Profile of complications in pterygium surgery - A retrospective analysis

Abstract

Purpose: Analysis of complication profile after pterygium excision, in primary and recurrent pterygia. Methods: Retrospective analysis of all the patients who had undergone pterygium excision in a tertiary center in South India from 2010 to 2018 was analyzed. A total of 2356 eyes in 2028 patients were included in the study. Patients who had undergone conjunctival autografting for primary pterygium, conjunctival limbal autografting for recurrent pterygium, vertical split conjunctival autografting for double head pterygium were included in the study. In all the surgical procedures fibrin glue was used for fixation of the autograft. The follow-up period ranged from 6 months to 75 months, with an average of 17 months. Patients with less than 6 months of follow-up were excluded from the study. Results: The following postoperative complications were noted, Sub-conjunctival hemorrhage in 912 eyes (38.7%), edema of the graft in 522 cases (22.15%), graft loss in 22 cases (0.93%), graft retraction in 692 cases (29.37%) and sliding of the graft was seen in 9 cases (0.38%). Granuloma was seen in 4 cases (0.16%) at the host site and 5 cases (0.21%) at the donor site. Recurrence was seen in 34 patients (1.44%). Other severe complications like corneal melt were seen in only 1 case (0.04%) who was operated on for recurrent pterygium. In comparison between primary and recurrent pterygia; subconjunctival hemorrhage, edema of the graft, graft loss, and recurrence was significantly ( P < 0.05%) higher in recurrent pterygia. Conclusion: Various complications can occur post pterygium surgery as listed above. Selecting a proper procedure for a particular type of pterygium with a proper graft fixation technique will improve the outcome with minimal complications.

The Effect of Micro-Conjunctival Autografting Combined with Amniotic Membrane Transplantation on Treating Recurrent Pterygium: A Non-randomized Controlled Trial

“…In our study, micro-conjunctival autograft combined with amniotic membrane transplantation showed lower recurrence than that of amniotic membrane transplantation reported in the literature, [18] and also significantly lower than that of amniotic membrane transplantation combined with autologous conjunctival transplantation reported in the past [19]. The possible reasons may be as follow: (1) The exposed sclera after pterygium excision was completely covered by the amnion membrane for conjunctival epithelium growth, while the limbal barrier was reconstructed by micro-conjunctival graft covered the limbal side of amniotic membrane graft. (2) The postoperative use of glucocorticoids can effectively inhibit the inflammation.…”

“…Recurrent pterygium is a common postoperative complication of pterygium excision with a minimum incidence of 1.44% [1], leading to the aesthetic decline, eye surface discomfort, visual acuity impairment or limitation of eye movement [2]. At present, autologous conjunctival transplantation is regarded as the first choice in normal conditions [3].…”

Comparison of pterygium recurrence with and without using postsurgical topical cyclosporin a 0.05%: A randomized clinical trial

“…Chronic inflammatory cells were shown to be present in pterygium samples; thus, chronic inflammation may contribute to pterygium occurrence. 2 3 4 One of the important concerns of pterygium surgery is the high risk of recurrence, the severity of which may vary according to patients' characteristics and surgical methods and control of postsurgical inflammation. 5 6 7 8 Furthermore, pterygium grade and size, as well as vascularity index, have also been identified as determinants of recurrence after pterygium surgery.…”

Repeated use of fibrin sealants kept at room temperature in conjunctival autografting: An animal study

“…[ 6 7 8 ] In a large series of 2,356 cases from South India, where pterygium surgery was performed with autologous conjunctival graft method using fibrin glue, the recurrence rate was reported as only 1.44%. [ 9 ] Dehiscence and loss of the graft in the fibrin sealant-used patients, and granuloma formation in the suture-used patients are the prominent complications after pterygium surgery. [ 5 7 ] However, in a study conducted in South India, graft loss was reported as low as 0.93% in fibrin glue–used cases.…”

“…[ 5 7 ] However, in a study conducted in South India, graft loss was reported as low as 0.93% in fibrin glue–used cases. [ 9 ] The advantage of using fibrin glue is shorter operation time and better postoperative patient comfort, but the most important disadvantage is that the price is higher than sutures. [ 4 5 ] In our study, we used fibrin glues on rabbit eyes at different times, and we evaluated the effectiveness and complications of the repeated use of fibrin glue kept at room temperature.…”