Comparison of Conjunctival Autografts, Amniotic Membrane Grafts, and Primary Closure for Pterygium Excision

Prabhasawat, Pinnita; Barton, Keith; Burkett, Gene; Tseng, Scheffer C.G.

doi:10.1016/s0161-6420(97)30197-3

Cited by 533 publications

(403 citation statements)

References 42 publications

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“…19 Recurrence rates of 10.9 and 37.5% were reported with the use of amniotic membrane following excision of primary and recurrent pterygia respectively. 16 These rates were significantly higher than those for CAG transplant. 18 The same group subsequently described a modification of the surgical technique and reported recurrences of 3 and 9.5% for primary and recurrent pterygia respectively.…”

Section: Amtmentioning

confidence: 86%

“…There are only three recent studies describing results of this technique with widely varying recurrence rates ranging from 2 to 69%. [14][15][16] Two of these 15,16 used a small sample with extremely high recurrences of 45 16 and 69%. 15 In the third retrospective study despite a large number of patients, 14 the description of the surgical technique and the number lost to follow-up were inadequate.…”

Section: Primary Closurementioning

confidence: 99%

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Outcome of pterygium surgery: analysis over 14 years

Fernandes

Sangwan

Bansal

et al. 2004

Eye

122

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Aim To report the outcome of pterygium surgery performed at a tertiary eye care centre in South India. Methods Retrospective analysis of medical records of 920 patients (989 eyes) with primary and recurrent pterygia operated between January 1988 and December 2001. The demographic variables, surgical technique (bare sclera, primary closure, amniotic membrane transplantation (AMT), conjunctival autograft (CAG), conjunctivallimbal autograft (CLAG), or surgical adjuvants), recurrences and postoperative complications were analysed. Results A total of 496 (53.9%) were male and 69 (7.5%) had bilateral pterygia. Bare sclera technique was performed in 267 (27.0%) eyes, primary conjunctival closure in 32 (3.2%), AMG in 123 (12.4%), CAG in 429 (43.4%), and CLAG in 70 (7.1%). Adjuvant mitomycin C was used in 44 (4.4%) cases. The mean duration of follow-up was 8.9717.0 and 5.978.8 months for unilateral primary and recurrent pterygia, respectively. The overall recurrence rate was 178 (18.0%). Following primary and recurrent unilateral pterygium excision respectively, recurrences were noted in 46 (19.4%) and 1 (33.3%) eyes after bare sclera technique, five (16.7%) and 0 after primary closure, 28 (26.7%) and 0 with AMG, 42 (12.2%) and five (31.3%) with CAG, and nine (17.3%) and two (40%) with CLAG. Recurrences were significantly more in males with primary (23.3 vs 10.7%, Po0.0001) and recurrent (26.7 vs 0%, P ¼ 0.034) pterygia, and in those below 40 years (25.2 vs 14.8%, P ¼ 0.003). Conclusion CAG appears to be an effective modality for primary and recurrent pterygia. Males and patients below 40 years face greater risk of recurrence. Bare sclera technique has an unacceptably high recurrence. Prospective studies comparing CAG, CLAG, and AMG for primary and recurrent pterygia are needed.

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Section: Amtmentioning

confidence: 86%

Section: Primary Closurementioning

confidence: 99%

Outcome of pterygium surgery: analysis over 14 years

Fernandes

Sangwan

Bansal

et al. 2004

Eye

122

View full text Add to dashboard Cite

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“…Briefly, human placenta was collected at elective cesarean delivery (Heiligenhaus et al, 2001;Lee and Tseng, 1997;Prabhasawat et al, 1997;Tseng et al, 1998). The amniotic membrane was flattened onto nitrocellulose paper (Hybond N+, Amersham, UK), with the epithelium surface up.…”

Section: Preparation Of Preserved Human Amniotic Membranementioning

confidence: 99%

On the influence of neutrophils in corneas with necrotizing HSV-1 keratitis following amniotic membrane transplantation

Bauer

Wasmuth

Hermans

et al. 2007

Experimental Eye Research

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Necrotizing herpetic stromal keratitis (HSK) in mice rapidly improved after amniotic membrane transplantation (AMT). In this study we determined the fate of polymorphonuclear neutrophils (PMN) after AMT. AMT or tarsorrhaphy (T) was performed in BALB/c mice with ulcerative HSK. After 2 days, corneas were studied histologically and by transmission electron microscopy (TEM). CD11b, Gr-1, and TUNEL-positive cells were identified. Macrophages were depleted by subconjunctival injection of dichloromethylene-diphosphonate-liposomes (Cl 2 MDP-LIP) before AMT. Corneas were studied for interleukin (IL)-1α, IL-2, interferon (IFN)-γ, CXCL1, CXCL2, and tumor necrosis factor (TNF)-α production by ELISA. PMN-enriched cell preparations cocultured with amniotic membrane (AM) or with AM and such recombinant (r) cytokines as rIL-1α, rIL-2, and rTNF-α or supernatants from activated lymphocytes were investigated by flow cytometry (Annexin-V/7-AAD and TUNEL), and a dimethylthiazolyl-diphenyltetrazoliumbromide (MTT)-viability assay. Corneas in the AMT mice had less inflammation, fewer PMN-like cells and fewer CD11b+, and Gr-1+ cells (P < 0.01), but a higher ratio of apoptotic to viable PMN-resembling cells (P < 0.01) than the T mice. Phagocytic removal of apoptotic PMN-like cells by macrophages was evident in the AMT group. After Cl 2 MDP-LIP treatment, the corneas had more cell debris and apoptotic cells with PMN-like morphology. The concentrations of IL-1 α, IL-2, CXCL1, and TNF-α were reduced in corneas of the AMT group as compared to that of the T group, while the concentration of CXCL2 was increased. Apoptosis of PMN-resembling cells was detected following cocultivation with AM, even when proinflammatory cytokines were present. Resolution of corneal inflammation in mice with necrotizing HSK after AMT is associated with increased apoptosis of PMN-like cells, reduction of pro-inflammatory cytokines, an increase of CXCL2, and increased removal of apoptotic PMN-like cells by macrophages.

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“…6 Conjunctiva autograft on the other hand has been said to be free of complications and although takes longer to perform is said to be associated with little or no recurrence. 7 The main objective of this study was to compare 5-FU to conjunctival autograft in the treatment of large, fleshy pterygium in terms of preventing recurrence as well as relative safety and complication rate.…”

Section: Introductionmentioning

confidence: 99%

Pterygium treatment using 5-FU as adjuvant treatment compared to conjunctiva autograft

Bekibele

Baiyeroju

Olusanya

et al. 2006

Eye

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Background The use of conjunctiva autograft, adjunct antimetabolite therapy has been shown to be effective in preventing pterygium recurrence. Objective To compare 5 fluorouracil (5-FU) to conjunctival autograft in the treatment of large, fleshy pterygium. Methods A randomised controlled prospective study of outcome of pterygium treatment using 5-FU as adjuvant treatment compared to conjunctiva autograft. Thirty-five eyes with large pterygium treated with bare sclera conjunctival excision plus 5-FU were compared with 33 eyes treated with excision and conjunctival autograft alone. Results Post-operative pterygium recurrence was observed in four (11.4%) eyes treated with 5-FU and 4 (12.1%) eyes treated with conjunctiva autograft (P40.05). The post-operative complications included, granuloma formation 11.4% for 5-FU and 3.0% for autograft and conjunctival discharge 5.7% for 5-FU group only. Conclusion 5-FU is marginally superior to conjunctival autograft in the prevention of pterygium recurrence but neither gives a more desirable single digit recurrence rate. Randomised studies combining both conjunctival autograft and 5-FU in pterygium treatment is advocated to further explore their effect.

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Comparison of Conjunctival Autografts, Amniotic Membrane Grafts, and Primary Closure for Pterygium Excision

Cited by 533 publications

References 42 publications

Outcome of pterygium surgery: analysis over 14 years

Outcome of pterygium surgery: analysis over 14 years

On the influence of neutrophils in corneas with necrotizing HSV-1 keratitis following amniotic membrane transplantation

Pterygium treatment using 5-FU as adjuvant treatment compared to conjunctiva autograft

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