How to minimize pterygium recurrence rates: clinical perspectives

Abstract

The main treatment for pterygium is surgical removal. However, pterygium surgery is concerned with high rates of postoperative recurrence. Predicting factors of recurrence are not fully understood, yet, but they probably depend on a multitude of patient-related, clinical, and/or surgical factors. Several adjuvant treatments have been proposed to reduce postoperative pterygium recurrence, including different antimetabolites, antiangiogenetic factors, and radiation therapy. The purpose of this review is to collect the current evidence regarding application and limits of different therapeutic approaches for preventing postoperative recurrence of pterygium, giving insights and perspectives for better management of this disease. In the light of the current evidence, pterygium surgery cannot disregard wound coverage with conjunctival autografting or rotational flap combined with adjuvant treatments. The rotational flap technique is associated with shorter surgical time rates and prevents graft displacement and necrosis, given its vascular pedicle. Amniotic membrane may still be reserved in case of great conjunctival defects or insufficient conjunctiva. Repeated subconjunctival antivascular endothelial growth factor injections can be considered as an effective and safe adjuvant treatment. Moreover, management of postoperative pain is crucial. Innovative treatment strategies will probably target different molecular pathways, considering recent findings regarding pterygium pathogenesis, to improve better understanding and develop universally shared guidelines. Great importance shall be dedicated to the identification of novel molecular biomarkers and favoring factors of recurrence, in order to achieve a customized surgical treatment for each patient and obtain maximal reduction of postoperative recurrence.

Femtosecond Laser-assisted Preparation of Conjunctival Autograft for Pterygium Surgery

“…Surgery performed by trainees was associated with borderline significantly higher postoperative recurrence (7.7%), which was consistent with previous studies 8,15 . Previous reported recurrence rate was 3.3-18.5% for experienced surgeons 6 , and 10-82% for trainees 8,15 . The lower recurrence rate in this study can be attributed to two reasons: CAG transplantation has been shown to be superior to bare sclera technique or AMT 4,9,10 , with respect to recurrence, and in all cases we used fibrin glue, which is associated with lower recurrence compared to sutures 38 .…”

“…The risk of recurrence after pterygium surgery is multifactorial, with patient-attributed factors, such as age, ethnicity, morphology of pterygium 3,6,7 , and surgeon-attributed factors, such as the surgical experiences and techniques 3,8 . A meta-analysis of randomized controlled trials has shown that bare scleral technique increases the risk of postoperative recurrence by 6 to 25 times compared to a tissue grafting technique 9 .…”

Use of Mitomycin C in Ocular Surgery; A Narrative Review

“…This study indicated that there was no difference in recurrence between intra-operative application of MMC or drops and also no statistically difference was found in groups receiving 0.2 mg/ml or 0.4 mg/ml MMC for 3 minutes. Since thenmultiple studies have followed with intra-operative use of MMC in concentration of 0.2 mg/ml or 0.4 mg/ml with application time of 3 -5 minutes 12,13,14 .…”

A novel role for Livin in the response to ultraviolet�B radiation and pterygium development

“…Pterygium is a common disease of the ocular surface, characterized by invasion of triangular inflammatory fibrovascular lesions into the cornea, which can cause inflammation, irregular corneal astigmatism and stromal opacity (1). Currently, the underlying mechanisms of pterygium have not been well elucidated and surgical excision is the standard treatment; however, pterygium recurrence is common following surgery (2). In order to devise strategies for the non-surgical treatment of pterygium or the prevention of recurrence after resection, it is important to understand the underlying molecular mechanisms of the pathogenesis of pterygium.…”