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

Abstract

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.

The in vitro anti-fibrotic effect of Pirfenidone on human pterygium fibroblasts is associated with down-regulation of autocrine TGF-β and MMP-1

“…International Publisher membrane transplantation techniques have been employed in efforts to lower the recurrence rate. However they have their own limitations, including increased operation time, requirement of technical surgeon, and lack of amniotic membranes/fibrin glues availability [6][7][8]. Intraoperative application of antifibrotic drugs such as mitomycin C (MMC) has also been used to reduce the recurrence rate [9,10].…”

Femtosecond Laser-assisted Preparation of Conjunctival Autograft for Pterygium Surgery

“…The prevalence rates of pterygia range from 3% to 19.5% 1 , with a higher rate in men and in countries closer to the equator 1,2 . Surgical removal is the main treatment for pterygia, and the surgical techniques can be divided into 3 types: (1) Bare sclera technique, in which no tissue grafting is used after pterygium excision (2) Simple closure, and (3) Tissue grafting technique, in which a conjunctival autograft (CAG), limbal conjunctival autograft, or amniotic membrane transplantation (AMT) is used to cover the area from which the pterygium is excised 3,4 . The surgery is minimally invasive, however, the recurrence rate can be as high as 88% in certain populations and is surgical technique dependent 5 .…”

<p>Management of double-head pterygium with conjunctival autograft and primary closure</p>

“…9,[18][19][20] In accordance with other studies, in our opinion amniotic membrane may still be in mind in cases of great conjunctival defects or insufficient conjunctiva after glaucoma filtering surgeries. 9,21 However, our study group showed that conjunctival autograft combined with primary closure in a one-time intervention seems to be effective for the treatment of double-head pterygium. Studies in the future will require a larger sample size, which would increase the power of the analysis and the validity of its findings.…”