Efficacy and Safety of a Large Conjunctival Autograft for Recurrent Pterygium

Abstract

Purpose: To evaluate the efficacy and safety of pterygium excision using a large conjunctival autograft for the treatment of recurrent pterygium. Methods: The medical records of 120 patients (126 eyes) with recurrent pterygium were reviewed. For each affected eye, pterygium excision with a large conjunctival autograft was performed. The graft was harvested from the superior bulbar area and measured more than 8 × 10 mm in size. Only patients who completed at least six months of follow-up were included. Postoperative clinical outcomes, recurrence rate, and complications were analyzed. Patients with any evidence of recurrence after surgery received a subconjunctival bevacizumab injection. Results: The average patient age was 56.5 ± 10.2 years, and 45 out of 120 patients were male. The mean study follow-up period was 17.7 ± 17.6 months. Most patients were satisfied with the cosmetic outcome. Postoperative visual acuity improved from 0.69 to 0.75 (p < 0.05). Postoperative refractive astigmatism and corneal astigmatism decreased by 0.55 and 2.73 diopters, respectively (p < 0.05). The postoperative recurrence rate was 4.0%, and the average recurrence period was 7.4 ± 0.6 weeks. A subconjunctival injection of 5 mg bevacizumab was performed in cases of recurrence; no progression of the pterygium was observed following the injection. Postoperative complications included 2 cases of conjunctival graft edema in 2 eyes, 5 donor site scars in 5 eyes, 13 pyogenic granulomas in 13 eyes, and a conjunctival epithelial inclusion cyst in 7 eyes. Conclusions: Pterygium excision with a large conjunctival autograft for the treatment of recurrent pterygium produced an excellent cosmetic outcome, a low recurrence rate, and minimal complications. A subconjunctival bevacizumab injection given in cases of recurrence following surgery might be effective in preventing progression of the pterygium.

Recurrent pterygium: A review

“…In choosing between different surgical techniques, CAU reduced the recurrence rates in many studies. 6 94 95 Using preoperative or intraoperative MMC as an adjunct to surgery has decreased the recurrence rates. However, this anti-proliferative drug has its own complications that should be taken in mind when applied for patients.…”

“…They concluded that surgeon's preferences should determine the method of treatment. 11 Lee et al 95 conducted a retrospective study to evaluate the efficacy and safety of pterygium excision using a large CAU for the treatment of recurrent pterygium. For each affected eye, pterygium excision with a large CAU was performed with a mean follow-up of 17 months.…”

“…The postoperative recurrence rate was 4.0%, and the average recurrence period was about 7.5 weeks. 95 A randomized, prospective, parallel-group clinical trial conducted by Al Fayez 22 compared the safety and efficacy of LCAU and CAU for treating recurrent pterygium. They included 224 patients with advanced recurrent pterygium with a mean follow-up of 62 months.…”

Ologen Implantation versus Conjunctival Autograft Transplantation for Treatment of Pterygium

“…Conjunctival autograft transplantation is a technically difficult and time-consuming procedure and a sacrificed part of the healthy conjunctiva. It may affect the outcome of surgical procedures that require healthy conjunctiva such as trabeculectomy if needed in the future for those patients [ 18 ].…”

Pyroptosis in pterygium pathogenesis

“…Surgery is still the main treatment for pterygia, although it has a high risk of surgical complications such as recurrence, graft necrosis, and granuloma formation [ 2 ]. The recurrence after surgery is still common, although diverse efforts have been made to avoid it [ 3 ]. Therefore, understanding the mechanism of pterygium formation is of vital importance in improving treatment and decreasing occurrence rate.…”