia. The graft was then vertically split into two halves. Postoperative complications of pterygium repair can include the following: Late postoperative complications of beta radiation of pterygia can include scleral and/or corneal thinning or ectasia, which can present years or even decades after treatment. The diagnosis is made by slit-lamp examination of the wing-shaped limbal growth at the characteristic location within the palpebral fissure. Scleral on long-term complications of MMC use after pterygium stromalysis may present anywhere from months to years after Hardten DR, Lindstrom RL. Cogan DG, Kuwabara T, Howard J. MeSH Carcinogenesis by Ultraviolet Light. Clipboard, Search History, and several other advanced features are temporarily unavailable. A total of 2356 eyes in 2028 patients were included in the study. Yao YF, Qiu WY, Zhang YM, Tseng SC. Alaniz-Camino F. The use of postoperative beta radiation in the treatment of pterygia. The graft was fixed using fibrin glue, Tisseel (Baxter, Vienna, Austria). Unable to load your collection due to an error, Unable to load your delegates due to an error. Recent reports favor the use of fibrin glue above sutures with improved comfort, decreased surgical time, and reduced complication and recurrence rates. 00:1-6. If you have a Best Practice personal account, your own subscription or have registered for a free trial, log in here: If your hospital, university, trust or other institution provides access to BMJ Best Practice through services such as OpenAthens or Shibboleth, log in via this button: If you have been provided an access code, you can register it here: For any urgent enquiries please contact our customer services team who are ready to help with any problems. Our study has limitation that it comprised a small study population of the designated area. Kamel S. The Pterygium: its etiology and treatment. To the best of our knowledge, this is the largest sample size reported with a long-term follow-up. 2021 Jul 1;10(8):18. doi: 10.1167/tvst.10.8.18. 2005 Aug. 33(4):447-8. Fibrin glue is not easily available to various eye clinics. Further evaluation of the recurrence rate is needed with even larger series. Analysis of variation in success rates in conjunctival autografting for primary and recurrent pterygium. Postoperatively, type of procedure, visual acuity, complications, duration of follow up was noted. In patients who have not yet undergone surgical excision, scarring of the medial rectus muscle is the most common cause of diplopia. Medscape Education, Patient and Lens Selection: An In-Depth Exploration of Intraocular Lenses for Patients With Presbyopia and Cataracts, encoded search term (Pterygium) and Pterygium. Conjunctival sutures used in pterygium surgery are not only time-consuming process but also may lead to local complications such as discomfort, scarring, granuloma, or infection. All the surgeries were performed by a single surgeon. 1d] was seen in 9 cases (0.38%). sharing sensitive information, make sure youre on a federal 8600 Rockville Pike Graft retraction [Fig. WebPreoperative Subpterygeal Injection Versus Intraoperative Mitomycin C for Pterygium Removal: Comparison of Results and Complications of pterygium remains the most enigmatic complication of pterygium surgery. Pterygium was graded depending on the extent of corneal involvement: Grade I crossing the limbus, Grade II mid-way between limbus and pupil, Grade III reaching up to pupillary margin, and Grade IV crossing pupillary margin. The conjunctival graft was taken from the superior conjunctiva. Bethesda, MD 20894, Web Policies WebUnfortunately, complications from intraoperative MMC application in pterygium surgery have been reported including vision-threatening complications such as glaucoma, corneal In cases with up to grade 2 pterygium with cataract and astigmatism <2 D can be managed in the same setting with good visual outcome.[28]. Understanding and managing pterygium. One group of patients with pterygium can present with minimal proliferation and a relatively atrophic appearance. Ophthalmology. 2022 Jul;42(7):2047-2053. doi: 10.1007/s10792-021-02199-w. Epub 2022 Jan 3. 0.39 D for Haigis, and 0.38 D for Holladay 2 formulas after pterygium surgery. To evaluate the effects of intraoperative triamcinolone injection on the outcome of pterygium surgery. Miyai T, Hara R, Nejima R, Miyata K, Yonemura T, Amano S. Limbal allograft, amniotic membrane transplantation, and intraoperative mitomycin C for recurrent pterygium. Ocular therapy with beta particles. Similarly, the temporal pterygium was excised. Department of Ophthalmology, Rustaq Hospital, Rustaq, Oman, 1Medical Officer, Rustaq Polyclinic, Oman. Ultraviolet light-induced damage to the limbal stem cell barrier with subsequent conjunctivalization of the cornea is the currently accepted etiology of this condition. Excision with conjunctival autograft is considered the current gold standard because of its low rate of recurrence. Ophthalmology. Pterygium excision with conjunctival autograft is a widely performed surgery for pterygium. government site. An eye with grade T2 of pterygium morphology (a) in the steroid group developed fine episcleral vessels at 3-month visit (b). All these techniques involve the use of sutures or fibrin glue and are therefore vulnerable to associated complications. Clearfield E, Muthappan V, Wang X, Kuo IC. (2.5%) and by Rathi et al. Other proposed theories include choline deficiency, inflammation, disregulation of angiogenesis, immune system abnormalities, tear film abnormalities, as well as the possible role of a viral stimulus. Complications between primary and recurrent pterygia were compared [Table 2]. Ti SE, Chee SP, Dear KB, Tan DT. Using no glue and no suture technique instead of sutures when attaching the conjunctival transplant in pterygium surgery causes significantly less postoperative pain and discomfort and shortens surgery time significantly. Princeton University Press; 1959. WebPatients and methods: One hundred thirty-five eyes of 128 patients considered at high risk for recurrence of pterygium were treated with a single, intraoperative, Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of OphthalmologyDisclosure: Nothing to disclose. 1999 Sep. 6(3):219-28. Cornea. Patients who had undergone (a) Conjunctival autografting for primary pterygium (CAG) (b) Conjunctival Limbal autografting for recurrent pterygium (CLAG), (c) Vertical split conjunctival autografting (VsCAG) for double head pterygium (primary) were included in the study. the contents by NLM or the National Institutes of Health. Transl Vis Sci Technol. Careers. [Fig.1f1f and and1g]1g] was seen in 4 cases (0.16%) at the host site and 5 cases (0.21%) at the donor site. Bookshelf Intraoperative 96% ethanol as an adjuvant in Pterygium (Pt) surgery our institution from January 2017 to January 2020 was performed to find out if there were any intra- or post-surgical complications related to the use of 96% ethanol. for pterygium) indicate a further decreased recurrence rate (as low as 1 in 1000 in one series)[7][8][9]. Malik et al. In the present study, we have used fibrin glue in all the cases and did not find any disadvantage over sutures. [9, 10, 11], The most common complication of pterygium surgery is postoperative recurrence. Outcomes of conjunctival autograft in primary pterygium cases in other studies[5,16,17,18,19] are listed in Table 3, in our study largest sample size is been considered. This prospective study included 54 eyes with primary nasal pterygia that underwent pterygium surgery with a bare-sclera technique and intraoperative mitomycin C application. Curr Eye Res. Hirst LW. 2c] which did not cause any symptoms to the patient. sharing sensitive information, make sure youre on a federal [QxMD MEDLINE Link]. Rathi G, Sadhu J, Joshiyara P, Ahir HD, Ganvit SS, Pandya NN. 2008 Jan;27(1):56-63. doi: 10.1097/ICO.0b013e31815873da. In pterygium surgery with a bare-sclera technique and mitomycin C application, intraoperative triamcinolone injection did not significantly reduce postoperative conjunctival inflammation or pterygium recurrence. Though frequently asymptomatic, pterygia can become inflamed and cause ocular surface irritation. Granuloma was also noted in 6 cases of primary and 4 cases of recurrent pterygium. [QxMD MEDLINE Link]. We included adult inpatients ( 18 In addition, they have different capacity to withstand the pain. Accessibility One patient developed an exotropia that required no treatment, and 1 patient lost 4 lines of vision as a result of a corneal ulcer. Other severe complications like corneal melt [Fig.