Conjunctival autograft for pterygium

Abstract

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...

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

“…The main objective of this summary of our Cochrane systematic review 19 is to report the comparative safety and effectiveness of conjunctival autograft compared with amniotic membrane graft for pterygium based on the best available evidence.…”

Femtosecond laser-assisted conjunctival autograft preparation for pterygium surgery

“…10,11 A recent Cochrane meta-analysis of 1947 eyes of 1866 patients revealed superiority of CAG over AM, with risk ratio for recurrence of pterygium (primary and recurrent) of 0.87 and 0.53 at 3 and 6 months follow-up intervals and recurrence rates from 3.33% to 16.7% in the CAG and 2.6% to 42.3% in the AM groups at 6 months. 11 It has been shown that the outcome of pterygium surgery is dependent on several factors, including thorough Tenon´s tissue removal and adequate management of the ocular surface, 8 as well as on the surgical experience in harvesting the CAG, with greater experience leading to lower recurrence rates and fewer complications. [12][13][14] An important factor for success in pterygium surgery is the ability to dissect a thin and adequately sized graft to cover the conjunctival defect with minimal inclusion of…”

New treatment options for pterygium

“…Hence, alternative reconstructive surgical procedures were sought including the use of a amniotic membrane (AM) or a conjunctival autograft (CAG) onto the bare sclera. This led to a significant reduction in recurrence rates [2,6]. A recent Cochrane meta-analysis of 1947 eyes of 1866 patients revealed superiority of CAG over AM with a risk ratio (RR) for recurrence of pterygium (primary and recurrent) of 0.53 (95% confidence interval [CI]: 0.33-0.85; p = 0.009) at 6-month follow-up and recurrence rates from 3.33% to 16.7% in the CAG and 2.6% to 42.3% in the AM group [6].…”

“…This led to a significant reduction in recurrence rates [2,6]. A recent Cochrane meta-analysis of 1947 eyes of 1866 patients revealed superiority of CAG over AM with a risk ratio (RR) for recurrence of pterygium (primary and recurrent) of 0.53 (95% confidence interval [CI]: 0.33-0.85; p = 0.009) at 6-month follow-up and recurrence rates from 3.33% to 16.7% in the CAG and 2.6% to 42.3% in the AM group [6]. Therefore, thorough pterygium and Tenon's tissue removal combined with a CAG transplantation is currently considered the gold standard surgical procedure.…”