Comparison of Two Techniques for the Treatment of Recurrent Pterygium: Amniotic Membrane vs Conjunctival Autograft Combined with Mitomycin C

Katircioğlu, Yasemin Arslan; Altiparmak, Uğur; Göktaş, Şeniz Engür; Çakır, Burçin; Şingar, Evin; Örnek, Firdevs

doi:10.3109/08820538.2013.874468

Cited by 27 publications

(42 citation statements)

References 43 publications

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“…No study reported clinical improvement in vision after surgery, an important clinical measure; however, one trial that enrolled only participants with recurrent pterygium compared baseline and postoperative logMAR visual acuity. 27 The mean baseline logMAR VAs in eyes in the CAG group (0.2 ± 1.4, n=30) and in the AMT group (0.2 ± 1.0, n=25) were similar. The mean postoperative logMAR VAs during the follow-up period also were similar: 0.1 ± 1.3 for CAG-treated eyes and 0.1 ± 1.2 for AMT-treated eyes; mean post-surgery difference 0.00 (95% CI −0.66 to 0.66).…”

Section: Resultsmentioning

confidence: 80%

Conjunctival Autograft Versus Amniotic Membrane Transplantation for Treatment of Pterygium: Findings From a Cochrane Systematic Review

Clearfield

Hawkins

Kuo

2017

American Journal of Ophthalmology

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Purpose 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. Design Cochrane systematic review. Methods 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. Results Twenty RCTs with 1866 participants (1947 eyes) were included. Pterygium recurrence 6 months after surgery ranged from 3.3%–16.7% in the CAG group and 6.4%–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% CI, 0.33 to 0.85). For 96 eyes with recurrent pterygium, the risk of recurrence 6 months after CAG was reduced by 55% compared with AMT (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). Conclusions 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.

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Section: Resultsmentioning

confidence: 80%

Conjunctival Autograft Versus Amniotic Membrane Transplantation for Treatment of Pterygium: Findings From a Cochrane Systematic Review

Clearfield

Hawkins

Kuo

2017

American Journal of Ophthalmology

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“…Eleven studies restricted enrollment to primary pterygium alone (Chen 2012; Fernández García 2012; Keklikci 2007; Kheirkhah 2011; Küçükerdönmez 2007; Liang 2012; Ozer 2009; Paes 2010; Pérez Parra 2008; Tananuvat 2004; Toker 2016), five studies restricted enrollment to recurrent pterygium alone (Aragonés Cruz 2008; Chen 2009; Katircioglu 2014; Salman 2011; Stangogiannis-Druya 2004), and three studies included participants with either primary or recurrent pterygium (Besharati 2008; Küçükerdönmez 2007a; Luanratanakorn 2006). Two of the three studies that included participants with both types of pterygium reported outcomes separately by pterygium status (Küçükerdönmez 2007a; Luanratanakorn 2006), and one presented combined results only (Besharati 2008).…”

Section: Resultsmentioning

confidence: 99%

“…All trials were reported as randomized, but 16 out of 20 trials did not describe the methods of random sequence generation, and were therefore rated as at unclear risk of bias (Aragonés Cruz 2008; Besharati 2008; Chen 2009; Chen 2012; Fernández García 2012; Katircioglu 2014; Keklikci 2007; Kheirkhah 2011; Liang 2012; Luanratanakorn 2006; Ozer 2009; Pérez Parra 2008; Perry 2000; Salman 2011; Stangogiannis-Druya 2004; Tananuvat 2004). None of the included trials reported their method of allocation concealment before randomization; we therefore judged each as having unclear risk of this type of selection bias.…”

Section: Resultsmentioning

confidence: 99%

“…Sixteen studies did not report on whether or not they masked participants and outcomes assessors and were judged to have unclear risk of bias (Aragonés Cruz 2008; Besharati 2008; Chen 2009; Chen 2012; Fernández García 2012; Katircioglu 2014; Keklikci 2007; Kheirkhah 2011; Liang 2012; Ozer 2009; Paes 2010; Pérez Parra 2008; Perry 2000; Salman 2011; Stangogiannis-Druya 2004; Tananuvat 2004). However, due to the nature of the surgical procedures and the different appearance of the eye in the early postoperative period, both performance and detection biases were inherent to these studies.…”

Section: Resultsmentioning

confidence: 99%

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Conjunctival autograft for pterygium

Clearfield

Muthappan

Wang

et al. 2016

Cochrane Database of Systematic Reviews

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Background A pterygium is a fleshy, wing-shaped growth from the conjunctiva, crossing over the limbus onto the cornea. Prevalence ranges widely around the world. Evidence suggests that ultraviolet light is a major contributor in the formation of pterygia. Pterygia impair vision, limit eye movements, and can cause eye irritation, foreign body sensation, and dryness. In some susceptible patients, the pterygium can grow over the entire corneal surface, blocking the visual axis. Surgery is the only effective treatment for pterygium, though recurrences are common. With simple excision techniques (that is, excising the pterygium and leaving bare sclera), the risk of recurrence has been reported to be upwards of 80%. Pterygium excision combined with a tissue graft has a lower risk of recurrence. In conjunctival autograft surgery, conjunctival tissue from another part of the person’s eye along with limbal tissue is resected in one piece and used to cover the area from which the pterygium was excised. Another type of tissue graft surgery for pterygium is amniotic membrane graft, whereby a piece of donor amniotic membrane is fixed to the remaining limbus and bare sclera area after the pterygium has been excised. Objectives The objective of this review was to assess the safety and effectiveness of conjunctival autograft (with or without adjunctive therapy) compared with amniotic membrane graft (with or without adjunctive therapy) for pterygium. We also planned to determine whether use of MMC yielded better surgical results and to assess the direct and indirect comparative costs of these procedures. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (Issue 10, 2015), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to November 2015), EMBASE (January 1980 to November 2015), PubMed (1948 to November 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to November 2015), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) (last searched 21 November 2014), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 23 November 2015. Selection criteria We included in this review randomized controlled trials that had compared conjunctival autograft surgery (with or without adjunctive therapy) with amniotic membrane graft surgery (with or without adjunctive therapy) in people with primary or recurrent pterygium. Data collection and analysis Two review authors independently screened search results and assessed full-text reports from among the potentially eligible trials. Two review authors independently extracted data from the included trials and assessed the trial characteristics and risk of bias. The primary outco...

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“…170 It can be administered intraoperatively or postoperatively in combination with a conjunctival autograft and amniotic membrane, yielding low recurrence and complication rates. [171][172][173][174] The intraoperative application of mitomycin C results in a high success rate; however, serious complications have been reported. 175 Its use requires strict selection of patients because of the severe symptoms associated with the uncontrolled doses, including corneal edema, corneal perforation, and scleral calcification.…”

Section: Treatmentmentioning

confidence: 99%

Molecular Basis of Pterygium Development

Cárdenas-Cantú

Zavala

Valenzuela

et al. 2014

Seminars in Ophthalmology

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Pterygium pathogenesis is mainly related to UV light exposure. However, the exact mechanisms by which it is formed have not been elucidated. Clinical advances in surgical treatment use conjunctival autografts and amniotic membranes in combination with adjuvant therapies, including mitomycin C, β-radiation, and 5-fluoroacil, to reduce recurrence. Several studies aim to unveil the molecular mechanisms underlying pterygium growth and proliferation. They demonstrate the role of different factors, such as viruses, oxidative stress, DNA methylation, apoptotic and oncogenic proteins, loss of heterozygosity, microsatellite instability, inflammatory mediators, extracellular matrix modulators, lymphangiogenesis, cell epithelial-mesenchymal transition, and alterations in cholesterol metabolism in pterygium development. Understanding the molecular basis of pterygium provides new potential therapeutic targets for its prevention and elimination. This review focuses on providing a broad overview of what is currently known regarding molecular mechanisms of pterygium pathogenesis.

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Comparison of Two Techniques for the Treatment of Recurrent Pterygium: Amniotic Membrane vs Conjunctival Autograft Combined with Mitomycin C

Abstract: Amniotic membrane combined with MMC has similar recurrence rate to CA combined with MMC, in patients with recurrent pterygium. Similar outcomes and complication rates make AMT-MMC a promising method for the treatment of recurrent pterygium cases.

Cited by 27 publications

References 43 publications

Conjunctival Autograft Versus Amniotic Membrane Transplantation for Treatment of Pterygium: Findings From a Cochrane Systematic Review

Conjunctival Autograft Versus Amniotic Membrane Transplantation for Treatment of Pterygium: Findings From a Cochrane Systematic Review

Conjunctival autograft for pterygium

Molecular Basis of Pterygium Development

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