Comparison of conjunctival autograft and conjunctival transposition flap techniques in primary pterygium surgery

Bilge, Ayşe Dolar

doi:10.1016/j.sjopt.2017.11.002

Cited by 19 publications

(17 citation statements)

References 18 publications

(14 reference statements)

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“…Syam et al reported a recurrence rate of 3.3% in their study, similar to the results obtained in a case series conducted by Bilge, 40 while Koranyi et al, Fernandes et al, Ma et al, and Al Fayez reported 13.5%, 12.2%, 5.4%, and 8.3% recurrence rates, respectively. 31 , 41 – 43 However, much higher recurrence rates have been reported (ranging from 31.3% to 33.3%), in case of recurrent pterygium excision.…”

Section: Surgical Treatmentsupporting

confidence: 83%

“… 31 , 41 – 43 However, much higher recurrence rates have been reported (ranging from 31.3% to 33.3%), in case of recurrent pterygium excision. 40 A novel technical variant named “pterygium extended removal followed by extended conjunctival transplantation” (P.E.R.F.E.C.T.) was conducted in Australia, with reports of patients’ follow-up longer than 1 year and a recurrence rate of 1.6%.…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…Conjunctival transpositional flap has less torsion effects on tissues and has better cosmetic results in an early and late postoperative period when compared with conjunctival autografting. 40 This technique can be used as an acceptable method for pterygium surgery, especially in patients with insufficient conjunctiva. 99 In general, conjunctival transpositional flap is a more challenging surgery than conjunctival autografting, but once mastered, it needs less surgery time when compared with conjunctival autografting.…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…In addition, conjunctival autografting may need peribulbar anesthesia and tractioning sutures, while it is nearly unnecessary for the transpositional flap technique. 40 Also, in transpositional graft technique, there is no risk of graft loss and inversion, and the vessel structure is preserved, with better healing process and reduced risk of graft necrosis ( Figure 1 ). However, transpositional flap cannot be taken into consideration in case of large pterygia in which a wider grafting is needed.…”

Section: Surgical Treatmentmentioning

confidence: 99%

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How to minimize pterygium recurrence rates: clinical perspectives

Nuzzi¹,

Tridico²

2018

OPTH

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The main treatment for pterygium is surgical removal. However, pterygium surgery is concerned with high rates of postoperative recurrence. Predicting factors of recurrence are not fully understood, yet, but they probably depend on a multitude of patient-related, clinical, and/or surgical factors. Several adjuvant treatments have been proposed to reduce postoperative pterygium recurrence, including different antimetabolites, antiangiogenetic factors, and radiation therapy. The purpose of this review is to collect the current evidence regarding application and limits of different therapeutic approaches for preventing postoperative recurrence of pterygium, giving insights and perspectives for better management of this disease. In the light of the current evidence, pterygium surgery cannot disregard wound coverage with conjunctival autografting or rotational flap combined with adjuvant treatments. The rotational flap technique is associated with shorter surgical time rates and prevents graft displacement and necrosis, given its vascular pedicle. Amniotic membrane may still be reserved in case of great conjunctival defects or insufficient conjunctiva. Repeated subconjunctival antivascular endothelial growth factor injections can be considered as an effective and safe adjuvant treatment. Moreover, management of postoperative pain is crucial. Innovative treatment strategies will probably target different molecular pathways, considering recent findings regarding pterygium pathogenesis, to improve better understanding and develop universally shared guidelines. Great importance shall be dedicated to the identification of novel molecular biomarkers and favoring factors of recurrence, in order to achieve a customized surgical treatment for each patient and obtain maximal reduction of postoperative recurrence.

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Section: Surgical Treatmentsupporting

confidence: 83%

Section: Surgical Treatmentmentioning

confidence: 99%

Section: Surgical Treatmentmentioning

confidence: 99%

Section: Surgical Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

How to minimize pterygium recurrence rates: clinical perspectives

Nuzzi¹,

Tridico²

2018

OPTH

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“…Age, hereditary factors, sunlight, chronic inflammation, microtrauma, and heat are possible contributing factors [2]. Due to the lack of effective therapeutic drugs, pterygium excision, combined with autologous conjunctival grafting, has been suggested as the best treatment for this disorder [3].…”

Section: Introductionmentioning

confidence: 99%

Tear Film Instability and Meibomian Gland Dysfunction Correlate with the Pterygium Size and Thickness Pre- and Postexcision in Patients with Pterygium

Wang

Duan

2019

Journal of Ophthalmology

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Purpose This study aimed to evaluate the effects of excision on dry eye and meibomian gland dysfunction (MGD) in individuals with pterygium, before and after surgery. It also aimed to investigate how these effects correlate with the size and thickness of the pterygium. Subjects and Methods 63 eyes from 63 patients with primary nasal pterygium and 45 eyes from 45 healthy volunteers without ocular pathologies were enrolled in this study. 63 eyes from 63 patients underwent pterygium surgery. ImageJ software was used to calculate the pterygium size based on images of the anterior segments. Anterior segment spectral domain optical coherence tomography (SD-OCT) was performed preoperatively to measure the thickness of the pterygium 1 mm anterior to the nasal scleral spur. The ocular surface disease index (OSDI), Schirmer I Test (SIT), and MGD grade were used to evaluate the eyes, and the eyes were imaged using the noninvasive keratograph average tear film breakup time (NIBUTav), tear meniscus height (TMH), meiboscore, and lipid layer grading tools of the Oculus® Keratograph 5M, preoperatively and at 1, 3, and 6 months postoperatively. Results The OSDI, NIBUTav, lid margin abnormality, meiboscore, and lipid layer grading values differed significantly in the pterygium patients in comparison with the controls (p < 0.01 for all scores). However, the SIT and TMH values were unchanged between the two groups (all p > 0.05). Multivariate regression analysis demonstrated that the NIBUTav, meiboscore, and lipid layer grading score was significantly correlated with the pterygium parameters, such as size and thickness. The postoperative OSDI, NIBUTav, lid margin abnormality, and lipid layer grading values improved significantly (p < 0.05 for all scores). The SIT, TMH, and meiboscore results did not differ significantly between the pre- and postoperative values (p > 0.05). Among the conventional and automated indexes, at 1 month postoperatively, SIT and TMH were significantly correlated with the pterygium parameters, but no correlation was observed at 3 and 6 months postoperatively. The OSDI, NIBUTav, meiboscore, and lipid layer grading values at 1, 3, and 6 months postoperatively were significantly correlated with the pterygium parameters. Conclusion Abnormal tear film and meibomian gland (MG) function improved following pterygium excision in the patients with primary pterygium, which was associated with uncomfortable ocular symptoms. Pterygium parameters, such as size and thickness, correlated with the dry eye and MGD indexes in patients pre- and postoperatively, potentially offering a novel strategy for clinical implementation of pterygium excision surgery.

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Conjunctival and Limbal Conjunctival Autograft vs. Amniotic Membrane Graft in Primary Pterygium Surgery: A 30-Year Comprehensive Review

Paganelli

Sahyoun²,

Gabison³

2023

Ophthalmol Ther

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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.

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Comparison of conjunctival autograft and conjunctival transposition flap techniques in primary pterygium surgery

Cited by 19 publications

References 18 publications

How to minimize pterygium recurrence rates: clinical perspectives

How to minimize pterygium recurrence rates: clinical perspectives

Tear Film Instability and Meibomian Gland Dysfunction Correlate with the Pterygium Size and Thickness Pre- and Postexcision in Patients with Pterygium

Conjunctival and Limbal Conjunctival Autograft vs. Amniotic Membrane Graft in Primary Pterygium Surgery: A 30-Year Comprehensive Review

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