Practice Patterns in the Management of Primary Pterygium: A Survey Study

Abstract

Purpose: To characterize cornea specialists’ current practice preferences in the management of primary pterygium. Methods: A 25-item survey regarding indications for surgery, surgical technique, use of adjuvant therapy, type and duration of postoperative therapy, and treatment of early recurrences was designed and sent to members of the Cornea Society through the kera-net listserv. Results: In total, 199 cornea specialists completed the questionnaire. More than 90% considered that surgery should be performed when there is proximity of the pterygium to the visual axis, pain or redness, eye movement restriction, or induction of astigmatism. Cosmesis was considered as an indication by 41.7% of the participants. The most frequent technique for pterygium excision was complete resection including the base and a moderate quantity of Tenon capsule followed by autologous conjunctival or limbal-conjunctival graft. The preferred graft fixation method in this survey was fibrin glue (61.2%). Most respondents reported a recurrence rate of less than 5% and no use of adjuvant agents to prevent recurrence. When early recurrence did occur, the preferred agents were corticosteroids. Conclusions: This study reflects the preferences of cornea experts regarding primary pterygium treatment and may serve as a guide for the management of this pathology.

Implementation and Application of an Intelligent Pterygium Diagnosis System Based on Deep Learning

“…The camera captured an anterior segment photograph of the interpalpebral zone, including the upper and lower lid margin and the whole cornea, at a right angle perpendicular to the iris, and uploaded it to the artificial intelligence diagnostic system. The photographs At present, there is no clear expert consensus on the indications for pterygium surgery; however, most ocular surface experts agree that the most important surgical indication is vision loss caused by the invasion of the visual axis (Twelker et al, 2000;Troutbeck and Hirst, 2001;Graue-Hernandez et al, 2019). In this study, a medium or large pterygium (horizontal length of the head extending beyond the corneal limbus ≥3 mm) warrants the recommendation for surgery (Wilson et al, 2008;Gumus et al, 2011).…”

“…A survey conducted by Mexican investigators, covering 199 cornea specialists worldwide, shows that more than 90% of the specialists considered that surgery should be performed when the pterygium blocks up on the visual axis, or when there is pain, redness, eye movement restriction, or induction of astigmatism. In the same study, cosmesis was considered by 41.7% of the participants (Graue-Hernandez et al, 2019). For patients with pterygium in the stationary phase and without vision impairment, observations could be made temporarily without surgery.…”

“…If the pterygium in the active phase enlarges and encroaches on the pupillary area, it may cause vision loss with limited eye movement, pain, congestion, and other symptoms, as well as affect an individual's appearance, and trigger astigmatism and higher-order aberrations (Lin and Stern, 1998;Gumus et al, 2012;Zhou et al, 2018). Currently, surgical resection is the main clinical treatment (Graue-Hernandez et al, 2019). If a patient is diagnosed early and treated with proper adjuvants, such as corticosteroids and mitomycin C, pterygium growth can effectively be controlled, and the recurrence rate could be reduced before and after surgical excision (Kaufman et al, 2013;Chen et al, 2015;Abdani et al, 2020).…”

Facilitated Tenon-Free Conjunctival Autograft Preparation and Limited Tenon Removal Technique in Pterygium Surgery

“…Although pterygium surgery is one of the most common ocular surgeries, recurrence remains an important concern [13]. Various and significant rates of recurrence have been reported in many studies.…”

Modified head inversion technique for pterygium and pseudopterygium surgery combined with keratopigmentation

“…Cosmesis is considered as an indication for pterygium surgery in 41.7% patients. 1 Most pterygium surgeries are based on the principle that approximation of healthy conjunctival tissue of the limbus after removal of the pterygium will prevent recurrences. Presently conjunctival autograft is considered the surgery of choice in most cases.…”