Risk Factors for Recurrence After Pterygium Surgery

Han, Sang Beom; Jeon, Hyun Sun; Kim, Moo‐Sang; Lee, Seung Jun; Yang, Hee Kyung; Hwang, Jeong Min; Kim, Kwang Gi; Hyon, Joon Young; Wee, Won Ryang

doi:10.1097/ico.0000000000000853

Cited by 37 publications

(31 citation statements)

References 44 publications

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“…Interestingly, men were negatively associated with pterygium recurrence. Indeed, major factors inducing pterygium recurrence include sun exposure, surgical technique, postoperative inflammation, and increased vascularity in pterygium (2324). It is known that estrogen stimulates immune responses, whereas androgens suppress inflammatory reactions (25).…”

Section: Discussionmentioning

confidence: 99%

Outdoor Air Pollution and Pterygium in Korea

et al. 2017

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We investigated relationships between outdoor air pollution and pterygium in Korean adults. This study includes 23,276 adults in population-based cross-sectional data using the Korea National Health and Nutrition Examination Survey 2008–2011. Pterygium was assessed using slit lamp biomicroscopy. Air pollution data (humidity, particulate matter with aerodynamic diameter less than 10 μm [PM10], ozone [O3], nitrogen dioxide [NO2], and sulfur dioxide levels [SO2]) for 2 years preceding the ocular examinations were acquired. Associations of multiple air pollutants with pterygium or pterygium recurrence after surgery were examined using multivariate logistic models, after adjusting for several covariates. Distributed lag models were additionally used for estimating cumulative effects of air pollution on pterygium. None of air pollution factors was significantly associated with pterygium or pterygium recurrence (each P > 0.05). Distributed lag models also showed that air pollution factors were not associated with pterygium or pterygium recurrence in 0-to-2 year lags (each P > 0.05). However, primary pterygium showed a weak association with PM10 after adjusting for covariates (odds ratio [OR] 1.23; [per 5 μg/m3 PM10 increase]; P = 0.023). Aging, male sex, and greater sun exposure were associated with pterygium, while higher education level and myopia were negatively associated with pterygium (each P ≤ 0.001). Male sex and myopia were negatively associated with pterygium recurrence (each P < 0.05). In conclusion, exposure to higher PM10 levels was associated with primary pterygium, although this study observed no significant association between air pollution and overall pterygium or pterygium recurrence in Korean adults.

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Section: Discussionmentioning

confidence: 99%

Outdoor Air Pollution and Pterygium in Korea

et al. 2017

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“… 24 25 Dimensions of pterygia: length of pterygia, maximum and minimum height, length over limbus horizontally and vertically, cornea surface covered with pterygia and corneal size horizontally and vertically. 26 27 Digital photography (Canon EOS 5D Mark II, Canon., Tokyo, Japan) will be performed for all participants before and after surgery. Based on the photograph, an author not involved in surgery and unaware of the participant allocation will grade pterygia using Tan’s classification 26 Classification of pterygia morphology by Tan: 1: atrophic/underlying episcleral blood vessels visible, 3: fleshy/episcleral blood vessels are not visible and 2: intermediate, between 1 and 3.…”

Section: Methods and Analysesmentioning

confidence: 99%

Cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery (CAGE CUP): study protocol of a randomised controlled trial

et al. 2018

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IntroductionPterygium is a non-cancerous growth of the conjunctival tissue over the cornea that may lead to visual impairment in advanced stages, restriction of ocular motility, chronic inflammation and cosmetic concerns. Surgical removal is the treatment of choice, but recurrence of pterygium is a frequent problem. It has been previously shown that fibrin glue may result in less recurrence and may take less time than sutures for fixing the conjunctival graft in place during pterygium surgery. However, fibrin glue is a biological material and it carries the risk of transmitting infectious agents from pooled and single-donor blood donors and anaphylaxis in susceptible individuals. Cauterisation is another surgical option, and it would be advantageous to know whether cauterisation may be superior surgical option compared with fibrin glue. This protocol describes the rationale and design of the randomised controlled trial (RCT) in which we will compare cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery.Methods and analysesThis will be a parallel group RCT comparing cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery. Computer-generated randomisation will be used, and allocation concealment will be conducted using sequentially numbered opaque sealed envelopes. Surgeons will not be blinded to the procedures, but participants, other investigators and outcome assessors will be blinded. Adult participants with primary pterygium operated in a tertiary hospital in Split, Croatia, will be included. Primary outcome will be recurrence of pterygium, defined as any regrowth of tissue from the area of excision across the limbus onto the cornea after 180 days.Ethics and disseminationThe trial was approved by the ethics review board of the University Hospital Split (500-03/17-01/68). Results will be disseminated at conferences and through peer-reviewed publications.Trial registration numberNCT03321201; Pre-results.

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“…Unlike the previous OCTA study on normal conjunctiva, 18 in which the border between the conjunctival and scleral tissues could not be delineated, the visible CAG margin in the present study provided us clear information for the depth sectioning at the CAG level or underlying episcleral level. Understanding the structure and vascularization of pterygium and the graft reperfusion after surgery helps to evaluate the risks for recurrence 19 and graft health.…”

Section: Discussionmentioning

confidence: 99%

Optical Coherence Tomography Angiography for Evaluation of Reperfusion After Pterygium Surgery

Liu

Devarajan

Tan

et al. 2019

American Journal of Ophthalmology

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PURPOSE: To describe the use of optical coherence tomography angiography (OCTA) to quantitatively monitor the conjunctival graft revascularization after pterygium excision and conjunctival autograft (CAG) transplantation.DESIGN: Prospective, interventional case series. METHODS: Ten patients undergoing pterygium excision and femtosecond laser-assisted CAG transplantation were included. OCTA was performed at 1 week, 1 and 3 months postoperatively at the CAG transplantation site and harvested area. The vessel density at three different depths: conjunctival epithelium or CAG epithelium, conjunctival stroma or CAG stroma, and episclera, was evaluated and quantified. The revascularization rate was assessed and correlated with the postoperative CAG thickness. RESULTS: No intraoperative and postoperative complications occurred. Reperfusion of the CAGs was observed at 1 week, and early reperfusion within the first month accounted for more than half of graft revascularization. The vessel regrowth density was 9.6±2.6 % and 11.1±2.8 % between 1 week and 1 month, and was 9.8±1.8 % and 11.9±1.9 % between 1 and 3 months, at the CAG and underlying episcleral levels, respectively. All the CAGs were well-perfused at 3 months. The vessel regrowth density was significantly and strongly correlated with the changes of CAG thickness in a negative relationship (g [ -0.94, P [ 0.019). At the harvested site, the vascular network of episclera was not affected, and the conjunctival vascularization was restored at 1 month. CONCLUSIONS: OCTA is a promising tool to evaluate the vascularization or revascularization of conjunctiva, conjunctival graft and episclera, in a quantitative and serial manner, helping in diseases diagnosis and treatment monitoring. The graft revascularization rate was predictive of postoperative graft deswelling.

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Risk Factors for Recurrence After Pterygium Surgery

Abstract: Increased vascularity was associated with a higher risk of recurrence. Quantification of vascularity using automated image analysis might be useful in predicting the risk of recurrence.

Cited by 37 publications

References 44 publications

Outdoor Air Pollution and Pterygium in Korea

Outdoor Air Pollution and Pterygium in Korea

Cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery (CAGE CUP): study protocol of a randomised controlled trial

Optical Coherence Tomography Angiography for Evaluation of Reperfusion After Pterygium Surgery

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